GIFT   OF 
Prof.    E.J .klckson 


MAIN  LIBHARY-AOWICUl-TUWC  DETT 


\.f-U> 


I 


v^ 


A  TEXT-BOOK 


VETERINARY    OBSTETRICS 


INCLUDING    THE     DISEASES    AND    ACCIDENTS    INCIDENTAL    TO 

PREGNANCY,  PARTURITION,  AND  EARLY  AGE  IN 

DOMESTICATED  ANIMALS. 


toil!)  Q^mo  ^nniixch  anh  ^mcivc  illustrations. 


GEORGE    FLEMING, 


VETERINARY     SURGEON,   2D    LIFE    GUARDS  ;  '  FELLOW,   MEMBER    #F   COUNCIL  AND  OF 
THE   EXAMINING   BOARD,   OF    THE   ROYAL    COLLEGE  OF   VETERINARY    SURGEONS  ; 
FELLOW     OF     THE     ROYAL     GEOGRAPHICAL     SOCIETY,    ANTHROPOLOGICAL     IN- 
STITUTE, AND  OF   THE   ANTWERP,   NEW  YORK,  MONTREAL,  CENTRAL,  AND 
LIVERPOOL      VETERINARY       MEDICAL      SOCIETIES;       CORRESPONDING 
MEMBER   OF  THE    PARIS   CENTRAL   VETERINARY    SOCIETY,    ETC. 

kor    of  "  Travels   on  Horseback   in   Mantchti    Tartary,'-    ^^Horse-shoes   and   Horse   Shoeing," 

A  >!imal  Plagues"   "■  Practical  Horse-shoeing,''^    '■'' Rabies  and  Hydrophobia,^^    '^' The  Contagious 

Diseases  of  A  nitnals,''  "  Manual  of  Veterinary  Sanitary  Science,^'  Translator  and  Editor  of 

'^  CJiauveaii's   Comparative  Anatomy  of  the  Domesticated  Animals,"   Editor  cf  the 

"  Veterinary  Journal,^'* 


id/ 


NEW  YORK: 

ALBERT    COGSWELL,    Publisher 

24  Bond  Street. 

1879. 


G 


f=  C^  > 


T 


UWIA»IY-AG«*CU, 


,TUIIE  DEPT 


TO  THE 

MEMBERS  OF  THE  VETERINARY  PROFESSION  AND 

STOCK  BREEDERS 

IN  ALL  ENGLISH-SPEAKING  COUNTRIES, 

THIS    CONTRIBUTION    TOWARDS    THE 

IMPROVEMENT  AND  PERFECTING  OF  A 

VERY  IMPORTANT  BRANCH  OF  VETERINARY  AND 

AGRICULTURAL  SCIENCE, 

AND    THE 

PRESERVATION  AND  DEVELOPMENT 

OF   A 

SOURCE  OF  NATIONAL  WEALTH, 

Js  reepcrtfulb   lUcbicateii   bg  tl)c  Author. 


Regent's  Park  Barracks,  London, 
November,  1877. 


520<>^Mr 


PREFACE 


When  we  consider  the  vast  and  yearly  increasing  amount  of  animal 
wealth  we  possess,  the  great  skill,  attention,  and  expense  bestowed  on 
the  perfecting  of  the  most  important  of  the  domesticated  creatures,  which 
are  daily  becoming  more  essential  factors  in  our  progressive  civilization, 
it  is  somewhat  remarkable,  and  rather  discreditable,  though  not  alto- 
gether inexplicable,  that  nothing  in  the  way  of  a  work  devoted  to  the 
parturition  of  animals,  and  to  the  diseases  and  accidents  incidental  to 
that  period,  has  yet  appeared  in  the  English  language.  For  very  many 
years  the  Anglo-Saxon  race  has  devoted  itself  most  assiduously  and 
praiseworthily,  and  with  the  greatest  measure  of  success,  to  the  multi- 
plication and  full  development  of  those  qualities  which  more  particularly 
enhance  the  value  and  utility  of  animals.  This  has  entailed  unwearied 
efforts,  the  closest  and  shrewdest  observation,  and  all  the  judgment  and 
practical  and  scientific  knowledge  which  generations  of  men  could  afford. 
It  might  therefore  be  considered  that  every  thing  relating  to  the  repro- 
duction and  rearing  of  these  creatures  must,  from  a  materialistic  point  of 
view  alone,  be  of  great  moment  not  only  to  breeders  and  stock-raisers, 
but  to  the  entire  community.  Great  loss  may  be,  and  far  too  often  is, 
quickly  sustained  among  animals  during  the  pregnant  or  parturient  period, 
and  this  loss  may  not  only  prove  very  serious  to  individuals,  but  make 
itself  gravely  felt  by  the  general  public.  A  treatise  which  might  aid,  to 
however  small  an  extent,  in  pointing  out  how  these  losses  may  be  averted 
or  remedied,  must  surely,  then,  prove  a  welcome  boon  to  those  who  are 
engaged  in  breeding  and  raising  animals,  as  well  as  to  all  who  are  in- 
terested— and  few  are  not — in  their  multiplication  and  welfare.  At  the 
commencement  of  this  century  a  book  was  published,  entitled  "  A  Prac- 
tical Treatise  on  the  Parturition  of  the  Cow,  or  the  Extraction  of  the 
Calf;  and  also  on  the  Diseases  of  Neat  Cattle  in  General."  The  author 
was  Edw^ard  Skellet,  "  Professor  of  that  part  of  the  Veterinary  Art ; " 
but  that  and  other  parts  of  this  art  were  certainly  in  a  very  crude,  meagre, 
and  elementary  condition  in  the  days  when  Skellet  ventured  to  touch 
upon  them  ;  and  yet  his  book  may  be  said  to  be  the  only  attempt  which 
has  been  made  in  this  direction  in  England.  Papers  on  obstetricy — 
some  of  them  of  much  value — have  appeared  from  time  to  time  in  pro- 
fessional journals  ;  but  while  in  other  countries  many  treatises  have  been 
produced,  no  one  in  this  country  has  undertaken  the  task  of  supplying 
what  has,  for  very  many  years,  been  an  urgent  want — a  text-book  of 
Obstetrics  worthy  of  modern  Veterinary  Science.  The  necessity  for  such 
a  guide  has  been  felt  more  particularly  by  the  Veterinary  practitioner  at 
the  commencement  of  his  career  ;  for  only  too  frequently  he  has  had  to 
rely  entirely  upon  his  own  resources,  and  to  painfully  acquire,  at  the 
expense  of  his  employers,  that  knowledge  of  the  subject  which  was  either 
very  imperfectly  or  not  at  all  taught  at  the  Veterinary  Schools,  and  could 
not   be   found  elsewhere.      To  deliver  one  of   the  larger  domesticated 


vi  PREFACE. 

animals  in  a  case  of  difficult  parturition  requires  special  knowledge  and 
aptitudes  ;  and  even  those  practitioners  who  are  fortunate  in  possessing 
these  will  be  the  first  to  confess  that  to  attempt  delivery  in  many  cases 
is  really  a  work  of  the  Danaides. 

To  the  members  of  the  Veterinary  profession,  therefore,  no  apology 
can  be  necessary  in  offering  for  their  acceptance  the  present  book.  Every 
endeavor  has  been  made  to  make  it  a  standard  work,  representative  of 
the  most  advanced  views  relating  to  this  department  of  Veterinary  Medi- 
cine. Animated  by  the  desire  to  present  my  colleagues  in  English- 
speaking  countries  with  a  text-book  at  least  equal  to  the  best  of  the  many 
which  have  been  published  on  the  Continent — a  list  of  which  is  appended 
— every  likely  source  of  information  has  been  made  available,  and  no 
labor  or  pains  have  been  spared  to  render  my  onerous  and  very  difficult 
task  as  complete  and  as  useful  as  possible.  A  glance  at  the  references 
and  illustrative  cases  will  testify  to  the  correctness  of  this  statement. 

It  has  often  been  a  matter  for  regret  by  the  accoucheur  of  women,  that 
the  parturient  period  of  animals  was  one  upon  which  they  could  obtain 
but  little,  if  any,  information  ;  and  its  relations  and  importance  with 
regard  to  this  and  the  puerperal  period  in  the  human  species  has  frequent- 
ly been  insisted  upon.  I  trust  that  this  cause  for  regret  may  be  at  least 
partialK''  removed,  and  that  the  text-book  may  prove  of  some  service  to 
those  medical  men  who  are  anxiously  striving  to  advance  human  obstet- 
ricy,  and  a  knowledge  of  those  pathological  processes  around  which  there 
is  still  doubt  and  uncertainty. 

My  best  thanks  are  due  to  Professor  Saint-Cyr,  of  the  Lyons  Veterinary 
School,  for  allowing  me  to  use  many  of  the  drawings  which  illustrate  his 
excellent  treatise  on  the  same  subject,  and  to  which  I  have  often  referred 
with  much  advantage.  I  am  also  greatly  indebted  to  Mr.  W.  A.  Cart- 
wright,  of  Whitchurch,  Salop,  for  his  kindness  in  looking  over  the  proof- 
sheets  containing  the  more  practical  portion  of  the  subject ;  his  long 
experience  and  skilful  practice,  combined  with  careful  reading  and  study, 
rendered  his  assistance  particularly  valuable  in  this  respect. 

In  this  first  attempt  to  deal  with  a  very  serious  task,  omissions  and 
defects  will  doubtless  be  discovered.  But  in  the  circumstances  in  which 
I  was  placed  they  were  unavoidable,  and  perhaps,  after  all,  they  will  not 
interfere  with  the  utility  of  the  work.  Now  that  certain  principles  in 
animal  obstetrics  have  been  laid  down,  and  a  commencement  has  been 
made  to  establish  the  practice  of  the  Veterinary  Obstetrist  on  a  sound 
scientific  basis,  it  is  to  be  hoped  that  rapid  progress  will  be  made  in 
rendering  it  more  perfect.  Humanity  is  perhaps  as  deeply  concerned  in 
this  direction  as  in  many  others,  and  it  must  always  be  an  important 
object  with  the  Veterinary  Surgeon  to  spare  animals  pain,  and  to  abridge 
their  sufferings  as  much  as  possible. 

GEORGE    FLEMING, 
Second  Life  Guards. 
Regent's  Park  Barracks 
November,  1877. 


CHRONOLOGICAL  LIST  OF  WORKS  ON  VET- 
ERINARY OBSTETRICS  PUBLISHED  UP  TO 
THE  PRESENT  TIME. 


France. 


Rainard.     Traite  Complet  de  la  Parturition  des  Femelles  des  Animaux 

Domestiques.     Paris,  1845. 
Saint-Cyr.     Traite  d'Obstetrique  Veterinaire.     Paris,  1875.  ♦ 

Germany. 

ydrg.     Anleitung  zu  einer  Rationellen  Geburtshiilfe  der  Landwirthschaft- 

lichen  Thiere.     Leipsic,  18 18. 
Binz.      Theoretisch-praktische   Geburtshiilfe   fiir   die    Haussaugethiere. 

Freiburg,  1830.  • 

Thomas.     Kenntnisse,  Erfahrungen  und  Hulfsleistungen  bei  den  Geburten 

der  Pferde.     Glogau,  1832. 
Seyffert.     Die  Geburtshiilfe  bei  den  Kiihen,  1838.    . 
Ziller.     Kurzgefastzter  jedoch  moglichst  griindlicher  Unterricht  tiber  die 

Geburtshiilfe  der  Grotzeren  landwirthschaftlichen  Hausthiere.     Sch- 

leusingen,  1838. 
Dieterichs.     Handbuch   der  Praktischen  Geburtshiilfe  bei  den  Groszeren 

Hausthieren.     Berlin,  1845. 
Baumeister-Rueff.     Die  Thierarztliche  Geburtshiilfe. 
Ziini.     Handbuch  der  Thierarztlichen  Geburtshiilfe.     Leipsic,  1863. 
Kehrer.    Beitrage  zur  vergleichenden  und  experimentellen  Geburtskunde. 

Geissen,   1864, 
Thomas.     Versuch  einer  Anweisung  zur  Geburtshiilfe  der  Pferde.     Mar- 
burg, 1866, 
Harms.     Lehrbuch  der  Thierarztlichen  Geburtshiilfe.     Hanover,  1867. 
Franck.     Handbuch  der  Thierarztlichen  Geburtshiilfe.     Berlin,  1876. 

Belgium. 

Delwart.     De    la    Parturition    des  Principales    Femelles    Domestiques. 
Brussels,  1839.  , 


viii        LIST  OF  WORKS  ON  VETERINARY  OBSTETRICS, 


Eherhard  and  Gunther.  Verhandeling  over  het  Verlossen  der  Koeyen. 
Amsterdam,  1793. 

Sweden. 

SJosfedf.  Handbok  i  Forlossnings  Konsten  for  Veterinarer  och  uppfodare 
af  Husdjur.     Stockholm,  1875. 

Austria. 
Henkel.     Die  Geburtshtilfe  bei  den  Kiihen.     Vienna,  1840. 

Poland. 

Seifert  and    Tenneker.      Lehrbuch    der    Pferdearztlichen    Geburtshtilfe. 

Prague,  1820. 
Kahlert.      Praktische  Anleituijg  zu  einer  naturgemaszen   Geburtshtilfe 

der  landwirthschaftlichen  Hausthiere.     Prague,  1830. 

Italy. 

Cataneo.     Manuale  di  Obstetricia  Vererinaria.     Milan,  1845. 
LanziUotti-Buonsanti.     Manuale  di  Obstetricia  Veterinaria.     Milan,  187 1. 

England. 

Skellet.  A  Practical  Treatise  -on  the  Parturition  of  the  Cow,  or  the 
Extraction  of  the  Calf ;  and  also  on  the  Diseases  of  Neat  Cattle  in 
general.     London,  1807. 


TABLE  OF  ILLUSTRATIONS. 


FIG.  PAGE 

1.  Pelvis  of  the  Mare Baumeister  and  Rueff  7 

2.  Pelvis  of  the  Cow . .    .  .Ibid 10 

3.  Pelvis  of  the  Sheep Ibid ii 

4.  Lateral  Ligaments  of  the  Sacrum  and  Pelvis.   Leyh 12 

5.  Ligaments  of  the  Lumbar  Vertebrae,   Sacrum 

and  Pelvis Ibid 13 

6.  Longitudinal  Section  of  the  Mare's  Pelvis.  . .  .Saint-Cyr 16 

7.  Longitudinal  Section  of  the  Cow's  Pelvis.    . .  .Ibid 19 

8.  Median  Section  of  the  Horse's  Pelvis Franck 20 

9.  Median  Section  of  the  Mare's  Pelvis Ibid 20 

10.  Pelvis  of  Mare Saint-Cyr 25 

11.  Pelvis  of  Horse Ibid 25 

1 2.  Generative  Organs  of  Mare  in  situ Ibid 27 

1 3.  Lobule  of  Mammae Virchow 34 

14.  Section  of  Cow's  Teat Guibourt 34 

15.  Generative  Organs  of  the  Mare,  isolated    Chauveau 36 

16.  Utricular  Gland  of  a  Pregnant  Goat Franck 42 

17.  Utricular  Gland  of  a  Pregnant  Cow Jbid 42 

18.  Horizontal  Section  of  L^erine  Glands.  . .    ...  .Ibid 43 

19.  Uterus,  Oviducts,  and  Ovaria  of  the  Sheep. .  .Owen 44 

20.  Ovary  opened  Vertically Saint-Cyr 48 

21.  Portion  of  the  Ovary  of  a  Pig Ibid 48 

22.  Graafian  Vesicle  in  Mare's  Ovary Franck 48 

23.  O vulum  of  Mare Ibid 48 

24.  Formation  of  the  Ovisac  in  the  Bitch's  OYzry. Bischoff". 50 

25.  Graafian  Vesicle  and  Ovum.  . .    Barry 51 

26.  Escape  of  Ovum  from  Ovisac Thomson 51 

27.  Successive    Stages   in  Formation  of  Corpus 

Luteum Poiichet 52 

28.  Ovum  from  Oviduct  of  Rabbit Bischoff. 64 

29.  A  more  advanced  Ovum ibid 64 

30.  Ovum  from  Uterine  Half  of  Oviduct Ibid 65 

31.  Ovum  from  Uterine  End  of  Oviduct Ibid 65 

32.  Blastoderm  and  Primitive  Trace Saint-Cyr 66 


X  TABLE  OF  ILLUSTRATIONS. 

FIG.  TAGE 

33.  Ovum  from  Twenty  to  Twenty-five  Days  old.  .Saint-Cyr ...  68 

34.  Ovum  about  a  Month  old Ibid 69 

35.  Chorion  of  Mare  at  Mid-term CoUji 70 

36.  Foetal  Membranes  of  the  Cow  at  Mid-term Ibid 71 

37.  Foetal  Membranes  of  the  Goat  at  Full  Time.  . .Ibid 72 

38.  Foetus  and  Foetal  Membranes  of  Cat Buffon 73 

39.  Foetus  of  Mare  and  its  Envelopes Chauveaii 74 

40.  Plan  of  Foetal  Envelopes  in  Mare Saint-Cyr 'j'] 

41.  Portion  of  Chorion  with  Placentulae  :  Cow.  . .  .Gurlt 81 

42.  Maternal  and  Foetal  Cotyledons  of  the  Cow . .  .  Colin 83 

43.  Cotyledon  of  a  Cow's  Uterus Pettigrew    84 

44.  Foetal  Circulation  in  a  Transition  State Saifit-Cyr 97 

45.  Foetal  Circulation  :  Advanced  Period Colin 99 

46.  Male  Foetus  of  the  Mare Franck 1 03 

47.  Genito-urinary  Organs  of  a  f^oetal  Sheep Midler 104 

48.  Female  Organs  of  a  Fcetal  Deer Ibid 106 

49.  Female  Foetus  of  the  Cow Franck 106 

50.  Genital  Organs  of  a  Hermaphrodite  Goat Leicckart 107 

51.  Section  of  Maternal  Cotyledon   during  Gesta- 

tion   Franck 121 

52.  Gravid  Uterus  of  a  Multiparous  and  Uniparous 

Animal Thonison 1 24 

53.  Twin  Pregnancy :  Cow Saint-Cyr 152 

54.  A  Mole Zundel 169 

55.  Hydated  Kyst Boivin 1 72 

56.  Cow  in  the  Act  of  Parturition :  Standing  Posi- 

tion  Original 222 

57.  Mare  in  the  Act  of  Parturition:    Recumbent 

Position Bauvieister ....  223 

58.  Vertebro-sacral  Position  of  the  Foetus Saint-Cyr 229 

59.  Lumbo-sacral  Position  of  the  Foetus Ibid 230 

60.  Right  Cephalo-ilial  Position  of  the  Foetus Ibid 231 

61.  Cephalo-sacral  Position  of  the  Foetus Ibid 232 

62.  Sterno-abdominal  Position  of  the  Foetus Ibid 233 

63.  Mammary  Gland  and  Milk  Cells Virchow 253 

64.  Completely  Deformed  Pelvis Saint-Cyr 271 

95.  Exostosis  of  the  Pelvis Ibid 273 

66.  Fracture  of  the  Pelvis Ibid 274 

67.  Uterine  Hernia  :  Mare Ibid 280 

68.  Incomplete  or  Simple  Torsion  of  the  Uterus.  .Zundel 295 

69.  Multiple  Torsion  of  the  Uterus Gurlt 296 

70.  Diagram  of  Uterine  Torsion Saint-Cyr 304 

71.  Left  Uterine  Torsion Gurlt 305 

72.  Right  Uterine  Torsion. Ibid 305 

73.  Right  Uterine  Torsion  :  Manipulation Saint-Cyr.  . .     306 

74.  Left  Uterine  Torsion  :  Manipulation. Ibid 306 

75.  Left  Uterine  Torsion  in  situ Rossignol 308 

'jd.  Darreau's  Uterine  Retroversor Darreau 316 


TABLE  OF  ILLUSTRATIONS.  xi 

FIG.  PAGE 

T].  Barnes's  Uterine  Dilator Original 346 

'jZ.  Skull  of  a  Hydrocephalic  Calf Saint-Cyr 380 

79.  Skull  of  a  Hydrocephalic  Calf Rueff—Baumeister . . .  380 

80.  Skull  of  a  Hydrocephalic  Foal Saint-Cyr 381 

81.  Calf  Affected  with  Hydrocephalus Rueff—Baumeister .  ...  381 

82.  Head  of  a  Hydrocephalic  Foal Original 382 

83.  Extraordinary   Development  of  the  Cranium 

of  a  Hydrocephalic  Calf Original 384 

84.  Deformed  Head  and  Neck  of  a  Foal Fratick   391 

85.  Ectromelian   Monstrosity :  Horse    Zimdel 402 

86.  Ectromelian   Monstrosity  :  Goat Rueff—Baumeister .  . . .  402 

^T.  Symelian   Monstrosity   Ibid 403 

88.  Celosomian  Monstrosity Ibid 403 

89.  Ectopia  Cordis Hering 404 

90.  Pseudencephalian  Monstrosity Ibid 404 

91.  Cyclopian  Monstrosity  :  Ram Ibid 405 

92.  Cyclopian  Monstrosity  :  Ass Gurlt 405 

93.  Acephalian  Monstrosity - Ibid 406 

94.  Schistocephalus  Fissilabrus Rueff—Baumeister . . . .  406 

95.  Camylorrhacchis  Contorta. Ibid 40^ 

96.  Monomphalian  Monstrosity Ibid 408 

97.  Skull  of  Syncephalian  Monstrosity Franck 408 

98.  Monocephalian  Monstrosity Rueff—Baumeister .  . .  .  409 

99.  Sysomian  Monstrosity Ibid 410 

100.  Monosomian  Monstrosity *. . .  .  Original 411 

1 01.  Polymelian  Monstrosity Rueff—Baumeister ....  41 1 

102.  Double  Parasitic  Monstrosity Zundel 412 

103.  Sysomian  Monstrosity Saint-Cyr 418 

104.  Celosomian   Monstrosity :  Lamb Youatt 421 

105.  Twin  Foetuses  in  Different  Presentations.  . .  .Saint-Cyr 428 

106.  Solid  Repeller Original 435 

107.  Jointed  Repeller Ibid 435 

108.  Jointed  Repeller:  Open Rainard 435 

109.  "            "            Closed Ibid 435 

no.  Anterior    Presentation:     Fore-limb    Crossed 

Over  the  Neck Saint-Cyr  442 

111.  Anterior   Presentation:    Fore-limbs    Bent  at 

the  Knees^ Ibid 444 

112.  Anterior  Presentation:  Extending  the  Fore- 

limb  Franck 445 

113.  Anterior  Presentation:  One  Fore-limb  Com- 

pletely Retained Saint-Cyr 447 

114.  Anterior  Presentation  :  Both  Fore-limbs  Com- 

pletely Retained Ibid 448 

115.  Anterior  Presentation  :  Downward  Deviation 

of  the  Head   Ibid .  452 

116.  Anterior  Presentation:    Extreme   Downward 

Deviation  of  the  Head Ibid 453 


xii  TABLE  OF  ILLUSTRATIONS. 

FIG.  PAGE 

117.  Anterior  Presentation:  Lateral  Deviation  of 

the  Head  Towards  the  Shoulder Saint-Cyr 456 

118.  Anterior  Presentation:  Lateral  Deviation  of 

the  Head  Towards  the  Abdomen Ibid 457 

119.  Straight  Porte-cord Original 459 

120.  Bent  Porte-cord 459 

121.  Finger-hook 459 

122.  Short  Blunt  Hook 459 

123.  Long  Blunt  Hook 460 

1 24.  Serrated  Forceps 460 

1 25.  Binz's  Porte-cord 461 

1 26.  Nelson's  Blunt  Forceps 462 

127.  Long  Sharp  Hook   , 463 

128.  Anterior  Presentation  :  Deviation  of  the  Head 

Upwards  and  Backwards Saint-Cyr 465 

129.  Anterior  Presentation  :  Deviation  of  the  Head 

Upwards  and  Laterally Ibid 465 

130.  Deviation  of  the  Hind-limbs  in  the  Pelvis  in 

the  Anterior  Presentation Ibid 468 

131.  Hind-limb  Deviation :  Anterior  Presentation. /^r^iw^--^ 469 

132.  Lumbo-sacral  Position  of  the  Foetus Saint-Cyr 474 

133.  Hock  Presentation  :  Calf Franck 478 

134.  Diagrams  of  the  Hind-limbs  in  Hock  Presen- 

tation      Ibid 478 

135.  Hock  Presentation  :  Hock  Corded Saint-Cyr.  .". 481 

136.  Thigh  and  Croup  Presentation Ibid 483 

137.  Thigh    and      Croup     Presentation:      Thigh 

Corded   Ibid 484 

138.  Thigh   and  Croup  Presentation:  Body  Cord- 

ed   Franck 485 

139.  Transverse  Presentation :  Right  Cephalo-ilial 

Position — Side  View Saint-Cyr 490 

140.  Transverse  Presentation  :  Right  Cephalo-ilial 

Position — Upper  View Franck 490 

141.  Transverse    Presentation:    Vertical'^  or    Ce- 

phalo-sacral  Position Saint-Cyr 491 

142.  Sterno-abdominal     Presentation,    Head     Re- 

tained :  Calf Ibid 495 

143.  Sterno-abdominal     Presentation,    Head     and 

Feet  Engaged  :  Foal Franck 496 

144.  Darreau's  Olive-shaped  Repeller , 497 

145.  Traction  Cord  and  Band,  and  the  Manner  of 

Applying  them Banmeister   502 

146.  Schaack's  Traction  Cord Saint-Cyr 502 

147.  Cartwright's  Porte-cord 504 

148.  Darreau's  Porte-cord 504 

149.  Gunther's  Bent  Porte-cord 504 

1 50.  Darreau's  Bent  Porte-cord 504 


TABLE  OF  ILLUSTRATIONS.  xiii 

FIG.  PAGE 

151.  Binz's  Simple  Head-collar Baiuneister 506 

1 52.  Rueff's  Head-collar,  No.  i    Rueff. 506 

153.  Rueff's  Head-collar,  No.  7.*. Ibid 506 

154.  Binz's  Forceps-band Baumeister — Rueff. . . .  507 

155.  Schaack's  Forceps-halter Saint-Cyr 508 

156.  Manner  of  Placing  Schaack's  Halter   Ibid 50S 

157.  Schaack's  Halter  Placed  on  a  Calf's  Head.  .  .Ibid 509 

158.  Short  Blunt  Crotchet Original : ..  510 

159.  Blunt  Finger  Crotchet   510 

160.  Short  Sharp  Crotchet  with  Round  Point 511 

161.  Short  Sharp  Crotchet  with  Broad  Point 511 

162.  Long  Blunt  Crotchet 512 

163.  Long  Pointed  Crotchet 512 

164.  Long  Pointed  Crotchet :  Darreau's  Pattern 512 

165.  "  "  "  "  "       512 

166.  Schaack's  Crotchet. ....    514 

167.  Simple  Short  Crotchet-forceps 516 

168.  Long  Simple  Crotchet-forceps 517 

169.  Gunther's  Long  Crotchet-forceps.  . ." 517 

170.  Jointed  Crotchet-forceps 517 

171.  Nelson's  Blunt  Crotchet-forceps 518 

172.  Nelson's  Serrated  Crotchet-foroeps . 518 

173.  Tallich's  Short  Bent  Crotchet-forceps 518 

174.  Andre's  Crotchet-forceps 519 

I  "j^.  Bitch  Forceps 520 

I  "](>.  Weber's  Forceps 520 

I TJ.  Defays's  Forceps 520 

178.  Defays's  Wire-extractor  with  the  Torsion-rods 521 

179.  Defays's  Wire-extractor  Applied ■■ 522 

180.  Breulet's  Tube  and  Noose.  , . 522 

181.  Breulet's  Noose  Fixed  on  the  Foetus 523 

182.  Diagram  of  the  Pelvic  Axis Saint-Cyr 524 

183.  Obstetric  Pulleys Ibid 528 

184.  Baron's  Obstetric  Machine Ibid 529 

185.  Straight  Embryotom Original 534 

1 86.  Curved  Embryotom   534 

187.  Gunther's  Embryotom  :   Improved  Pattern 535^ 

188.  Scalpel  Embryotom ^ 535 

189.  Gunther's  Long-handled  Embryotom ....   536 

190.  Cartwright's  Subcutaneous  Spatula 536 

191.  Carsten-Harms's  Spatula < 536 

192.  Ungefrohrn's  Spatula 537 

193.  Cartwright's  Bone-chisel 537 

194.  Cartwright's  Bone-saw , 537 

195.  Swedish  Bone-saw 537 

1 96.  Pad  Pessary Saint-Cyr, 593 

197.  Ring  Pessary Ibid 594 

198.  Cup  and  Ball  Pessary. .*.  .Ibid 594 


xiv  TABLE  OF  ILLUSTRATIONS. 

FIG.  PAGE 

199.  Labial  Sutures Zundel 597 

200.  Loop  of  Delwart's  Truss Franck 598 

201.  Delwart's  Truss  Applied Saint-Cyr 599 

202.  Renault's  Truss Ibid 600 

203.  Leather  Truss Franck 601 

204.  Lund's  Truss  Iron   602 

205.  Lund's  Truss  Applied Saint-Cyr 603 

206.  Parturient  Apoplexy  :  Cow Armatage 658 

207.  Teat-syphon Original 710 

208.  Ringed  Teat-syphon 710 

209.  Luthi's  Perforating  Sound   718 

210.  Armatage's  Umbilical  Truss Armatage 726 

211.  Wooden  Clam  for  Hernia Ibid 730 

212.  Iron  Screw-clams  for  Hernia Ibid 730 


TABLE  OF  CONTENTS. 


I'AGE 

Introduction i 

Preface v 

PART   FIRST. 

EUTOKIA. 

BOOK  I.— OBSTETRICAL  ANATOMY....' 5 

CHAPTER  I.— THE  PELVIS  . . 5 

Section  I.— Bones  of  the  Pelvis 6 

1.  Os  Innominatum 6 

Ilium   «..., .„.    7 

Ischium     8 

Pubis 8 

2.  Sacrum 9 

3.  Ooccyx 10 

Differences  in  the  Bones  of  the  Pelvis  of  other  Animals 10 

Cow 10 

Sheep  and  Goat 1 1 

Bitch  and  Cat 1 1 

Pig " 

Section  II. — Articulations  of  the  Pelvis 12 

1.  Sacro-lumbar  Articulation 12 

2,  3.  Sacro-iliac  Articulations 12 

4.  Ischio-pubic  Symphysis   13 

5.  Sacro-coccygeal  Articulations .  .  14 

Differences  in  the  Pelvic  Articulations  of  other  Animals 14 

Cow . .  ~    . .    .    ......  14 

Sheep  and  Goat •  •  14 

Bitch  and  Cat 14 

Sacro-sciatic  Ligament 14 

Section  1 1 1.— The  Pelvis  and  its   Cavity 15 

Mare ^5 

External  Surface IS 

Anterior  Opening  or  Inlet 17 


TABLE  OF  CONTENTS. 

PAGE 

Posterior  Opening  or  Outlet 17 

The  Cavity  of  the  Pelvis 18 

Differences  in  other  Animals 18 

Cow 18 

Sheep  and  Goat 19 

Pk  19 

Bitch  and  Cat 19 

Section  IV. — Capacity  of  the  Pelvis  or  Pelvimetry...  20 

Differences  in  the  Pelvis  according  to  Sex 25 

CHAPTER  II.— FEMALE  GENERATIVE  ORGANS 27 

Section  I. — External  Generative  Organs 27 

The  Vulva. 27 

Differences  in  the  Vulva  of  other  Animals 30 

Cow 30 

Sheep 31 

Pk 31 

Bitch  and  Cat ....  31 

Section  II. — The  Mammae 31 

Differences  in  other  Animals 33 

Cow 33 

Sheep  and  Goat ...    34 

Pig 35 

Bitch 35 

CHAPTER  III.— INTERNAL  ORGANS  OF  GENERATION..  35 

Section  I. — The  Vagina 35 

Differences 37 

CoWy  Sheep,  and  Goat 37 

Pig 38 

Bitch  and  Cat 38 

Section  1 1. — The  Uterus  38 

Differences 41 

Cow 41 

Sheep  and  Goat 43 

Pig 43 

Bitch  and  Cat 43 

Development 44 

Section  III. — Fallopian  Tubes  or  Oviducts 45 

Differences 46 

Cow,  Sheep,  and  Goat 46 

Pig 46 

Bitch 46 

Section  IV. — The  Ovaries 47 

Differences , 49 

Cow,  Sheep,  and  Goat 49 

Pig 49 

Bitch  and  Cat 49 

Development 49 


TABLE  OF  CONTENTS.  xvii 

PACK 

BOOK  II.— OBSTETRIC AL  PHYSIOLOGY 53 

REPRODUCTION 53 

CHAPTER  I  .—Section  I.— Puberty ; .  55 

Section  II. — CEstrum  or  Menstruation 56 

Section  HI. — Maturation  of  the  Graafian  Vesicles...  60 

CHAPTER  H.— FECUNDATION 61 

CHAPTER  III.— STERILITY 62 

CHAPTER  IV.— CHANGES  IN  THE  OVUM 64 

Section  I. — Development  of  the  Embryo 66 

Section  1 1. — Annexes  of  the  Fcetus 70 

Chorion yi 

Differences 73 

Ruminants 73 

Pig 73 

Bilc/f^  and  Cat 74 

Amnion 74 

Liquor  Amnii 75 

Differences  in  the  Amnion  of  other  Animals ♦. 76 

Ruminants 76 

Pig  76 

Bitch  and  Cat. ......    76 

Allantois 77 

Differences 70 

Ruminants 7q 

P'S V 79 

Bitch  and  Cat. 70 

UmbiHcal  Vesicle , . ,  70 

Differences go 

Ruminants  and  Pig go 

The  Placenta go 

Differences gi 

Cow .  . , gi 

Sheep  and  Goat g4 

Pig ^S 

Bitch  and  Cat Z^ 

Functions 85 

Umbilical  Cord 86 

Differences ^y 

Ruminants •  87 

Pig ^7 

Bitch  and  Cat 88 

Section   III. — Development  of  the  Fcetus 89 

The  Nervous  System <y^ 

The  Organs  of  Sense 91 

The  Skin  and  its  Appendages 92 


i  TABLE  OF  CONTENTS, 

PAGE 

The  Locomotory  Apparatus 94 

The  Circulatory  System .    96 

The  Respiratory  Apparatus 100 

The  Digestive  System loi 

The  Genito-urinary  Organs 102 

Section  IV. — Periods  of  Development 107 

Section  V. — Physiological  Phenomena  in  the  Fcetus no 

Nervous  Functions no 

Absorption 112 

Nutrition 113 

Circulation 114 

Secretion 116 

Section  VI. — Weight  and  Dimensions  of  the  Fcetus  at 

Birth 117 

CHAPTER  v.— GESTATION 119 

Section     I. — Modifications    in    the    Uterus    during 

Pregnancy 119 

Volume 119 

Structure 1 20 

Sensibility 122 

Form 1 23 

Situation 125 

Direction 125 

Influence  on  and  Alterations  in  the  Position  of  Neighboring 

Organs 1 26 

Section*  1 1. — Position  of  the  Fcetus  in  the  Urerus 128 

Section  1 1 1. — Signs  of  Pregnancy 1 29 

Rational  Signs 1 29 

Material  Signs 131 

Sensible  Signs 1 34 

Section  IV. — Duration  of  Pregnancy 138 

Mare 139 

Cow 141 

Sheep  and  Goat 141 

Pig 142 

Bitch   142 

Cat • 143 

Section  V. — Gemelliparou.s,  Pluriparous,  or  Multipa- 

Rous  Gestation 143 

Mare 143 

Cow   .'. .  145 

Sheep 147 

Goat 148 

Free-Martins 149 

Diagnosis  of  Multiple  Pregnancy 150 

Position  of  the  Foetuses  in  Multiple  Pregnancy   151 


TABLE  OF  CONTENTS.  xix 


PAGE 


CHAPTER  VI.— HYGIENE  OF  PREGNANT  ANIMALS 153 

BOOK  III.— PATHOLOGY  OF  GESTATION 156 

CHAPTER  I.— ANOMALIES  IN  GESTATION 156 

Section  I. — Superfcetation 156 

Section  II. — Extra-uterine  Pregnancy 160 

Symptoms,  Course,  and  Terminations 167 

Diagnosis  and  Treatment 168 

Section  III. — Spurious  or  Pseudo-pregnancy 169 

Moles 169 

Uterine  Kysts 171 

Hydrops  Uteri  or  Hydrometra 1 73 

CHAPTER  II.— DISEASES    OF    THE  PREGNANT  ANI- 
MAL       175 

Section    I. — Influence   of    Gestation    on    Ordinary 

Diseases 175 

Section  II.— Diseases  Peculiar  to  Pregnancy 176 

Cramp 1 76 

Pica 177 

Constipation 1 77 

CEdema 177 

Hydrops  Amnii 1 78 

Paraplegia 1 80 

Amaurosis 181 

Cough 181 

Albuminuria 181 

CHAPTER  III.— ACCIDENTS  OF  PREGNANCY 182 

Ante-par tum  Prolapsus  of  the  Vagina 182 

Hernia  of  the  Uterus  (Hysterocele) 183 

Ante-partum  Rupture  of  the  Uterus.  . . . _. 184 

Metrorrhagia 190 

Abnormal  Retention  of  the  Foetus 191 

Abortion ....    197 

Sporadic  Abortion 1 99 

Epizootic,  Enzootic,  or  Infectious  Abortion 209 

BOOK  IV.— NORMAL  PARTURITION 214 

CHAPTER  I.— PHYSIOLOGY  OF 'PARTURITION 214 

Section  I.— Causes  of  Parturition 215 

Section  II. — The  Expelling  Powers 215 

Section  III. — Symptoms  and  Course  of  Parturition 219 

CHAPTER    II.— PRESENTATIONS    OF    THE     FCETUS 

AND  MECHANISM  OF  PARTURITION 226 

Section  I. — Presentations 227 

Section  II. — Positions  ...    228 

Section  III. — Mechanism  of  Parturition 232 


TABLE  OF  CONTENTS. 


PAGE 


CHAPTER  III.— NECESSARY    AID  IN    NORMAL    PARTU- 
RITION   238 

Section  I. — Attention  to  the  Mother 238 

Section  II. — Attention  to  the  Offspring  246 

CHAPTER  IV.— SEQUELS  OF  PARTURITION 250 

ection  I. — Functional  Modifications 250 

Section  II. — Organic  Modifications...- 257 


PART   SECOND. 

DVSTOKIA. 

General  Considerations 260 

BOOK  I.— MATERNAL  DYSTOKIA 270 

CHAPTER  I.— DYSTOKIA  BY  PELVIC  CONSTRICTION...  270 

Complete  Deformity  of  the  Pelvis 271 

Exostoses 273 

Fractures 273 

Tumors  in  the  Pelvic  Cavity 276 

Indications  for  Surgical  Treatment 276 

CHAPTER  II.— DYSTOKIA  BY   DISPLACEMENT  OR 

CHANGED  RELATIONS  OF  THE  UTERUS 279 

Hernia  of  the  Uterus — Hysterocele 280 

Origin  and  Symptoms  in  Uniparous  Animals 280 

Origin  and  Symptoms  in  Multiparous  Animals 281 

Diagnosis 282 

Indications 284 

Pathological  Anatomy 287 

Deviation  of  the  Uterus 288 

Diagnosis • 289 

Complications   289 

Indications 290 

Torsion  of  the  Uterus :  Contorso  Uteri 291 

History 291 

Nature  and  Frequency 294 

Etiology 298 

Symptoms 300 

Diagnosis 303 

Prognosis 307 

Pathological  Anatomy 307 

Treatment 3" 


TABLE  OF  CONTENTS.  xxi 

PAGE 

Torsion  of  the  Uterus  in  the  Mare 325 

Causes 325 

Symptoms 326 

Prognosis  and  Treatment   326 

Torsion  of  the  Uterus  in  other  Animals 327 

CHAPTER  III.— DYSTOKIA  FROM    MORBID  ALTERA- 
TIONS  IN  THE  GENITAL  ORGANS 327 

1 .  Utero-vaginal  Tumors 327 

Diagnosis 329 

Treatment 329 

Cancerous,  Carcinomatous,  or  Sarcomatous  Tumors 331 

Condylomatous,  Papillomatous,  and  Lipomatous  Tumors.   331 

Fibroid  and  Myomatous  Tumors 331 

•  Thrombus  or  Haematoma 336 

Serous  Kysts 336 

Hernia  of  the  Bladder  into  the  Vagina  :  Vaginal  Cysto- 

cele 337 

Treatment 338 

Tumors  in  the  Vicinity  of  the  Genital  Organs 340 

2.  Rigidity  of  the  Cervix  Uteri 341 

Symptoms 341 

Diagnosis 342 

Prognosis 343 

Treatment 343 

3.  Induration  of  the  Cervix  Uteri 349 

Symptoms 350 

Diagnosis 351 

Prognosis 351 

Pathological  Anatomy 352 

Treatment 353 

4.  Complete  Obhteration  of  the  Os  Uteri 356 

Causes 357 

Symptoms 357 

Results 357 

Diagnosis 357 

Treatment 357 

CHAPTER  IV.— OTHER  CAUSES  OF  MATERNAL  DYS- 
TOKIA   358 

Anomalies  in  the  Placenta 358 

Schirrous  Chorion 359 

Morbid  Adhesion  between  the  Foetus  and  Uterus 359 

Stricture   or  Occlusion  of  the  Uterus  by  External  Bands  or 

Membranes 361 

Persistent  Hymen 364 

Treatment 365 

Vaginal  and  Vulvular  Constriction  or  Atresia : 365 


TABLE  OF  CONTENTS. 


PAGE 


BOOK  IL— FCETAL  DYSTOKIA 368 

GROUP  L— OBSTACLES  INDEPENDENT  OF  PRESENTA- 
TIONS AND  POSITIONS 369 

CHAPTER  I.— EXCESS  IN  VOLUME  OF  THE  FCETUS .  . . .  369 

Causes 369 

Diagnosis 372 

Prognosis 374 

Indications 374 

Anomalies  in,  and  Diseases  of,  the  Foetal  Membranes 375 

Abnormal  Quantity  of  Placental  Fluid 377 

Anomalies  in  the  Umbilical  Cord 378 

Indications , 379 

CHAPTER  II.— DISEASES  OF  THE  FCETUS 379 

Hydrocephalus 379 

Pathological  Anatomy 379 

Dystokia 383 

Diagnosis 383 

Indications 384 

Ascites,  Anasarca,  and  Hydrothorax 386 

Causes 387 

Dystokia 388 

Diagnosis 388 

Indications 389 

Emphysema 390 

Indications .    390 

Polysarcia 391 

Indications 301 

Contractions 301 


Indications. 


393 


Tumors 3Q3 

Indications 3r)_}. 

Death 394 

CHAPTER  III.— MONSTROSITIES 395 

.    Classifications 396 

Class  I. — Simple  Monstrosities 396 

Order  I. — Simple  Monstrosities  through  Absence  of  Parts.  ..  396 
Order    11. — Sim^Dle    Monstrosities    through    Smallness   of 

Parts 397 

Order  III. — Simple  Monstrosities  through  Abnormal  Divis- 
ion of  the  Body 397 

Order  IV. — Simple  Monstrosities  through  Absence  of  the 

Natural  Division  of  Parts 398 

Order  V. — Simple  Monstrosities  through  Fusion  or  Coali- 
tion of  Organs 398 


TABLE  OF  CONTENTS.  xxiii 

PAGE 

Order  VI. — Simple  Monstrosities  through  Abnormal  Posi- 
tion and  Form  of  Parts 398 

Order  VII. — Simple  Monstrosities  through  Excess  in  For- 
mation   ' 398 

Order  VII I. — Hermaphrodites 398 

Class  II. — Treble  and  Double  Monstrosities 399 

Order  I. — Trigeminal  Monstrosities 399 

Order  II. —  Monsters  with  Two  Heads. 399 

Order  III. — Double-headed  Monstrosities,  with  the  Trunk 

Wholly  or  Partially  Double 400 

Order  IV. — Monstrosities    with   a   Single    Head,  but  the 

Trunk  or  Limbs  more  or  less  Completely  Double 400 

Order  V. — Monstrosities   with  a  Single   Head  and  Trunk, 

and  more  than  Four  Limbs 400 

Order  VI. — Monstrosities  with  the  Head,  Trunk,  and  Limbs 

more  or  less  Completely  Double 401 

Origin  of  Monstrosities,  and  the  Laws  of  Teratology 411 

Frequency  of   Monstrosities 416 

Distorted  Monstrosities 417 

Cyclopian  Monstrosity 417 

Pseudencephalian  Monstrosity 418 

Double-headed  Monstrosities 418 

Celosomian  Monstrosities 420 

Diagnosis 420 

Prognosis 421 

Extraction 421 

Double  and  Triple  ALonstrosities   424 

Diagnosis 424 

Extraction 425 

CHAPTER  IV.— DYSTOKI A  FROM  MULTIPARITY 427 

Diagnosis 429 

Extraction 429 

GROUP  IL— DYSTOKIA  FROM    MALPRESENTATION    OR 

MALPOSITION  OF  THE    FCETUS     ..432 

CHAPTER  I.— DYSTOKIA  DEPExNDING  ON  THE  ANTE- 
RIOR PRESENTATION 440 

Section  I. — Dystokia  Due  to  the  Fore-limbs : 441 

1.  Anterior  Limbs  Incompletely  Extended  in  the  Pelvis 441 

Indications 441 

2.  Fore-limbs  Crossed  Over  the  Neck 441 

Indications 442 

3.  Fore-limbs  Flexed  at  the  Knees 443 

Indications 444 

4.  Fore-limbs  Completely  Retained 447 

Indications   _. 449 


TABLE  OF  CONTENTS. 


PAGE 


Section  II. — Dystokia  Due  to  the  Head 450 

Downward  Deviation 451 

Indications 453 

Lateral  Deviation  to  the  Right  or  Left 455 

Indications • 457 

Deviation  Upward  and  Backward 464 

Indications 464 

Section  III. — Dystokia   Due   to    Misdirection    of   the 

Hind-limbs  in  the  Anterior  Presentation 466 

Extreme  Abduction  of  the  Hind-limbs 466 

Indications 467 

Deviation  of  the    Hind-limbs   in  the  Pelvis,  the  Anterior 

Part  of  the  Body  Presenting 467 

Indications 469 

CHAPTER  II.— DYSTOKIA  DEPENDING    ON  THE    POS- 
TERIOR PRESENTATION 473 

Section  I. — Dystokia  Resulting  from  the  Lumbo-pubic 

AND    LUMBO-ILI AL    POSITIONS 474 

Lumbo-pubic  Position 474 

Indications 475 

Lumbo-ilial  Positions 476, 

Section   II.— Complications    Caused   by   Deviation    of 

THE  Hind-limbs 476 

Fetlock  Presentation 477 

Hock  Presentation 477 

Indications 478 

Thigh  and  Croup  Presentation 482 

Indications 482 

Dystokia  from  the  Head  and  Fore-limbs  in  the   Posterior 

Presentation 487 

Indications 487 

CHAPTER  III.— DYSTOKIA   FROM    TRANSVERSE    PRE- 
SENTATIONS  488 

Dystokia  from  the  Dorso-lumbar  Presentation 489 

Indications 491 

Dystokia  from  the  Sterno-abdominal  Presentation 494 

Indications 495 

BOOK  III.— OBSTETRIC  OPERATIONS 500 

CHAPTER    I.— MECHANICAL    MEANS    FOR    THE     EX- 
TRACTION OF  THE  FCETUS 501 

Cords  and  Bands 501 

Head-cord  or  Head-collar 505 

Crotchets  or  Hooks 510 

Forceps 515 

The  Employment  of  Force  in  Dystokia 523 


TABLE  OF  CONTENTS.  xxv 


PAGE 


Direction  of  Traction 523 

Degree  of  Traction 524 

Means  for  Developing  the  Necessary  Force 527 

Comparison  between  Manual  and  Mechanical  Force 530 

CHAPTER  II.— EMBRYOTOMY 532 

Embryotomy  Instruments 533 

Preliminary  Arrangements  for  Embryotomy 539 

Cephalotomy . .    539 

Puncture  of  the  Cranium 539 

Craniotomy 540 

Decapitation 541 

Amputation  of  the  Limbs 543 

Amputation  of  the  Fore-limbs 544 

Amputation  of  the  Hind-limbs    546 

Division  or  Detruncation  of  the  Foetus 547 

Evisceration 548 

Thoracic  Evisceration 548 

Abdominal  Evisceration 548 

CHAPTER  III.— VAGINAL  HYSTEROTOMY 549 

CHAPTER  IV.— GASTRO-HYSTEROTOMY,  OR  THE    C/E- 

SAREAN  SECTION 554 

Indications 556 

Operation 557 

CHAPTER  v.— SYMPHYSIOTOMY 566 

BOOK    IV.— ACCIDENTS    INCIDENTAL    TO    PARTURI- 
TION   567 

CHAPTER    I.— RETENTION    OF    THE    FCETAL    ENVEL- 
OPES    567 

Symptoms  and  Terminations '. 568 

Causes 569 

Treatment 570 

CHAPTER  II.— POST-PARTUM  HEMORRHAGE 577 

Symptoms 578 

Treatment 578 

CHAPTER  III.— INVERSION  OF  THE  UTERUS 581 

Symptoms 581 

Complications 584 

Prognosis 584 

Causes 585 

Treatment 587 

Preliminary  Measures   5S7 

Reduction  or  Reposition . 589 

Contention  or  Retention  of  the  Uterus 593 


xxvi  TABLE  OF  CONTENTS. 

PAGE 

After  Treatment 603 

Ampufation  of  the  Uterus. — Metrotomy 604 

CHAPTER  IV.— INVERSION  OF  THE  VAGINA 611 

Symptoms 612 

Prognosis 613 

Treatment 613 

CHAPTER  v.— INVERSION  OF  THE  BLADDER 615 

CHAPTER  VI.— TRAUMATIC    LESIONS    OF    THE  GENI- 
TAL AND  NEIGHBORING  ORGANS 619 

Section  I. — Laceration  and  Rupture  of^the  Uterus....  619 

Treatment 621 

Rupture  of  the  Uterus  after  Parturition 622 

Section  II. — Laceration  and  Rupture  of  the  Vagina...  625 

Complications  of  Ruptured  Vagina ...   629 

Rupture  of  the  Perinaeum 632 

Vesico-vaginal  Fistulae 635 

Section  III.— Thrombus  of  the  Vagina  and  Vulva 636 

Section  IV.— Relaxation  of  the  Pelvic  Symphyses 637 

Section  V. — Rupture  of  the  Bladder 637 

Section  VI.— Rupture  of  the  Intestines 638 

Section  VII. — Rupture  of  the  Diaphragm 638 

Section  VIII. — Rupture  of  the  Abdominal  Muscles 639 

Section  IX.— Rupture  of  the  Sacro-sciatic  Ligament.  ..  639 

BOOK  v.— PATHOLOGY  OF  PARTURITION 640 

CHAPTER  I.— VAGINITIS 640 

CHAPTER  II.— LEUCORRHCEA 642 

CHAPTER  III.— METRITIS,  METRO-PERITONITIS,  AND 

PARTURIENT  FEVER • 643 

Symptoms 643 

Termin  ations 644 

Pathological  Anatomy 646 

Causes 649 

Prognosis 654 

Prophylaxis 654 

Treatment ; . .  , 654 

CHAPTER  IV.— PARTURIENT    APOPLEXY  —  PARTURI- 
ENT COLLAPSE 656 

Symptoms.... 657 

Duration,  Terminations,  and  Complications 660 

Prognosis 661 

Causes 662 

Pathological  Anatomy 665 

Nature ^^ 


TABLE  OF  CONTENTS.  xxvii 

PAGE 

Preventive  Treatment 675 

Curative  Treatment 675 

CHAPTER  v.— POST-PARTUM  PARALYSIS  679 

Symptoms 680 

Nature 680 

Treatment '    . .  680 

CHAPTER  VI.— PART/URIENT  ECLAMPSIA 681 

Symptoms 682 

Nature  and  Causes   - 683 

Treatment 684 

CHAPTER  VII.— EPILEPSIA  UTERINA.— MANIA  PUER- 

PERALIS 687 

Symptoms 687 

Causes 689 

Treatment 689 

CHAPTER  VIII.—PARTURIENT    LAMIMITIS 689 

Symptoms 690 

Causes 691 

Treatment 692 

CHAPTER  IX.— MAMMITIS  OR  MASTITIS 693 

Pathological  Congestion  of  the  Mammse 693 

Causes . .   .  .• 693 

Symptoms 694 

Treatment 695 

Inflammation  of  the  Mammas   696 

Symptoms 696 

Course  and  Terminations 699 

Prognosis 704 

Complications .• 704 

Pathological  Anatomy 704 

Causes 705 

Treatment 709 

CHAPTER  X.— AGALACTIA 714 

CHAPTER  XL— INJURIES  TO  THE  TEATS 715 

Fissures 715 

Causes 715 

Symptoms 716 

Treatment 716 

Obliteration  of  the  Galactophorus  Sinus 717 

Symptoms 717 

Treatment , . . .  717 

Fistula  of  the  Teat 718 


xxviii  TABLE  OF  CONTENTS. 

PAGE 

BOOK  VI.— DISEASES  AND  ABNORMALITIES  OF  THE 

YOUNG  ANIMAL 719 

CHAPTER  L— ASPHYXIA  OF  THE  NEW-BORN  ANIMAL.    719 

CHAPTER  II.— UMBILICAL  HEMORRHAGE...    720 

Treatment 720 

CHAPTER  III.— PERSISTENCE  OF  THE  URACHUS 721 

Treatment , ' 721 

CHAPTER  IV.— UMBILICAL   HERNIA 722 

Causes 723 

Pathological  Anatomy 724 

Symptoms 724 

Prognosis   725 

Diagnosis 725 

Treatment   725 

CHAPTER  v.— (EDEMA  OP   THE  UMBILICUS 731 

Treatment 732 

CHAPTER  VL— INFLAMMATION  OF  THE  UMBILICAL 

CORD 732 

Symptoms 732 

Pathological  Anatomy 733 

Causes 734 

Treatment ; 735 

CHAPTER  VIL— ARTHRITIS 736 

Causes 737 

Symptoms 740 

Prognosis 742 

Pathological  Anatomy 742 

Treatment 746 

CHAPTER  VIIL— INDIGESTION 748 

Causes 748 

Symptoms 748 

Treatment 748 

CHAPTER  IX.— DIARRHCEA 749 

Symptoms ...  750 

Pathological  Anatomy 751 

Causes 753 

Prognosis 755 

Treatment..-. 755 


TABLE  OF  CONTENTS.  xxix 

PAGE 

CHAPTER  X.— RETENTION  OF  MECONIUM-— CONSTI- 
PATION    TS'^ 

Causes 758 

Symptoms 758 

Treatment 758 

CHAPTER   XL— SKIN    DRYNESS    OF    THE    NEW-BORN 

ANIMAL 759 

CHAPTER  XIL— IMPERFORATION  OF  THE  ANUS 759 

Symptoms 759 

Treatment 760 

CHAPTER    XIII.— IMPERFORATION    OF    THE    VULVA 

AND  VAGINA 762 

CHAPTER  XIV.— IMPERFORATION  OF    THE  PREPUCE..   763 

CHAPTER  XV.— CYANOSIS 764 


A  TEXT-BOOK   OF  VETERINARY   OBSTETRICS. 


m 


INTRODUCTION. 


The  generation  and  development  of  animated  creatures  is  correctly  de- 
scribed as  an  "  eminently  physiological  act,"  and  one  which  is  ordinarily 
carried  out,  from  beginning  to  end,  as  a  perfectly  natural  process,  and 
without  any  extraneous  interference  being  required  for  its  accomplish- 
ment. But,  speaking  now  with  regard  to  the  higher  orders  of  viviparous 
animals,  this  happy  termination  of  a  most  important  series  of  phenomena 
is  not  always  observed  ;  and  not  unfrequently  various  causes — internal 
as  well  as  external — may  operate  unfavorably  in  a  number  of  ways,  and 
more  or  less  imperil  the  perfect  development  or  existence  of  the  young 
creature,  or  compromise  the  health  or  life  of  the  mother.  More  espe- 
cially is  this  danger  likely  to  occur  when  the  period  arrives  for  the  ex- 
pulsion of  the  fcetus  from  the  abdomen  of  its  parent. 

With  the  domesticated  animals,  when  these  obstacles  to  development 
or  birth  intervene,  in  order  to  remove  or  overcome  them,  and  assist  or 
supplement  nature,  recourse  must  be  had  to  artificial  means,  and  the 
resources  of  science  and  art  are  accordingly  invoked. 

The  term  "  parturition  (from  partus^  to  bring  forth)  "  is  the  act  by 
which  the  product  of  conception,  when  it  has  reached  a  certain  stage  of 
development,  is  expelled  from  the  body  of  the  mother  ;  and  this  act  is 
that  which  is  usually  considered  to  be  the  most  critical  in  the  existence 
of  the  young  creature,  and  to  most  frequently  demand  attention  in  such 
valuable  animals  as  the  Mare,  Cow,  Sheep,  Bitch,  etc. 

The  parturition  of  the  domesticated  animals,  and  the  abnormal  condi- 
tions which  may  precede  or  follow  that  event,  come  within  the  province  of 
Veterinary  Science,  and  form  that  division  of  it  named  "Obstetrics,"  which 
has  aptly  been  designated  the  "  Science  of  Midwifery,"  when  applied  to 
this  division  of  human  surgery.  Though  it  is  that  which  has  been  selected 
as  the  title  of  this  work,  and  though  it  is  also  that  which  is  most  frequently 


ii  INTRODUCTION. 

employed  in  technical  speech  by  the  Veterinarian,  yet  it  is  not  so  cor- 
rectly applied  with  respect  to  animals  as  it  is  to  mankind ;  inasmuch  as, 
according  to  one  derivation,  it  implies  to  "  stand  before  "  (from  obstare^ 
to  stand  before),  whereas,  in  aiding  in  the  birth  of- animals,  the  operator 
generally  stands  behind  the  creature  which  is  in  difficulty  ;  though  if  the 
derivation  from  obstare^  which  also  means  to  "oppose,"  "hinder  pro- 
gress," "  offer  obstruction,"  be  accepted,  then  the  term  is  quite  justifiable 
and  expressive.  The  term  "  accouchment,"  so  often  used  when  speak- 
ing of  the  birth  of  a  human  being,  is  not  always  appropriate  when  em- 
ployed with  reference  to  this  event  in  animal  life,  as  the  larger  domesti- 
cated creatures  are  more  frequently  delivered  of  their  young  in  a  standing 
than  a  recumbent  position. 

Instead  of  Obstetrics,  the  terms  "  Tokology  "  (rozo?,  a  birth,  from 
rcxTEfv,  to  bring  forth,  and  loyn:;^  a  discourse),  "  Tokognosia,"  "  Toka- 
rexeologia,"  and  "  Toxarexis  " — the  practice  of  Tokology — have  been 
introduced  ;  but  they  are  not  sufficiently  familiar  to  warrant  their  adop- 
tion at  present,  and  we  have  therefore  deemed  it  advisable  to  retain  the 
better-known  word. 

The  term  Obstetrics  is  not,  as  has  been  already  shown,  limited  to  the 
act  of  parturition — certainly  one  of  the  most  important,  and  yet  difficult, 
of  all  the  animal  functidns — but  includes  not  only  rules  which  should  be 
followed  in  order  to  remove  or  remedy  the  material  obstacles  or  accidents 
which  may  hinder  the  accomplishment  of  that  act,  and  likewise  embraces 
every  thing  connected  with  the  health  and  preservation  of  the  female 
parent  and  the  young  creature  while  they  are  in  the  closest  relations  with 
each  other  before  parturition,  as  well  as  for  some  time  after  their  dis- 
junction. 

It  therefore  essentially  comprehends  a  mechanical  portion,  which  con- 
sists in  devising  means  for  surmounting  obstacles  that  may  impede  the 
birth  of  the  young  animal ;  and,  scarcely  less  important,  a  thorough 
knowledge  of  those  complex  functions  and  conditions  connected  with 
conception,  generation,  and  the  parturient  state.  The  Veterinarian,  then, 
to  be  a  successful  obstetrician,  must  possess  special  and  varied  information 
of  a  highly  scientific  kind  in  the  domain  of  anatomy,  physiology,  hygiene, 
pathology,  surgery,  etc.,  and  to  this  must  be  added  the  benefits  to  be 
derived  from  experience  -,  for,  as  has  been  well  remarked  by  Saint-Cyr, 
in  proportion  as  his  intervention  is  salutary  and  beneficial  when  it  is 
intelligent  and  opportune,  so  may  it  be  fatal  and  disastrous  when  it  is 
irrational  or  even  inopportune.  His  knowledge  of  the  subjects  above 
named  must  be  grouped  in  a  certain  order,  so  as  to  form  a  doctrinal 
code,  and  to  constitute  a  perfect  science,  having  its  object,  its  rules,  and 
its  means  perfectly  defined. 

The  science  of  Veterinary  Obstetrics,  then,  demands  a  perfect  acquaint- 
ance with  the  anatomy  and  physiology  of  the  generative  organs  and  the 


INTRODUCTION.  .  iii 

region  in  which  they  are  situated  in  the  different  animals.  The  study  of 
the  organs  concerned  in  generation  is  essential  to  acquiring  a  knowledge 
of  their  several  functions,  and  it  is  only  through  understanding  these 
functions  that  we  can  appreciate  the  normal  or  abnormal  course  they  may 
pursue,  and  be  prepared  to  interfere  successfully  when  required.  And  a 
correct  notion  of  the  formation,  structure,  magnitude,  and  other  features 
of  the  space  containing  these  organs — and  which  has  been  named  the 
pelvic  cavity — is  absolutely  necessary  if  we  wish  to  understand  the  act  of 
parturition  in  the  several  animals,  and  be  able  to  render  useful  service  if 
the  deliver}'  of  the  young  is  hindered  by  mechanical  obstacles.  A  knowl- 
edge of  the  physiology  of  these  organs  and  the  phenomena  pertaining  to 
generation,  the  formation  of  the  foetus,  its  development,  and  external  con- 
formation, and  its  connections  with  the  parent,  with  gestation  and  the 
modifications  it  produces  in  the  organism,  as  well  as  the  anomalies,  ac- 
cidents, and  diseases  which  may  occur  during  this  period,  is  required,  in 
addition  to  an  acquaintance  with  that  of  the  final  act,  which  we  have 
named  "parturition." 

The  four  chief  functions  of  the  generative  system  may  be  enumerated 
as  follows :  menstruation  or  oestrum^  conception,  gestation  and  parturition^ 
all  of  which  are  intimately  related  to  and  dependent  upon  each  other:  a 
failure  or  defect  in  one  disturbing  their  relationship,  and  leading  to  ster- 
ility or  irregularity.  Deviations  or  anomalies  in  form  or  structure  of  the 
individual  organs  upon  which  these  functions  rely  for  their  proper  per- 
formance, will  also  tend  to  interfere  more  or  less  with  their  accomplish- 
ment. 

Every  thing  connected  with  this  portion  of  the  subject,  which  terminates 
with  natural  ox  spontaneous  parturition,  has  been  included  under  the  head 
of  EuTOKiA  (from  eu,  well,  and   ro/f<ir,  birth). 

The  difficulties  attending  parturition,  whether  they  depend  upon  the 
mother  or  the  foetus,  or  upon  both,  with  the  means  for  overcoming  them, 
and  the  accidents  which  may  complicate  difficult  parturition,  come  under 
the  general  designation  of  Dystokia  (from  <5uc,  difficult,  and  r^/oc,  birth). 

This  arrangement  of  the  various  subjects  is  necessary  in  a  compre- 
hensive treatise  on  Obstetrics,  and  it  is  the  one  which  will  be  followed  in 
our  manual. 

The  maladies  to  which  the  parent  is  most  exposed  after  parturition,  and 
their  medical  or  surgical  treatment,  as  well  as  the  condition  of  the  young 
animal  after  birth  and  up  to  the  time  of  weaning,  also  form  a  portion  of 
the  veterinary  obstetrist's  study. 

Such  is  the  plan  of  the  work  :  and  I  have  only  now  to  state  that  the 
animals  more  particularly  referred  to  are  of  the  Horse,  Ox,  Dog,  Pig, 
Sheep  and  Goat  species ;  the  other  creatures  which  man  has  domesti- 
cated— such  as  the  elephant,  camel,  rabbit,  and  cat — coming  but  rarely 
within  the  observation  of  the  veterinary  accottcheur. 


iv  INTRODUCTION. 

It  may  be  remarked  that  gestation  and  parturition  in  the  domesticated 
animals  differ  in  several  important  features  from  these  processes  in  the 
human  species — the  differences  being  mainly  due  to  the  dissimilarity  in 
their  respective  attitudes  :  the  quadrupedal  position  of  the  former,  and 
the  horizontal  direction  of  the  trunk,  giving  rise  to  peculiarities  which 
are  not  observed  in  our  own  species,  whose  vertical  and  bipedal  charac- 
teristics again  entail  wide  contrasts  in  this  respect. 

In  addition  to  the  knowledge  which  has  been  mentioned  as  necessary 
for  the  successful  prosecution  of  Veterinary  Obstetrics,  other  qualifica- 
tions must  be  looked  upon  as  essential.  The  practitioner  must  be  pos- 
sessed of  great  tact  in  manipulation,  a  certain  amount  of  mechanical  skill, 
much  patience,  and  readiness  in  device  ;  and  for  the  larger  animals,  ad- 
dress, a  fair  amount  of  physical  strength,  and  the  advantage  which  long 
arms  and  fingers  confer. 

We  need  not  allude  to  the  immense  importance  of  this  branch  of 
Veterinary  Science  from  an  economical  point  of  view.  The  highly-in- 
creasing value  of  nearly  all  the  domesticated  animals,  and  the  necessity 
for  their  multiplication  to  supply  the  demands  and  meet  the  requirements 
of  a  widely-extending  and  rapidly-progressive  civilization,  renders  every 
thing  connected  with  their  reproduction  of  great  moment  and  concern  ; 
while  to  assist  creatures  in  the  pangs  of  protracted  or  important  labor, 
and  to  prevent  or  abbreviate  suffering — in  all  probability  to  preserve  their 
life — previous  to,  during,  or  subsequent  to  the  occurrence  of  this  physio- 
logical act,  is  no  less  a  duty  than  it  should  be  a  source  of  satisfaction  to 
the  Veterinarian. 


PART    FIRST. 

EUTOKIA. 

Those  divisions  of  Anatomy,  Physiology,  and  Pathology  which  are 
directly  related  to  the  processes  oi  generation,  gestation,  diwd  parturition,  as 
well  as  that  act  itself,  belong  to  the  section  of  Obstetrics  to  which  the 
designation  of  EUTOKIA  (  eu,  well  or  favorable,  rJ/oc,  birth)  has  been 
given.  We  shall  discuss  each  of  these  subjects  in  the  order  in  which 
they  now  stand,  commencing  with  the  anatomy  of  the  pelvis^  and  of  the 
external  and  internal  organs  of  generation. 


BOOK  I. 

OBSTETRICAL  ANATOMY. 

The  female  organs  chiefly  concerned  in  generation  and  parturition  are 
either  entirely  passive,  or  more  or  less  active  ;  according  as  they  are  com- 
posed of  hard  or  bony,  or  soft  parts.  The  pelvis  constitutes  the  first, 
while  the  second  are  composed  of  the  organs  and  structures  contained 
within,  or  more  or  less  directly  attached  to  it.  The  pelvis  also  forms  the 
passage  which,  the  fcetus  has  to  traverse  in  order  to  reach  the  external 
world  in  the  act  of  parturition. 

The  soft  organs  are  the  vulva,  vagina,  uterus,  ovaries,  and  mammce :  the 
latter  furnish  the  young  creature  with  its  proper  nourisJiment  immediately 
after  birth.  Of  these  soft  organs  some  are  external,  and  others  are  internal ; 
the  first  are  the  vulva  and  mammae,  and  the  second  are  the  vagina,  uterus, 
and  ovaries.  The  vagina  and  the  greater  portion  of  the  unimpregnated 
uterus  are  contained  in  the  cavity  of  the  pelvis ;  and  the  ovaries,  as  well 
as  the  uterus  during  pregnancy,  are  lodged  in  the  abdomen. 

Our  study  will  commence  with  an  examination  of  the  pelvis  in  the  vari- 
ous domesticated  animals,  beginning  with  a  description  of  the  bones  of 
which  it  is  composed  ;  then  its  ligaments  ;  and  lastly,  this  osseous  frame- 
work, which  is  of  much  importance,  will  be  considered  as  a  whole,  and 
from  an  obstetrical  point  of  view. 

Afterwards  the  external  and  internal  organs  of  generation  will  be  de- 
scribed, and  their  differences  noted  in  the  various  species. 

The  equine  species  will  be  taken  as  the  type,  and  the  differences  in  the 
other  species  compared  with  it. 


CHAPTER  I. 
The  Pelvis. 


The  pelvis  is  the  large,  symmetrical,  more  o'r  less  horizontal,  conoidal 
cavity  or  canal  which  continues  the  abdomen  posteriorly,  and  with  which 


6  OBSTETRICAL  ANATOMY. 

it  communicates  in  front.  It  is  formed  of  bony  and  ligamentous  walls, 
and  contains,  sustains,  and  protects  a  portion  of  the  genito-urinary  ap- 
paratus, as  well  as  the  terminal  portion  of  the  alimentary  canal.  It  is 
situated  towards  the  end  of  the  spine,  and  is  supported  by  the  posterior 
extremities,  with  which  it  is  connected  by  joints  and  muscles.  For  the 
hind  limbs,  as  well  as  for  some  of  the  powerful  muscles  of  the  trunk,  the 
pelvis  constitutes  a  most  important  fulcrum  or  fixed  point  in  various 
movements.  It  is  one  of  the  two  mechanical  elements  concerned  in  the 
act  of  parturition,  and  its  form  varies  more  or  less  in  different  species  ; 
though  its  direction  is  always  rectilinear  in  the  domesticated  animals, 
and  not  incurvated  as  in  woman. 

SECTION    I. BONES   OF   THE    PELVIS. 

The  pelvis  is  composed  of  three  principal  bones — the  two  coxce  or  ossa 
innominata,  and  the  sacrum  ;  and  to  a  certain  extent  of  the  coccygeal  or  tail 
bones.  At  an  early  period  of  life  these  bones  can  be  subdivided,  but  after 
a  certain  time  they  become  consolidated.  Each  coxal  bone,  for  instance, 
is  at  an  early  stage  of  intra- uterine  existence  composed  of  cartilage  only  j 
subsequently  three  centres  of  ossification  appear,  and  these  extend  until 
at  birth  they  have  coalesced  to  form  three  bones  which  are  united  by  car- 
tilage. In  addition  to  these  centres,  two  complementary  nuclei  are  pres- 
ent, one  of  which  constitutes  what  is  termed  the  atiterior  iliac  crest  (k  s^ifie 
and  the  ilio-pectineal  lifie  or  ridge^  and  the  other  the  ischiaiic  tuberosity. 
After  birth,  the  three  chief  portions  of  the  coxae  are  completely  ossified, 
and  meet  in  the  acetabulum — where  they  are  closely  joined — and  at  the 
pubic  symphysis,  where  the  coxa  of  one  side  meets  its  fellow  of  the  other. 
In  youth,  the  different  parts  of  each  coxa  are  very  thick,  the  spongy  tissue 
being  abundant,  and  the  compact  tissue  scanty;  as  the  animal  advances 
in  age,  the  former  diminishes  and  the  latter  increases  iff  density  and 
thickness,  the  two  layers  closely  approaching  each  other. 

I.   Os  Innominatum. 

The  coxa  or  os  innominatum  is  a  pair  bone,  there  being  one  on  each 
side  ;  it  belongs  to  the  trunk,  through  its  concurrence  in  the  formation  of 
the  pelvis,  and  also  to  the  posterior  limb,  of  which  it  constitutes  the  first 
ray  or  haunch. 

It  is  a  flat  bone,  widely  expanded  at  either  extremity,  rather  constricted 
in  the  middle  portion,  and  curved  or  twisted  in  two  different  directions,  its 
anterior  part  forming  an  obtuse  angle  with  the  posterior ;  so  that  while  its 
external  surface  is  inferior  in  the  hinder  portion,  the  anterior  looks  out- 
wards, or  even  upwards,  in  front.  At  its  middle  portion  it  offers  a  wide 
and  deep  articular  depression  surrounded  by  a  high  rim — the  cotyloid  cav- 
ity or  acetabulum — in  which  the  corresponding  articular  head  of  the  femur 
is  lodged  and  moves.  Above  this  cavity  is  a  marked,  roughened  thin 
ridge — the  supra-cotyloid  crest  or  ischiatic  spine,  into  which  the  sacro- 
sciatic  ligament  is  fixed. 

Below  the  cotyloid  cavity,  and  inclining  inwards,  is  a  large  circular  or 
oval  aperture,  which  is  occupied  by  the  obturator  muscles,  and  is  named 
t\iQ  foramen  ovale  or  sub-pubic  openifig  or  foramen. 

The  two  coxae  are  united  interiorly  on  the  median  line,  and  posteriorly 
by  an  articulation  or  solid  suture — syjnphysis  pubis  or  ischio-pubic  symphysis, 
and  form  by  this  junction  a,kind  of  V-shaped  figure,  the  widest  portion  of 
which  is  in  front,  and  renders  the  lateral  diameter  of  the  pelvis  more  ex- 
tensive before  than  behind.     Above,  they  articulate  with  the  sacrum. 


THE  PELVIS. 


Each  coxa,  as  has  been  stated,  is  composed  of  three  portions  which 
unite  at  the  acetabulum  ;  and  although  consolidated  into  one  pjece,  yet 
they  are  separately  described  as  if  distinct.  The  names  of  these  divisions 
are  ilhim,  ischium,  and />u^is.  ' 

Ilium. — The  ilium,  hip,  or  haunch  bone  (os  ilium),  gives  its  name  to  the 
region  it  occupies.  It  is  the  largest  of  the  three  bones,  as  well  as  being 
that  which  is  most  elevated.  In  shape  it  is  irregularly  triangular  and 
flat,  and  is  directed  obliquely  downwards,  inwards,  and  backwards,  and 
has  two  faces,  three  borders,  and  three  angles.  Its  external  or  superior 
face  or  dorsum  is  marked  by  some  muscular  imprints,  and  is  curved  in 
its  widest  part  to  form  a  concave  space — the  external  iliac  fossa — which 
lodges  the  gluteal  muscles.     The  internal  or  inferior  face,  or  venter,  offers 


Pelvis  of  the  Mare. 

A,  Tlium  ;  B,  Pubis  ;  C,  Ischium  ;  D,  Foramen  Ovale  ;  E,  Tuberosity  of  the  Ischium  ; 

F,  Cotyloid  Cavity. 

a  smooth  external  portion — the  iliac  surface — into  which  is  implanted 
the  iliac  psoas  or  iliacus  muscle;  and  an  internal  roughened,  ear-shaped, 
irregularly  diarthrodial  surface,  most  apparent  from  behind — the  auricu- 
lar facet — for  articulation  with  the  sacrum. 

The  anterior  border,  or  crest  oj  the  ilium,  is  slightly  concave,  and  bears 
a  rugged  lip  for  muscular  insertion.  The  external  border  is  thick  and 
roughened,  and  grooved  for  the  passage  of  blood-vessels  ;  inferiorly  it  has 
three  nutrient  foramina.  The  internal  border  is  thin  and  concave,  espe- 
cially in  its  posterior  part,  where  it  constitutes  the  great  sciatic  notch;  it 
affords  attachment  to  the  sacro-sciatic  ligament.  The  spine  or  ridge  of 
the  same  name  partly  belongs  to  it. 

The  external  angle,  antero-superior  spinous  process,  or  point  of  the  hip,  is 
a  wide,  thick,  and  flattened  portion,  bearing  four  tuberosities  affording 
attachments  to  muscles.  The  internal  or  antero-internal  angle  or  supero- 
posterior  spinous  process,  is  a  rough  tuberosity  curving  upwards  and  back- 
wards to  form  an  angle  with  the  corresponding  portion  of  the  opposite 
ilium — the  summit  of  the  croup.  The  inferior,  posterior  or  cotyloid  angle 
(concurring  in  the  formation  of  the  acetabulum)  is  very  large  and  pris- 
matic in  shape.  Posteriorly,  it  offers  a  concave  articular  surface  (acetab- 
ular), and  above  this  cavity  is  the  supra-cotyloid  ridge  or  crista  Hit :  an 
elongated    eminence    passing  backwards,   sharp    at    its  summit,  smooth 


8  OBSTETRICAL  ANATOMY. 

internally,  and  roughened  externally,  which  is  continuous  anteriorly  with 
the  inner  border  of  the  bone,  divides  its  iliac  and  articular  surfaces, 
becomes  lost  on  the  anterior  margin  of  the  pubis,  and  laterally  limits 
the  anterior  circumference  or  border  of  the  pelvic  cavity — the  linea  ilio- 
pectinea. 

The  ilium  is  therefore  united  to  or  in  contact  with  the  sacrum  supe- 
riorly, and  inferiorly  and  posteriorly  with  the  two  bones  next  to  be 
described. 

Ischium. — The  ischium  {os  sedentarum  of  man)  is  next  in  size  to  the 
ilium,  and  the  most  posterior  of  the  three  bones.  In  form  it  is  flat  and 
irregularly  quadrilateral  ;  and  is  composed  of  a  thick  solid  portion — the 
body,  and  a  narrow  part — the  neck.  It  has  two  faces,  four  borders,  2iV\dfour 
angles. 

The  upper  face  is  smooth  and  nearly  flat,  and  forms  part  of  the  floor 
of  the  pelvic  cavity.  The  lower  or  exter?ial  face  bears  some  rugged 
imprints,  particularly  towards  the  symphysis.     • 

The  anterior  border  is  thick  and  concave,  and  posteriorly  circumscribes 
the  obturator  or  oval  foramen.  The  posterior  border  is  straight  and  di- 
rected obliquely  forward  and  inward,  composing,  with  the  corresponding 
border  of  the  opposite  bone,  a  large  notch — the  pubic  or  ischiatic  arch. 
Throughout  its  extent  it  exhibits  a  roughened  depressed  lip  which  pro- 
jects on  the  lower  face — this  is  the  spine.  The  external  border  is  thick 
and  concave,  affords  attachment  to  the  sacro-sciatic  ligament,  and  forms 
the  small  sciatic  notch.  The  internal  border  joins  its  homologue  of  the 
opposite  side  to  complete  the  ischio-pubic  symphysis. 

The  external  or  cotyloid  angle  is  the  most  voluminous,  and  shows  :  an 
excavated  diarthrodial  facet,  forming  part  of  the  acetabulum  ;  and  the 
posterior  extremity  of  the  crista  ilii,  limited  by  a  small  transverse  fissure 
which  separates  it  from  the  external  border  of  the  bone.  The  antcro- 
internal  angle  ]o\ns  the  posterior  angle  of  the  pubis.  The  postero-external 
angle  is  the  most  important  in  an  obstetrical  point  of  view,  as  it  consti- 
tutes what  is  commonly  named  the  point  of  the  hip  ;  with  the  correspond- 
ing bone  of  the  opposite  side,  it  forms  the  ischiatic  tuberosity  {tuber 
ischii)  :  a  thick,  up-curved  prismatic  mass  which  is  continued  by  a  prom- 
inent ridge  elongated  from  before  to  behind,  the  thin  margin  of  which  is 
curved  outwards  and  downwards.  The  distance  between  the  external 
tuberosities  of  the  two  ischii  gives  the  width  of  the  ischial  arch,  and  al- 
lows an  estimate  to  be  formed  of  the  transverse  diameter,  of  the  posterior 
opening  of  the  pehds.  The  postero-internal  angle  constitutes,  with  that 
of  the  other  ischium,  the  summit  of  the  triangular  notch  or  space  named 
the  "  ischial  "  or  "  pubic  arch  "  in  some  species. 

Pubis. — The  pubis  {pecten  or  share-bone)  is  the  smaller  of  the  three,  and 
is  situated  between  the  ilium  and  ischium.  It  is  irregularly  triangular, 
and  is  described  as  having  two  faces,  three  borders  and  tliree  a?igles. 

The  tipper  face  is  concave  and  smooth,  and  concurs  in  forming  the  floor 
of  the  pelvis.  In  the  pelvis  of  many  Mares  it  has  a  more  or  less  marked 
depression,  apparently  produced  at  the  expense  of  the  anterior  portion  of 
the  bone,  which  is  thin  ;  while  in  the  Horse  it  is  generally  much  thicker 
at  this  part,  and  instead  of  a  depression  the  surface  may  be  plane  or  even 
convex.  The  lower  face  is  rough  and  traversed  on  its  whole  length  by  a 
wide  groove  which  reaches  the  bottom  of  the  acetabulum,  and  lodges  the 
pubio-femoral  ligament  and  a  very  large  vein. 


THE  PEL  VIS.  9 

The  ajiterior  border  is  thin  and  uneven,  and  is  curved  like  the  arc  of  a 
circle  ;  it  concurs  in  forming  the  anterior  circumference  of  the  pelvis.  The 
posterior  border  is  thick  and  concave,  and  in  front  circumscribes  the  oval^ 
sub-pubic  ox  obturator  foramen.  It  is  channeled,  near  the  acetabulum,  by 
a  fissure  that  passes  obliquely  downwards  and  inwards.  The  internal 
border  joins  that  of  the  opposite  pubic  bone  in  the  middle  line,  to  form 
the  anterior  portion  of  the  ischio-pubic  or  pelvic  symphysis. 

The  external  ox  cotyloid  angle  is  the  thickest,  and  constitutes  the  largest 
portion  of  the  roughened  depressed  surface  at  the  bottom  of  the  ace- 
tabulum. The  internal  angle  is  united  to  the  corresponding  angle  of  the 
opposite  bone.  Tho.  posterior  angle  is  fused  at  an  early  period  with  the 
anterointernal  angle  of  the  ischium,  to  form  the  inner  boundary  of  the 
obturator  foramen. 

The  pubis  does  not  alter  much  in  form  with  age,  but  retains  its  convex 
shape,  while  the  part  around  the  acetabulum  is  of  considerable  thickness  : 
a  circumstance  which  tends  to  diminish  the  pelvic  cavity  to  a  notable 
depfree.  During  life,  the  pubic  bones  gradually  lose  their  spongy  tissue, 
and  to  such  an  extent  that  in  old  age  it  has  almost  disappeared,  and  the 
parts  are  translucid. 

It  may  also  be  well  to  note  that  the  compact  tissue  is  most  abundant  in 
the  vicinity  of  the  acetabulum,  that  cavity  being  the  point  where  the 
impulsive  efforts  communicated  to  the  body  by  the  posterior  limbs  are 
concentrated  ;  at  this  part,  also,  ossification  commences. 

2.  Sacrum. 

The  sacrum  {os  basilare  of  man)  may  be  said  to  terminate  the  vertebral 
spine  posteriorly,  and  results  from  the  fusion  of  five  vertebrae  into  a  single, 
voluminous,  pyramidal  or  triangular  mass.  It  encloses  the  pelvic  cavity 
above,  and  articulates  in  front  with  the  last  lumbar  vertebra,  behind  with 
the  first  coccygeal  or  tail-bone,  and  laterally  with  the  ossa  innominata. 
It  has  an  upper  2iX\d  a  lower  face,  two  lateral  borders,  2l  base  or  anterior 
extremity,  sutiimit  or  posterior  extremity,  and  central  cajial, 

ThQ  upper  face  shows  the  supra-spiyious  processes  or  supra-sacral  spine 
(though  the  processes  only  meet  at  their  base).  On  each  side  of  this  spine 
is  a  channel  in  which  are  four  openings — the  supra-sacral foramifia,  which 
communicate  with  others  on  the  inferior  face.  The  lower  face  is  smooth, 
and  slightly  concave  from  before  to  behind  ;  this  is  the  roof  of  the  pelvic 
cavity,  and  shows  traces  of  its  being  composed  of  five  bones,  as  well  as 
offers  four  foramina  for  the  passage  of  the  sub-sacral  nerves. 

The  two  lateral  borders  are  thick  and  concave,  and  posteriorly  show  a 
rugged  lip.  In  front  is  an  irregular  oblique  surface  for  articulation  with 
the  ossa  innominata  ;  this  is  divided  into  two  portions,  the  lower  of 
which,  slightly  uneven  and  diarthrodial,  is  the  auricular  surface ;  the 
upper  is  for  the  insertion  of  the  sacro-sciatic  ligament. 

The  base,  or  anterior  extrefnity,  is  articulated  by  a  slightly  oval  and  con- 
vex surface  with  the  last  lumbar  vertebra,  and  forms  with  the  spine  a 
salient  angle  looking  down  towards  the  abdominal  cavity,  named  the  sacro- 
vertebral  angle.  Laterally,  it  is  united  with  the  two  coxae,  between  which 
it  is  fixed  like  a  horizonta/  wedge.  In  front  it  shows  the  opening  of  the 
spinal  canal. 

The  summit  or  posterior  extremity  likewise  offers  the  opening  of  the 
spinal  canal,  and  a  surface  for  articulation  with  the  first  tail-bone.  The 
central  ca7ial\s  a  continuation  of  that  in  the  other  vertebrae,  for  the  passage 


lo  OBSTETRICAL  ANATOMY. 

of  the  spinal  cord.     In  this  bone,  however,  instead  of  being  circular,  it 
is  triangular,  and  diminishes  in  width  posteriorly. 

The  position  of  the  sacrum  is  more  or  less  inclined  downwards  from 
before  to  behind,  according  to  the  breed  of  the  Mare. 

3.   Coccyx, 
The  coccygeal  or  tail-bones  are  a  series  of  small,  cylindrical,  or  irregularly 
prismatic  pieces,  from  fifteen  to  eighteen  in  number,  behind  the  sacrum, 
the  first  three  of  which  may  be  said  to  belong  to  the  pelvis.     They  form 
the  base  of  the  tail. 

Differences  in  the  Bones  of  the  Pelvis  of  other  Animals. 

In  all  the  domesticated  animals,  the  coxai  are  nearly  horizontal,  and 
the  ilium  has  a  vertical  direction. 

Cow. 
In  the  pelvis  of  the  Cow,  the  space  between  the  coxae  is  no  greater 
before  than  behind  ;  they  are  not  so  solid  nor  voluminous,  comparatively, 
as  in  the  Mare.    This  is  more  particularly  the  case  with  the  iliuffi,  the  iliac 


Pelvis  of  the  Cow. 

A,  Ilium  ;    B,   Pubis ;    C,    Ischium  ;  D,  Foramen  Ovale ;    E,  Ischiatic   Spine  ;  F,   Cotyloia 
Cavity  ;  G,  Tuberosity  of  the  Ischium. 

concavity  of  which  is  not  so  wide.  It  is  more  vertical  than  in  the  Mare. 
The  ischiu7n,  though  thinner  than  in  the  Mare,  has  a  much  wider  surface, 
and  is  more  curved  from  before  to  behind  and  from  side  to  side  ;  while 
the  ischiatic  spine  or  supra-cotyloid  crest  is  very  prominent  and  thin. 
Three  tuberosities  are  observed  on  the  postero-external  angle. 

The  pubis  is  wide  and  thin  ;  it  has  no  channel  on  its  inferior  face,  and 
the  upper  face  is  ^rery  concave.  The  foramen  ovale  is  large,  and  its 
margin  thin.     The  symphysis  is  ossified  earlier  than  in  the  Mare. 

The  sacrum  is  longer,  and  more  curved  and  voluminous  than  that  of  the 
Mare.  The  lateral  borders  are  sharp  and  directed  downwards.  It  is 
composed  of  the  same  number  of  vertebrae  as  in  the  Horse.  The  articular 
surfaces  for  union  with  the  coxae  approach  the  vertical  direction. 


THE  PELVIS.  II 

The  coccygeal  bones  are  stronger  and  more  tuberous :  they  are  from 
sixteen  to  twenty  in  number. 

The  pelvis  of  the  Cow  is  therefore  more  developed  than  that  of  the  Mare, 
and  has  more  extensive  bony  walls.  We  shall  see  that  it  also  differs  in 
its  form  and  direction,  and  that  this  has  a  notable  influence  in  the  mech- 
anism of  parturition. 

Sheep  a?id  Goat 

In  the  Sheep  and  Goat,  the  bones  of  the  pelvis  greatly  resemble  those 
of  the  Cow.  The  ischium,  instead  of  being  curved  in  a  longitudinal 
direction,  however,  is  nearly  rectilinear,  and  the  external  iliac  fossa  is 
divided  into  two  portions  by  a  small  longitudinal  crest.  *  The  pelvis,  on 
the  whole,  is  more  horizontal  and  longer. 

Bitch  and  Cat. 
In  the  Bitch  and  Cat,  the  lateral  diameter  of 'the  pelvis  is  greater  be- 
fore than  behind ;  the  ilium  is  almost  vertical,  and  its  external  face  is 


Fig.  3. 

Pelvis  of  the  Sheep. 

A,  Ilium  ;  B,  Pubis  :  C,  Ischium  ;  D,  Foramen  Ovale  ;  E,  Cotyloid  Cavity. 

much  depressed.  The  space  which  forms  the  pubic  arch  only  occupies 
the  inner  moiety  of  the  posterior  border  of  the  ischium,  which  is  very  broad ; 
between  the  arch  and  the  ischial  tuberosity  is  a  roughened  lip,  which  is 
directed  downwards.  The  sacrum  is  somewhat  quadrangular  and  com- 
posed of  three  bones,  which  are  anchylosed  at  an  early  age,  and  the  lateral 
surfaces  for  articulation  with  the  ilium  are  turned  outwards  and  almost 
vertical.  There  are  only  three  vertebral  foramina.  The  coccygeal  bones 
are  strong  and  tuberous,  and  the  first  five  or  six  are  as  perfect  as  the  true 
vertebral  bones. 

Pig- 
The  pelvis  of  the  Pig  resembles  that  of  the  Sheep.  The  crest  of  the 
ilium  is  convex,  and  there  is  no  external  protuberance  on  the  symphysis 
pubis.  The /«^/j- is  narrow;  and  the  ischium,  m?>\.&d.d  of  a  crest,  has  a 
tuberous  prominence.  The  sacrum  is  formed  by  four  vertebrae,  which  do 
not  become  fully  consolidated  for  a  long  time,  and  it  is  sometimes  difficult 
to  discover  where  the  sacrum  ends  and  the  coccyx  begins.  The  spinous 
processes  are  absent;  and  the  neural  arch  being  deficient  on  each  side, 
the  spinal  canal  is  open  above.  There  is  nothing  particular  to  note  in 
the  coccygeal  bones. 


12  OBSTETRICAL  ANATOMY. 

SECTION    II. — ARTICULATIONS   OF   THE   PELVIS. 

The  bones  of  the  pelvis  are  united  by  articulations  and  ligaments,  as 
well  48  fibrous  bands,  which  are  complementary,  A  knowledge  of  these 
is  of  some  importance  to  the  obstetrist.  The  articulations  are  five  in 
number:  (i)  the  sacro-lumbar,  (2,3)  the  two  sacro-iliac,  (4)  the  ischio- 
pubic  symphysis,  and  (5)  the  sacro-coccygeal  articulations.  The  ilio-sacral 
and  sacro-sciatic  ligaments  complete  the  subject  of  this  section. 

I .  Sacro-lumbar  Articulation. 

The  sacro-lumbar  articulation  is  formed  between  the  anterior  face  or 
base  of  the  sacrum,  and  the  last  lumbar  vertebra  j  the  union  takes  place 
by  five  articular  surfaces  and  thick  fibro-cartilages,  and  numerous  strong 
ligaments  bind  the  two  bones  closely  and  very  firmly  together,  so  as  to 
allow  only  a  minimum  amount  of  movement  between  them.  It  would 
appear  that  these  bones,  though  so  limited  in  their  movements  on  each, 
yet  are  never  anchylosed  through  old  age,  nor  yet  by  accident,  even  if  all 
the  other  vertebrae  in  this  region  should  happen  to  be  consolidated. 

This  arrangement  is  particularly  remarkable  in  the  Mare,  on  which  it 
confers  great  strength  and  solidity.  It  is  not  present  in  the  Cow ;  con- 
sequently that  animal  is  liable  to  a  kind  of  incomplete  luxation,  which 
may  at  times  become  an  obstacle  in  parturition. 

We  have  already  alluded  to  the  salient  angle  formed  by  the  union  of 
the  last  lumbar  vertebra  with  the  sacrum  {sacra-vertebral  angle),  and 
which  looks  downward  into  the  abdominal  cavity.* 

2,  3.  Sacro-iliaC  Articulations . 

The  sacro-iliac  articulation  of  each  side  establishes  the  union  of  the  pos- 
terior limbs  with  the  spine,  and  is  formed  by  the  sacrum  and  ossa  ilii ;  it 


Fig.  4- 

Lateral  Ligaments  of  the  Sacrum  and  Pelvis. 

A,  Superior  Sacro-iliac  Ligament ;  B,  Sacral  Ligament  ;  C,  Lateral  Sacro-iliac  Ligament ; 
D,  Sacro-sciatic  Ligament ;  E,  Small  Ischiatic  Notch ;  F,  Great  Ischiatic  Notch. 

belongs  to  the  arthrodial  class  of  joints.  The  two  surfaces  which  come  into 
opposition  have  been  already  described,  and  it  only  now  remains  to  point 
out  that  the  sacrum  is  fixed  between  the  antero-superior  extremities  of  the 

*  This  angle  is  much  more  marked  in  woman,  and  is  immediately  at  the  entrance  to  the  pelvis  ;  for 
these  reasons  it  is  frequently  a  cause  of  difficult  parturition  in  her,  while,  from  its  less  development  and 
distance  from  the  pelvis,  it  offers  no  obstacle  in  animals. 


THE  PEL  VIS. 


13 


ossa  ilii,  like  a  horizontal  wedge  or  the  keystone  of  an  arch  inverted :  the 
transverse  diameter  is  greater  below  than  above — the  pressure  it  has  to 
resist  being  from  below.  The  oblong  roughened  surfaces  on  the  sacrum 
and  ilium  have  a  layer  of  cartilage  between  them  to  diminish  shock  and 
facilitate  movement,  which  is  further  promoted  by  each  articulation 
being  provided  with  a  synovial  membrane,  though  the  amount  of  synovia 
secreted  is  very  trifling.  The  union  of  the  bones  at  this  part  is  strength- 
ened by  three  powerful  ligaments  :  the  sacro-iliac — superior  and  inferior, 
and  the  sacro-iliac  proper.  There  is  also  the  sacro-sciatic  or  sacro-ischiatic 
to  be  noticed  hereafter.  Though  the  movements  of  this  articulation  are 
very  limited,  but  still  useful  in  locomotion  and  parturition,  yet  it  rarely, 
if  ever,  becomes  consolidated.  The  diarthrodial  union  between  the 
bones  appears  to  be  chiefly,  if  not  exclusively,  intended  to  obviate  the 
fractures  which  must  occur  had  they  been  united  in  a  more  solid  manner ; 
while  the  two  articulations  being  the  centre  towards  which  all  the  impul- 
sive efforts  of  the  posterior  extremities  converge,  a  great  degree  of 
mobility  would  not  be  compatible  with  their  solidity. 

4.  Ischio-pubic  Symphysis. 

The  symphysis  pubis,  as  it  is  sometimes  termed,  is  the  amphiarthrosis 
formed  by  the  union,  inferiorly,  of  the  two  ossa  pubis  and  ischia.  The 
articulation  is  consolidated  by  means  of  a  layer  of  fibro-cartilage  be- 
tween the  margin  of  these  bones,  and  which  becomes  ossified  more  or 
less  completely  and  rapidly  according  to  species  ;  and  by  a  layer  of 
white  ligamentou   fibres — short  and  compact — which  pass  across  above 

b 


Fig.  5- 

Ligaments  of  the  Lumbar  Vertebr/E,  Sacrum  and  Pelvis,  seen  from  below. 

A,  Intertransverse  Ligament  of  the  Lumbar  Vertebrae  ;  B,  Capsular  Ligament  of  the  Spinous 
Process  of  the  fifth  and  sixth  Lumbar  Vertebrae  ;  C,  Capsular  Ligament  of  the  Sacrum  ;  D, 
Inferior  Sacro-iliac  Ligament ;  E,  Obturator  Ligament ;  F,  Transverse  Ligament  of  the 
Ischio-pubic  Symphysis. 


and  below,  the  latter  being  the  strongest.  The  movements  of  this  ar- 
ticulation are  very  limited,  and  depend  solely  upon  the  elasticity  of  the 
interosseous  cartilage  ;  they  are  abolished  when  ossification  occurs. 
This  happens  in  the  majority  of  Horses  before  adult  age  ;  though  some- 
times the  posterior  portion  is  cartilaginous  after  this  period. 


# 


14  OBSTETRICAL  ANATOMY. 

5 .   Sacro-coccygeal  Articulations. 

These  resemble  those  of  the  vertebras  in  general :  there  being  a  thick 
disc  of  fibro-cartilage  placed  between  each  tail-bone,  the  first  of  which  is 
joined  to  the  posterior  extremity  of  the  sacrum.  Their  solidity  is  further 
assured  by  a  common  fibrous  sheath  which  completely  envelops  them, 
but  without  interfering  with  their  mobility.  This  mobility  greatly  favors 
parturition  ;  but  it  must  be  noted  that  not  infrequently  the  first  coccygeal 
bone  is  completely  ossified  with  the  sacrum,  and  as  this  necessarily  limits 
the  elevation  of  the  tail,  it  diminishes  the  supero-inferior  diameter  of  the 
posterior  opening  of  the  pelvis,  and  may  in  this  way  prove  an  obstacle  to 
the  expulsion  of  the  foetus. 

Differences  in  the  Pelvic  Articulations  of  other  Animals. 

In  all  the  domesticated  animals  other  than  the  Equine  species,  the 
sacrum  is  joined  to  the  last  lumbar  vertebra  by  three  diarthrodial  sur- 
faces only  :  the  head  of  the  body  and  two  transverse  processes ;  these 
latter  on  the  vertebrae  not  being  in  immediate  contact  with  the  base  of 
the  sacrum,  an  interosseous  ligament  unites  them.  Therefore  it  is  that, 
in  the  Cow  more  particularly,  there  is  greater  mobility  in  the  sacro-lum- 
bar  articulation,  and  the  possibility  of  a  greater  increase  in  the  supero- 
inferior  diameter  of  the  pelvis  when  it  is  subjected  to  such  eccentric 
pressure  as  the  passage  of  the  foetus  would  produce. 

Cow. 

In  the  Cow  the  ischio-puhic  symphysis  is  longer  than  in  the  Mare,  not 
rectilinear,  and  much  curved  downwards  in  the  middle  ;  across  this  con- 
cavity on  the  floor  of  the  pelvis,  the  foetus  passes  during  parturition.  In 
the  Cow  ossification  of  the  symphysis  is  less  complete,  and  does  not  take 
place  until  much  later  than  in  the  Mare,  though  it  may  in  some  instances 
be  found  entirely  accomplished  in  old  animals.  Ossification,  according 
to  Saint-Cyr,  commences  in  the  Cow  at  the  ischial  arch,  and  proceeds 
forwards,  while  in  the  Mare  it  begins  at  the  pubis  and  extends  back- 
wards. The  same  authority  remarks  that  this  symphysis  in  the  Cow  has 
often  a  salient  crest  projecting  *into  the  pelvic  cavity,  and  which,  if 
it  does  not  offer  a  very  considerable  obstacle  to  the  passage  of  the  foetus, 
may  nevertheless  greatly  fatigue  the  obstetrist  when  his  hand  is  engaged 
between  it  and  the  young  creature,  during  the  straining  of  the  mother. 

Sheep  and  Goat. 

In  these  animals  the.  ischio-pubic  symphysis  is  rectilinear;  the  inter- 
posed cartilage  is  not  ossified  until  very  late  in  life,  and  almost  never  in 
those  which  have  had  many  young.  The  same  remarks  are  applicable 
to  this  symphysis  in  the  Pig. 

JBitch  and  Cat. 

The  symphysis  in  the  Bitch  and  Cat  scarcely  ever  ossifies  ;  so  that 
these  animals,  when  advanced  in  age,  still  have  a  notable  degree  of 
mobility  in  this  region,  and  the  diameter  of  the  pelvic  cavity  may  be 
proportionately  increased. 

Sacro-sciatic  Ligament. 

The  sacro-sciatic  ligament  (Fig.  4,  d)  transforms  the  pelvic  cavity  into  a 
complete  canal  by  filling  up  the  space  on  the  side  of  the  pelvis,  between 


THE  PELVIS.  ,5 

the  sacrum  and  coxae.  It  is  a  wide  membranous  expansion,  composed  of 
white  fibrous  tissue — the  fibres  crossing  each  other  in  different  directions, 
and  serves  rather  to  enclose  this  portion  of  the  pelvic  space  than  to  main 
tain  the  solidity  of  the  sacro-iliac  articulation.  It  is  irregularly  quadri- 
lateral ;  its  superior  dormer  being  rectilinear,  and  attached  along  the  rough 
crest  on  the  side  of  the  sacrum,  as  well  as  to  the  first  two  or  three  coccy- 
geal bones.  It  anterior  border  is  irregular,  and  not  well  defined,  but  it  is 
inserted  above  into  the  base  of  the  sacrum,  and  below  into  the  inner 
border  of  the  ilium,  circumscribing  in  its  middle  the  opening  which  has 
been  named  the  great  ischiatic  notch,  through  which  the  gluteal  vessels 
and  nerves,  as  well  as  the  sciatic  nerves,  pass,  and  to  the  compression  of 
which  against  the  bones  of  the  pelvis  during  pregnancy  may  be  due  cramp 
of  the  posterior  limbs,  or  even  more  or  less  persistent  paralysis  ;  the 
inferior  border  is  attached  to  the  spine  of  the  ischium,  as  well  as  to  the 
ischiatic  tuberosity,  and  between  these  insertions,  and  immediately  behind 
the  cotyloid  cavity,  it  forms  the  small  ischiatic  notch,  the  opening  through 
which  the  obturator  internus  muscle  passes  j  while  the  posterior  border^ 
not  well  limited,  completes  the  posterior  circumference  of  the  pelvic 
cavity,  and  divides  into  two  layers,  between  which  lies  the  semimembra- 
nosus muscle,  and  above  it  is  mixed  up  with  the  enveloping  sheath  of 
the  tail  muscles  and  bones. 

The  inner  face  of  this  wide  ligament  is  covered  by  peritoneum  to  the 
extent  of  one-third  in  front ;  a-nd  behind  it  is  in  direct  relation  with 
various  organs  contained  in  the  pelvic  cavity,  by  means  of  an  abundant 
loose  connective  tissue.  Its  external  face  is  traversed  by  the  sciatic 
nerves  and  covered  by  muscles. 

SECTION  III. THE  PELVIS  AND  ITS  CAVITY. 

Having  now  studied  the  individual  pieces  which  compose  the  pelvis,  as 
well  as  the  manner  in  which  they  are  united,  it  remains  to  consider  this 
region  in  its  entirety,  and  with  regard  to  its  general  conformation,  dimen- 
sions, axes,  and  other  important  features.  This  study  is  of  much  moment 
in  an  obstetrical  point  of  view,  and  for  the  full  comprehension  of  the 
mechanism  of  parturition.  We  will  first  notice  the  pelvis  of  the  Mare 
and  proceed  to  compare  it  with  the  other  domesticated  animals. 

^  Mare. 

Considered  in  a  general  manner,  the  pelvis  of  the  Mare  represents 
a  slightly  cone-shaped,  bony  cavity  at  the  pdsterior  part  of  the  trunk, 
completing  or  continuing  the  abdominal  cavity  ;  the  base  of  this  conical 
excavation,  intersected  obliquely  downwards  and  backwards,  is  anterior  : 
its  axis  forming,  with  that  of  the  abdomen,  a  very  wide  angle,  the  sinus 
of  which  is  inferior.  The  summit  or  narrowest  part  of  the  cavity  is  pos- 
terior. With  regard  to  conformation,  it  offers,  for  convenience  of  de 
scription,  an  external  and  internal  surface  and  tivo  openings. 

External  Surface. — This  surface  may  be  considered  as  consisting  of 
four  regions,  planes,  or  faces.  The  superior  region  or  croup  is  the  narrowest, 
and  is  slightly  oblique  downwards  and  backwards  :  the  degree  of  obliquity 
varying  not  only  in  different  breeds,  but  also  in  different  animals  of  the 
same  breed  and  species;  In  the  Mare  it  is  indicated  by  the  droop  or 
slope  of  the  croup,  which  is  generally  greater  than  that  of  the  Cow.     It  is 


1 6  OBSTETRICAL  ANATOMY. 

more  conspicuous  in  common  than  in  well-bred  horses,  in  which  the  croup 
is  almost  horizontal,  and  the  tail  nearly  on  a  level  with  its  highest  point. 
The  width  of  this  region  also  varies  not  only  with  the  height  and  volume 
of  the  animal's  body,  but  also  according  to  breed :  the  draught  or  coarse- 
bred  horse  having  a  wider  croup  than  the  thorough-bred  one.  This  region 
is  constricted  from  before  to  behind,  and  shows,  on  the  middle  line,  the 
spinous  processes  of  the  sacrum  and  the  first  coccygeal  vertebrae  ;  and  on 
each  side  the  channels  into  which  open  the  four  sacral  foramina. 

The  inferior  region  is  nearly  horizontal,  and  is  slightly  convex.  Formed 
by  the  pubic  and  ischial  bones,  it  offers  in  the  middle  the  symphysis 
pubis,  on  each  side  the  subpubic  channels,  and  the  obturator  foramen, 
and  outwardly  the  cotyloid  cavities  through  which  the  pelvis  rests  on  the 
posterior  limbs. 

The  lateral  regions  are  more  extensive  than  the  others  ;  they  are  in- 
clined downwards  and  inwards,  and  are  wider  before  than  behind.  On 
each  are  observed  the  crest  of  the  ilium  and  the  two  anterior  iliac  spines, 
the  external  iliac  fossa,  the  great  sciatic  notch,  the  spine  of  the  ischium, 
the  small  sciatic  notch,  and  the  tuberosity  of  the  ischium. 

The  internal  surface,  as  has  been  already  mentioned,  is  formed  partly 
of  bony  and  partly  of  ligamentous  walls,  and  circumscribes  the  pelvic 
cavity,  which  is  a  continuation  of  that  of  the  abdomen,  and  with  which  it 
communicates  by  a  wide  osseous  circle — the  anterior  opening  or  i7ilel 
of  the  pelvis.  A  transverse  section  of  this  canal  shows  that  it  is  oval- 
shaped,  the  largest  portion  being  towards  the  pubis,  and  the  narrowest 
to  the  sacrum. 

The  internal  surface  is  more  regular  than  the  external,  but  it  cannot  be 
divided  into  two  portions  like  the  human  pelvis,  the  inner  aspect  of  the 
ilia  not  being  excavated  to  form  an  anterior  cavity.  It  may,  however, 
be  considered  as  having  four  co7icave  planes^  an  anterior  opening  or  inlet^ 
and  2t.  posterior  opening  ox  outlet. 


Fig.  6. 
Longitudinal  Section  of  the  Mare's  Pelvis. 

The  superior,  sacral,  or  rectal  plane,  or  roof  of  the  pelvis,  is  formed  by 
the  lower  face  of  the  sacrum,  and  is  in  contact  with  the  rectum,  subsacral 
vessels,  and  sympathetic  nerves.     It  is  slightly  concave  longitudinally. 

The  inferior  plane,  or  floor  of  the  pelvis,  is  constituted  by  the  upper 
surface  of  the  pubic  bodies  and  ischia.  It  is  rectilinear  from  before  to 
side  to  side.     The  symphysis  pubis  occupies 


THE  PELVIS.  1 7 

the  median  line ;  it  is  salient,  and  varies  in  length  according  to  the  size 
of  the  animal,  being  usually  about  six  or  seven  inches.  In  front,  at  the 
pubis,  is  a  depression  more  or  less  marked,  in  which  the  previously- 
emptied  bladder  may  be  lodged  during  the  passage  of  the  foetus.  On 
each  side  is  the  obturator  foramen,  which  is  partly  closed  by  the  internal 
obturator  muscles,  and  through  which  the  obturator  vessels  and  nerves 
make  their  exit. 

The  two  lateral  planes  are  formed  by  the  inner  surface  and  spine  of 
the  ischia,  and  in  great  part  by  the  sacro-sciatic  ligaments;  the  sciatic 
notches  belong  to  them,  and  they  are  traversed  from  before  to  behind  by 
the  obturator  vessels  and  nerves,  and  pierced  by  the  gluteal  and  ischio- 
muscular  vessels  and  nerves,  the  internal  pudic,  and  the  great  and  small 
sciatic  nerves.  As  has  been  stated,  it  is  the  compression  of  these  nerves 
by  the  uterus  and  its  contents  which  cause  the  cramps  pregnant  animals 
experience  towards  the  termination  of  gestation.  The  lateral  planes  are 
readily  dilatable  during  parturition. 

Anterior  Opening  or  Inlet. — This,  which  may  also  be  designated  the 
bri77i^  afiterior  circumference,  ftr  abdominal  opening  of  the  pelvis,  is  nearly 
circular,  or  slightly  oval,  the  widest  part  corresponding  to  the  symphysis 
pubis.  It  is  a  little  obliquely  inclined  downwards  and  backwards,  and  is 
limited  above  by  the  anterior  border  of  the  sacrum  and  its  articulations 
with  the  lumbar  vertebra  and  ilia  ;  below,  by  the  anterior  border  of  the 
pubic  bones  ;  and  on  each  side,-by  the  ileo-pectineal  crest  and  a  portion 
of  the  inner  aspect  of  the  ilia.  Owing  to  this  circumference  being  entirely 
bony,  and  to  the  solidity  of  the  articulations  between  the  different  bones, 
the  inlet  of  the  pelvis  cannot  be  dilated  to  any  appreciable  degree,  even 
under  the  most  violent  efforts,  and  supposing  the  sacro-iliac  and  ischio- 
pubic  ligaments  to  become  softened  and  relaxed  before  pregnancy — a 
change  which  must  be  indeed  rare  in  the  Mare. 

It  is  by  the  inlet  that  the  foetus  enters  the  pelvic  cavity,  and  a  knowl- 
edge of  its  dimensions  is  therefore  of  much  moment  to  the  obstetrist. 
These  dimensions  are  ascertained  by  taking  the  diameter  of  the  opening 
at  several  points,  but  two  diameters  are  generally  recognized :  a  supero- 
inferior  and  a  trafisverse.  The  sicpero-inferior,  or  sacro-pnbic  diameter,  is  the 
width  between  the  sacro-vertebral  angle  and  the  symphysis  pubis.  This 
is  generally  the  largest  diameter,  though  exceptions  are  met  with  now  and 
again  ;  it  is  the  diameter  which  should  receive  the  widest  part  of  the  foetus 
when  it  enters  the  pelvis.  It  varies  with  the  size  of  the  Mare,  but  is 
usually  between  eight  and  ten  inches.  The  transverse  diameter  is  measured 
from  one  ileo-pectineal  crest  to  another,  and  is  generally  less  than  the 
supero-inferior,  though  sometimes  it  may  be  equal,  or  even  greater.  It  is 
from  seven  to  nine  inches. 

Posterior  Opening  or  Outlet. — This  is  also  sometimes  named  the 
perineal  circumfereftce,  or  recto-urethral  openifig;  it  includes  in  its  contour 
the  rectum  and  vagina,  and  is  related  to  the  vulva  and  anus,  which  are 
external  to  it.  Owing  to  the  horizontal  direction  of  the  Mare's  pelvis, 
this  outlet  is  limited  above  by  the  apex  of  the  sacrum  and  the  base  of  the 
coccyx  ;  below,  by  the  ischial  arch  formed  by  the  junction  of  the  two 
ischia  ;  and,  laterally,  by  the  upper  face  of  the  ischia  and  posterior  border 
of  the  sacro-sciatic  ligaments.     The  opening  is  oval. 

The  diameters  are  ordinarily  much  less  than  those  of  the  inlet — perhaps 


1 8  OBSTETRICAL   ANATOMY. 

one-fifth  ;  but  this  circumstance  has  rarely  any  influence  in  parturition,  as 
the  opening  is  very  dilatable,  owing  to  the  relaxation  that  takes  place  in 
the  sacro-sciatic  ligaments  during  the  later  months  of  pregnancy,  and  the 
great  mobility  of  the  sacrum  and  coccyx,  which  may  allow  the  supero- 
inferior  diameter  to  be  increased  considerably. 

The  Cavity  of  the  Pelvis. 

The  cavity  of  the  pelvis  is  the  space  between  the  inlet  and  outlet.  In 
the  human  female,  it  lodges  nearly  the  whole  of  the  uterus,  and  in  the  early 
days  of  pregnancy  the  foetus  also.  This  is  not  the  case  with  the  domesti- 
cated animals,  owing  to  their  different  attitude,  until  the  act  of  parturition 
carries  the  progeny  there.*  With  its  two  openings,  the  pelvic  cavity  is 
capable  of  more  or  less  increase  in  capacity  in  every  direction,  through 
relaxation  of  the  pubic  and  sacro-iliac  articulations  and  sacro-sciatic  liga- 
ments. The  yielding  of  the  latter  is  very  noticeable  in  the  larger  animals 
immediately  before  parturition,  as  well  as  the  elevation  of  the  coccyx  by 
the  body  of  the  foetus  in  its  passage  outwards.  It  is  also  a  fact  of  daily 
observation  that  the  pelvis  permanently  widqfis  in  animals  which  have  had 
young  frequently  ;  this  accounts  for  the  peculiar  rocking  gait  they  exhibit 
in  progression,  which,  in  some  of  the  domesticated  creatures  at  least,  is 
no  doubt  due  to  persistent  relaxation  in  the  articulations  above  men- 
tioned. 

It  may  be  again  observed  that  the  anterior  margin  of  the  flopr  of  this 
cavity  is  nearly  straight,  and  its  posterior  border  is  deeply  cut  into  by  the 
ischial  arch,  while  the  floor  itself  often  offers  some  diversities.  For  in- 
stance, it  may  be  convex  in  front  and  concave  behind,  or  vice  versa,  the 
concavity  being  separated  from  the  convexity  by  a  transverse  ridge,  which 
may  also  be  represented  by  a  series  of  small  conical  eminences  ;  or  the 
floor  may  be  a  smooth  plane  sloping  upwards  from  before  to  behind, 
with  a  kind  of  raised  border  surrounding  the  anterior  contour  of  the  ob- 
turator foramen. 

Differences  in  other  Animals. 

Cow, 

In  the  Cow,  the  pelvis  is  longer  than  in  the  Mare,  and  less  vertical  ;  the 
ischio-pubic  symphysis  is  also  longer,  and  instead  of  being  straight  is  very 
curved  ;  so  that  the  floor  of  the  pelvis  is  concave  in  every  direction.  The 
ischial  arch  is  more  deeply  cut  at  the  symphysis,  and  the  posterior  borders 
of  the  ischia  join  at  an  acute  angle  or  V-shape,  the  opening  being  supero- 
posterior.  The  external  border  of  these  bones  is  higher,  and  the  sciatic 
spine  or  supra-cotyloid  crest  is  thinner  and  more  elevated.  So  that,  alto- 
gether, the  bony  parietes  of  the  Cow's  pelvis  are  more  extensive,  com- 
paratively speaking,  than  the  Mare's.  The  sacral  surface  is  more  concave, 
and  the  sacro-sciatic  ligaments  wider,  though  shorter. 

The  pelvic  cavity  of  the  Cow  is  also  less  wide,  when  compared  with  its 
height.  The  diameters  of  the  inlet — which  is  more  oblique  than  in  the 
Mare — are  very  unequal  \  the  difference  between  the  sacro-pubic  and  the 
transverse,  according  to  Saint-Cyr,  being  one-third  (nine  and  six  incli^s). 
The  dimensions  of  the  outlet  are  more  equal,  and  are  about  those  of  the 

*  Girard  thought  that,  in  the  Bitch,  one  of  the  young  in  the  body  of  the  uterus  might  occupy  this  space  ; 
but  Rainard  could  not  verify  this,  all  his  examinations  of  pregnant  animals  which  had  died  before  bring- 
ing forth  their  young  proved  the  body  of  the  uterus  to  be  quite  empty. 


THE  PELVIS. 


19 


transverse  diameter  of  the  inlet.  It  therefore  results  that  the  pelvis  of  the 
Cow  is  more  cylindrical  and  less  conical  than  that  of  the  Mare  ;  but  this  fea- 
ture does  not  render  parturition  any  easier,  for  though  the  outlet  is  a  little 
larger  than  in  the  latter  animal,  yet  this  advantage  is  counterbalanced  by 
the  length  of  the  pelvic  cavity,  the  greater  extent  of  its  bony  walls,  and 
the  very  marked  curvature  of  the  symphysis.  So  it  is  that,  while  it  rarely 
happens  that  the  foal  experiences  any  difficulty  in  passing  through  the 
pelvis,  once  it  has  fairly  cleared  the  inlet,  it  is  not  at  all  infrequent  for 
the  calf  to  become  fixed  in  the  pelvis,  and  to  remain  there  unless  removed 
by  artifical  means. 

It  is  also  to  be  noted  that  the  floor  of  the  pelvic  cavity  is  on  a  much 


Fig.  7. 
Longitudinal  Section  of  the  Cow's  Pelvis. 


higher  level  than  thaj  of  the  abdomen  ;  so  that  a  kind  of  steep  step  has 
to  be  ascended  by  the  calf  before  it  can  enter  this  passage  ;  consequently, 
it  often  remains  fixed  against  this  upper  level  at  the  inlet. 

Sheep  and  Goat. 

With  these  animals  the  pelvis  does  not  differ  to  any  notable  extent — 
except,  of  course,  in  size — from  that  of  the  Cow.  The  symphysis  is  nearly 
rectilinear  in  its  direction,  and  its  ossification  occurs  at  a  very  much  later 
period  than  in  the  Cow  or  Mare  ;  this  allows  the  diameters  of  the  pelvic 
cavity  to  be  increased  during  parturition,  and  accounts  for  the  rarity  of 
difficult  births  in  the  Sheep  and  Goat. 

Pig. 

The  general  conformation  of  the  pelvis  in  the  Pig  is  not  unlike  that  of 
ruminants,  except  that  the  sacro-vertebral  angle,  or  "promontory  of  the 
sacrum,"  is  more  salient,  the  canal  longer,  the  plane  of  its  anterior  cir- 
cumference more  oblique,  and  the  direction  of  the  ischio-pubic  symphysis 
perfectly  rectilinear.  The /<?/z;zV  ^r.a'z///);  is  very  large  in  proportion  to  the 
size  of  the  young  at  birth  ;  therefore  it  is  that  accidents  are  very  rare 
during  the  act  of  parturition. 

Bitch  and  Cat. 

In  these  creatures  the  sacro-vertebral  angle  is  still  more  marked,  and 
diminishes  the  inlet  of  the  pelvis  to  a  notable  extent ;  the  direction  of 
the  symphysis  is  rectilinear,  and  the  general  outline  of  the  pelvic  cavity 


20 


OBSTETRICAL  ANATOMY 


is  nearly  cylindrical.  The  ischium^  immediately  above  the  obturator  fora- 
men, rises  abruptly  to  almost  a  right  angle  ;  this  is  the  narrowest  part  of 
the  canal,  and  here  it  is  that  the  passage  of  the  foetus  is  obstructed  in 
small  females  which  have  been  impregnated  by  large  dogs.  It  must  be 
remarked,  however,  that  the  late,  and  often  incomplete,  ossification  of 
the  symphysis  allows  a  certain  amount  of  dilatation  of  the  canal,  and 
renders  the  passage  of  a  comparatively  large  foetus  possible. 


SECTION    IV. CAPACITY    OF    THE    PELVIS    OR    PELVIMETRY. 

We  have  already  casually  alluded  to  the  capacity  of  the  pelvic  cavity  in 
the  larger  domesticated  animals,  and  to  its  diameters  ;  and  it  will  be  in- 
ferred that  these  must  vary  with  the  different  sizes  existing  in  the  Mare, 
Cow,  Pig,  and  Bitch,  though  in  others  which  are  generally  of  uniform 
volume — as  the  Sheep,  Goat,  Ass,  ayd  Cat — the  pelvis  does  not  offer 
much  diversity.  In  this  respect  the  latter  species  resemble  mankind,  in 
the  female  of  which  a  difference  in  size  does  not  make  much  difference 
in  pelvic  dimensions  :  half  an  inch  probably  covering  the  variations.  But 
in  the  Mare  or  Cow,  if  we  compare  a  small  with  a  large  animal,  this  dif- 
ference in  diameters  may  extend  to  nearly  two  or  three  inches. 

The  subject  oi pelvimetry  is  very  important  to  tlie  accoucheur  of  the  hu- 
man species,  as  the  female  pelvis  is  particularly  liable  to  be  deformed  or 
defective  in  its  proportions.  It  is  not  nearly  of  so  much  moment  to  the 
veterinary  obstetrist,  as  the  head  of  young  animals  generally  experiences 
no  difficulty  in  passing  through  the  pelvic  cavity,  except  sometimes  in  the 


Fig.  8.  Fig.  9. 

Medium   Section  of  the  Pelvis  of  the  Horse  (Fig.  8)  and  Mare  (Fig.  9). 

I,  Sacrum  ;  2,  Two  first  Coccygeal  Vertebrae  ;  3,  Two  last  Lumbar  Vertebrae  ;  4,  Ischio-pubic 
Symphysis:  a,  b,  Axis  of  tlie  Pelvic  Cavity;  c,  d,  Supero-inferior  Diameter  of  the  Inlet; 
e,  /,  Supero-inferior  Diameter  of  the  Outlet  ;  c,  g.  Vertical  Diameter  of  the  Inlet ;  i,  h, 
V&rtical  Diameter  of  the  Mid-pelvis  ;  k,/,  Vertical  Diameter  of  the  Outlet. 

carnivora  or  in  cases  of  hydrocephalus  ;  and  also  because  the  less  value 
of  animal  life  leads  the  operator,  when  in  difficulties,  to  sacrifice  the  foetus 
rather  than  endanger  the  existence  or  value  of  the  mother. 

It  is,  nevertheless,  useful  to  know  the  diameters  of  the  pelvis  of  differ- 
ent animals,  in  order  not  only  to  fully  understand  the  mechanism  of  par- 
turition, but  also  with  regard  to  the  indications  it  may  furnish  in  many 
cases  of  dystokia. 

We  have  shown  that  the  pelvic  canal  in  the  large  and  small  herbivors 
is  sojiriewhat  of  an  oval  shape,  the  narrowest  part  being  above,  and  the 


THE  PELVIS,  21 

widest  below  ;  and  that  in  the  carnivora  it  is  somewhat  cylindrical.  This 
difference  in  outline  is  conformable  with  the  shape  of  the  foetal  thorax, 
which  in  the  former  is  deeper  than  it  is  wide,  particularly  at  the  period  of 
birth.  During  parturition,  the  fcetus  of  herbivorus  animals  is  so  placed, 
generally,  that  the  withers  and  shoulders  are  towards  the  roof  or  superior 
plane  of  the  pelvis  ;  while  the  sternum  and  anterior  limbs,  which  form  a 
larger  mass,  rest  on  the  floor  or  inferior  plane.  The  passage  of  the 
thorax  of  the  foetus  in  these  animals  is,  apart  from  other  causes,  the 
chief  difficulty  in  parturition.  In  the  human  female,  it  is  the  head  of  the 
foetus.  The  thorax  of  the  carnivorous  foetus  is  not  nearly  so  deep,  com- 
paratively ;  it  is  therefore  better  adapted  to  pass  through  the  nearly 
circular  canal. 

The  term  diameter,  in  obstetrics,  is  employed  to  designate  the  distance 
between  certain  points  in  the  pelvic  cavity,  and  by  which,  practically,  we 
may  compare  the  capacity  of  that  space  with  the  volume  of  the  largest 
part  of  the  foetus  that  has  to  pass  through  it. 

In  the  human  species,  four  diameters  are  usually  given  for  the  inlet  and 
outlet  of  "the  pelvis,  and  some  veterinarians  also  furnish  these  measure- 
ments. They  are  :  (i)  a  vertical  or  sacro-pubic,  from  the  sacro-lumbar 
articulation  to  the  ischio-pubic  symphysis ;  (2)  a  transverse,  passing  be- 
tween the  most  concave  portion  of  the  ilia ;  and  (3,  4)  two  oblique,  from 
the  ilio-pectineal  line  of  one  side  to  the  sacro-articulation  of  the  other. 

Chauveau,  in  his  measurement  of  the  Horse's  pelvis,  gives  these  four 
measurements  for  the  inlet  (mean  vertical,  834^  inches  ;  transverse,  8^ 
inches  ;  oblique,  8^  inches)  ;  but  for  the  outlet  only  the  vertical  and 
transverse  (mean  vertical,  6^  inches  j  transverse,  7  inches).  Rainard, 
for  the  inlet,  gives  three  diameters  :  (i)  a  siipero-inferior,  from  the  sacro- 
lumbar  articulation  to  the  anterior  border  of  the  ischio-pubic  symphysis  ; 
(2)  a  transverse,  from  the  inner  surface  of  the  cotyloid  angle  on  one  side 
to  the  same  point  on  the  opposite  side  ;  (3)  a  vertical,  from  the  middle  of 
the  sacrum  to  the  ischio-pubic  symphysis  in  the  larger  animals,  and  to  the 
sacro-coccygeal  articulation  in  the  smaller.  But  for  the  outlet,  he  has 
only  two  diameters  :  (i)  a  vertical,  from  the  posterior  part  of  the  ischio- 
pubic  symphysis  perpendicularly  to  the  sacrum  or  its  prolongation,  the 
coccyx ;  (2)  a  transverse,  from  one  ischial  tuberosity  to  the  other. 

The  most  important  diameter  is  certainly  that  between  the  middle  of 
the  sacrum  and  the  ischio-pubic  symphysis  in  the  larger  animals,  and  the 
sacro-coccygeal  articulation  and  ischio-pubic  symphysis  in  the  smaller 
creatures.  For  it  must  be  remembered  that  the  pelvis  of  the  domesticated 
animals  offer  a  vpry  inclined  plane,  and  if,  placing  it  in  the  position  of  the 
human  pelvis,  we  draw  a  horizontal  line  from  the  symphysis  towards  the 
spine,  it  will  be  found  that  this  line  does  not  touch  the  sacro-lumbar 
articulation,  but  the  middle  of  the  sacrum  in  the  large,  and  the  sacro- 
coccygeal articulation  in  the  smaller  animals.  This  point  is  the  narrowest 
through  which  the  foetus  has  to  pass,  and  in  which  it  will  meet  most  re- 
sistance ;  for  while  the  top  of  its  shoulder  is  towards  the  sacrum,  its  chest 
is  resting  on  the  pubis.  So  that  it  may  be  said  that  this  is  really  the  first 
solid  resistance  to  be  overcome  in  parturition. 

Considering  the  variations  in  size  in  some  species,  it  is  not  possible  to 
give  general  measurements  for  all ;  but  we  may  follow  the  example  of 
Rainard,  and  give  average  diameters  for  different-sized  animals.  These 
are  tabulated  as  follows  ;  the  last  column,  headed  "  Symphysis,"  gives  the 
length  of  the  floor  of  the  pelvis. 


22 


OBSTETRICAL  ANATOMY. 


Height. 

OPENINGS. 

Species. 

Inlet. 

Outlet. 

Symphysis. 

Diameters. 

Measures. 

Diameters. 

Measures. 

Horse 

1 5  hands 

Supero-inferior 

Vertical 

Transverse 

9/^  in. 
9X  in- 
()%  to  9>^  in. 

Vertical 
Transverse 

6/5  in. 
lYz  in. 

9  to  9>^  in. 

14  hands 

Supero-inferior 

Vertical 

Transverse 

9%  to  ^}i  in. 
8/5  in. 
8/5  to  9  in. 

Vertical 
Transverse 

6  to  6>^  in. 
6to  to  7  in. 

8/5  in. 

12  hands 

Supero-inferior 

Vertical 

Transverse 

8T='iT  to  SiV  in. 

7:fir  in. 

lYz  to7i%in. 

Vertical 
Transverse 

4fij  to  4t5  in. 
5iff  to  5^  in. 

ih  to    7>^ 
in. 

Ass 

Middle 
size 

Supero-inferior 

Vertical 

Transverse 

7-h  in. 
ST'ain.    ^ 
4/5  in. 

Vertical 
Transverse 

415  in. 
3x^5  in. 

3/0  in. 

Cow 

Middle 
size 

Supero-inferior 

Vertical 

Transverse 

8/s  in. 
7  A  in. 
7t*5  in. 

Vertical 
Transverse 

■]-?Ti  in. 
7K  in. 

415  in. 

Sheep 

Ordinary 
size 

Supero-inferior 

Vertical 

Transverse 

415  in. 
21*5  in. 
3^  in. 

Vertical 
Transverse 

3>^  in.  (varies) 
21%  in. 

2  in. 

Goat 

Middle 
size 

Supero-inferior 

Vertical 

Transverse 

4|<in. 
2}i  m. 
3K  in- 

Vertical 
Transverse 

2%  in. 
2^  in. 

214:  in. 

Pig 

27>^  in. 
Length 
from 
snout  to 
tail,  54^ 
in. 

Supero-inferior 

Vertical 

Transverse 

4  in. 
3ft  in. 
l^ji  in. 

Vertical 
Transverse 

2fS  in. 
4  in. 

4  in. 

Dog 

Large 

Supero-inferior 

Vertical 

Transverse 

2Kin. 
2  in. 
2  in. 

Vertical 
Transverse 

23^  in. 
2  in. 

2  in. 

Small 

Supero-inferior 

Vertical 

Transverse 

2  in. 

rfs  in. 

I A  to  1/5  in. 

Vertical 
Transverse 

2  in 
I  h  in. 

IiIj  in. 

Cat 

Ordinary 
size 

Supero-inferior 

Vertical 

Transverse 

2Kin- 
2  in. 
iT%  in. 

Vertical       21^  in. 
Transverse  1/0  in. 

1 10  in. 

Some  veterinarians,  however,  who  have  made  this  subject  an  ahnost 
special  study,  only  specify  two  diameters,  the  stcpero-ififerior  or  sacro-pubic, 
and  the  transverse  or  bis-iliac.  The  following  are  the  measurements  fur- 
nished by  four  of  these  authorities  : — 


THE  PELVIS. 
MARE. 


23 


iJiameters. 

Daumeis- 
\z\-   nr.d 
Rucff. 

Carsten- 
Harms. 

Arloing. 

Saint- 
Cyr. 

Remarks. 

Inlet. 

Inches. 

In. 

In. 

In. 

Supero-inferior  Diameter 

9  to  10 

9% 

9 

8^* 

*The  average  of  28  meas- 
urements of  Mares  vary- 
ing   from     l^y^    to    1 6- 1 

hands  in  height. 

Transverse  Diameter 

II  to  12^ 

9\ 

9\ 

8rVt 

tThe  average  of  25  meas- 
urements as  above. 

Outlet. 

Supero-inferior  Diameter 

9  to  10 

jyi 

7 

— 

Transverse  Diameter 

9 

(>Vz 

7% 

— 

COW. 


1  Baumeister 
Diameters.                       i         ^^^ 

j       Rueff. 

Carsten- 
Harms. 

Arloing. 

Saint- 
Cyr. 

Remarks. 

Inlet. 
Sujjero-inferior  Diameter 

Transverse  Diameter 

Outlet. 
Supero-inferio  Diameter 
Transverse  Diameter 

Inches. 
9      to9>^ 

6|<to7|4: 

9 
9 

In. 

8/6 

7 
6K 

In. 

'  In. 

7Xt 

- 

*The  average    of   5  meas- 
urements of  Cows  of  dif- 
ferent sizes  and  breeds. 

tibid. 

It  will  be  seen  from  these  measurements  that  no  great  practical  utility 
can  be  derived  from  pelvimetry,  so  far  as  averages  are  concerned  ;  as  the 
diameters  of  the  pelvis  must  vary  with  the  size  and  other  peculiarities  in 
an  animal's  conformation  ;  so  that  we  may  have  considerable  differences. 
In  the  Mare  alone,  Saint-Cyr  found  a  difference  in  the  supero-inferior 
diameter  of  2I-  inches,  and  in  the  transverse  diameter  of  2%  inches. 

With  the  view  of  determining  the  capacity  of  the  pelvis  of  the  living 
animal  at  a  given  \\\t\q,  external  pelvimef?y  has  been  resorted  to.  This 
consists  in  ascertaining  the  distance  between  the  angles  of  the  haunch  on 
each  side,  that  between  the  two  ischial  tuberosities,  and  that  between  the 
coxo-femoral  articulation  and  the  highest  part  of  the  croup.  To  find  out 
the  first,  a  piece  of  wood  is  placed  vertically  against  each  haunch,  and  the 
space  between  them  is  measured  ;  for  the  second,  a  tape  measures  the 
distance  between  the  ischial  tuberosities  ;  and  for  the  third,  a  piece  of  wood 
is  placed  horizontally  across  the  summit  of  the  croup,  while  another  is 
laid  in  the  same  direction  along  the  trochanter  and  the  ischial  tuberosity, 
the  vertical  distance  between  the  two  pieces  giving  the  measurement. 
Taking  into  consideration  the  shape  of  the  pelvis,  it  has  been  calculated 
that  the  transverse  diameter  of  the  outlet  should  be  nearly  equal  to  one- 
fourth  of  the  distance  between  the  haunches  added  to  that  between  the 
ischial  tuberosities  ;  while  the  supero-inferior  diameter  of  the  outlet  is 
supposed  to  be  equal  to  three-fourths  of  the  vertical  distance  separating 
the  coxo-femoral  articulation  from  the  summit  of  the  croup.  These 
measurements  only  give  the  supposed  diameters  of  the  outlet ;  but  Ar- 
loing, who  has  devoted  much  attention  to  pelvimetry  in  animals,  points 
out  the  means  whereby  the  diameters  of  the  inlet  may  be  attained.* 

*■  The  calculations  and  measurements  are  given  in  Saint-Cyr's  "  Traite  d'Obstetrique  Vet^rinaire,"  p.  21. 


24  OBSTETRICAL  ANATOMY. 

This  method  is,  however,  so  complicated  and  unsatisfactory,  that  it 
requires  further  elaboration  before  it  can  be  recognized  as  useful  and 
reliable. 

Saint-Cyr  has  endeavored,  in  a  somewhat  similar  manner,  to  arrive  at 
some  criterion  as  to  the  diameters  of  the  inlet  of  the  pelvis — which  is, 
after  all,  the  most  important  in  parturition — in  the  living  animal.  For 
the  sacro-piibic  diameter,  he  has  taken  for  guide  the  height  of  the  Mare, 
supposing  that  the  two  should  be  nearly  always  constant  in  their  rela- 
tions ;  and  to  fix  this  relation,  the  diameter  was  measured  in  twenty-eight 
animals  of  various  sizes.  Taking  the  average  of  these  twenty-eight  meas- 
urements, and  dividing  it  by  the  average  of  the  heights,  the  quotient  ob- 
tained gave  the  co-efficient,  by  which  it  was  necessary  to  multiply  the  height 
of  any  Mare  to  find  the  sacro-pubic  diameter  of  its  pelvis.  For  the 
transverse  or  bis-iliac  diameter,  t\\Q  vj'idxh.  oi  the  croup  measured  between 
the  external  angles  of  the  ilia  (taken  by  a  tape),  or  between  the  coxo-fe- 
moral  articulations  (taken  by  a  large  pair  of  compasses),  was  adopted. 
But  it  was  soon  discovered  that  one  and  the  same  co-efficient  would  not 
serve  for  all  cases  ;  as  in  common-bred  lymphatic  horses,  the  bones  are 
large,  the  soft  textures  abundant,  and  the  pelvic  cavity  less  than  would 
be  surmised  from  the  width  of  the  croup  ;  while  in  those  which  are  well- 
bred,  the  bones  are  smaller  and  denser,  the  soft  tissues  more  condensed, 
and  the  pelvic  space  large,  comparatively  speaking.  So  that  the  co- 
efficient had  to  be  less  in  the  latter  than  the  former. 

The  results  of  Saint-Cyr's  measurements  and  calculations  are  fairly 
reliable  ;  and  the  external  measurements  do  not  differ  very  widely  in  their 
indications  from  those  furnished  by  actual  measurement  of  the  pelvic 
cavity. 

This  method,  however,  even  when  accepted  as  perfectly  reliable,  only 
furnishes  us  with  the  dimensions  of  the  well-formed  normal  pelvis  ;  it 
gives  no  information  with  regard  to  internal  deformities,  for  the  estima- 
tion of  which  it  is  necessary  to  have  recourse  to  "  direct  exploration," 
either  through  the  vagina  or  rectum,  by  which  we  may  not  only  discover 
the  character,  but  also,  approximately,  the  extent  of  the  deformity.  "  In- 
ternal pelvimetry  "  may  also  be  resorted  to  in  this  way  ;  and  in  practice, 
after  a  little  experience,  it  will  be  found  sufficiently  simple  and  trust- . 
worthy  to  be  of  much  service.  This  internal  measurement  of  the  pelvic 
cavity  cannot  be  satisfactorily  made  by  means  of  compasses  or  other  in- 
struments in  the  living  animal,  as  in  woman  ;  but  the  hand  may  be  suc- 
cessfully employed  in  ascertaining  the  different  diameters  by  spans — as 
the  thumb  from  the  index,  to  the  middle  finger,  and  even  widely  spread 
to  the  little  finger :  the  distance  between  these  being  previously  known, 
we  may  readily  ascertain  with  sufficient  accuracy  the  diametrical  capacity 
of  the  pelvis. 

ThQ  axis  of  the  pelvis  IS  the  term  given  to  an  imaginary  line  drawn 
through  the  canal  of  the  region  from  before  to  behind,  at  an  equal  dis- 
tance from  the  circumference.  In  the  human  pelvis  there  are  two  axes — 
those  of  the  upper  and  lower  oudet,  and  a  knowledge  of  them  is  of  much 
importance  in  midwifery  ;  they  form  an  obtuse  angle  with  each  other, 
and  when  combined  with  the  inclination  of  the  pelvis,  we  observe  that 
the  direction  the  human  foetus  must  take  is  somewhat  tortuous  or  curved. 
In  animals  there  is  only  one  axis,  and  that  is  almost  rectilinear :  the 
sacro-vertebral  angle  or  "promontory"  being  comparatively  little  de- 
veloped, and  the  sacrum  passing  almost  in  a  direct  line  from  the  vertebral 


THE  PELVIS.  25 

column.  This  rectilinear  direction  of  the  pelvic  axis  is  greatly  to  the  ad- 
vantage of  animals  during  parturition  ;  so  that  the  axis  of  this  canal  re- 
quires but  little  notice  from  the  veterinary  obstetrist,  except  when  the 
passage  is  very  constricted. 

Differences  in  the  Pelvis  according  to  Sex. 

There  is  a  considerable  difference  in  the  size  and  conformation  of  the 
male  zxid  female  pelvis  in  the  domesticated  animals,  the  latter  being  larger  in 


ft 


Fig.  10. 
Pelvis  of  Mare. 


every  sense,  but  more  particularly  in  its  transverse  diameter.  These 
differences  have  only  been  carefully  studied  in  the  equine  species,  but 
they  exist  in  a  somewhat  similar  degree  in  the  pelvis  of  other  species. 


Fig.  II. 
Pelvis  of  Horse. 


In  the  Mare,  in  addition   to  the  pelvis  being  wider  than  that  of  the 
Horse,  the  inlet  is  much  larger,  the  ileo-pectineal  crests  are  further  apart, 


26 


OBSTETRICAL  ANATOMY. 


and  the  distance  between  the  lower  face  of  the  sacrum  and  the  anterior 
border  of  the  pubis  is  much  greater,  the  ilia  and  pubis  being  broader  and 
more  concave.  On  the  upper  surface  of  the  Mare's  pelvis,  the  sacro-sciatic 
notches  are.  very  deep  ;  the  inner  border  of  the  ilium  forms  a  very  concave 
line,  anc]  the  ischiatic  spines  are  widely  separated.  The  floor  of  the  pelvis 
is  wide,  and  the  bones  composing  it  have  a  tendency  to  assume  the  same 
horizontal  direction.  In  the  Horse,  the  ischiatic  border  does  not  describe 
a  regular  curve  ;  it  is  composed  of  two  nearly  straight  portions,  which  unite 
where  the  neck  of  the  ilium  begins.  The  supra-cotyloid  crests  are  not 
much  separated,  and  are  turned  outwards,  and  the  two  portions  of  the 
floor  of  the  canal  are  directed  very  obliquely  downwards  and  inwards.  In 
the  Mare,  the  ischial  arch  is  wider  than  in  the  Horse,  and  forms  a  regular 
curve  in  joining  the  tuber  ischii  ;  while  in  the  Horse,  these  tuberosities 
are  not  nearly  so  wide  apart,  and  the  ischial  arch  forms  a  somewhat  acute 
angle,  the  margin  of  which  is  nearly  straight.  The  obturator  foramina 
are  also  large  and  almost  circular  in  the  Mare,  while  they  are  small  and 
oval  in  the  Horse  ;  the  ischio-pubic  symphysis  is  farther  from  the  coty- 
loid cavities  in  the  former  than  in  the  latter. 

The  sacrum  is  also  broader  and  longer  in  the  Mare,  and  in  the  majority 
of  animals  it  is  more  concave  from  before  to  behind.  The  first  coccygeal 
vertebrae  are  larger  and  more  flexible,  and  carried  at  a  greater  elevation 
than  in  the  Horse. 

This  difference  of  conformation  in  the  pelvis  of  the  Mare  is  adapted  to 
the  passage  of  the  foetus  through  the  canal,  and  it  causes  the  animal  to 
appear  lower  in  the  forehand  than  the  Horse,  in  which  the  croup  is  not 
so  high.  It  is  rare  to  find  a  Mare  which  has  the  croup  so  square  as  the 
Stallion,  the  hind  quarter  of  which  is  almost  equal  in  depth,  breadth,  and 
length. 

The  width  of  the  pelvis  of  the  Mare,  as  before  observed,  produces  a 
rocking  motion  during  progression,  and  this  is  all  the  more  marked  as  the 
animal  has  been  frequently  bred  from  ;  for  the  same  reason  the  speed  is 
not  so  great,  and  Mares  which  have  had  several  foals  are  not  well  adapted 
for  the  circus. 

The  differences  between  the  pelvis  of  the  Mare  and  Horse  are  some- 
times noticeable  at  birth  ;  but  they  are  generally  most  apparent  when  the 
adult  period  has  been  reached,  and  the  body  has  acquired  its  definitive 
form.  In  both  sexes,  the  supero-inferior  diameter  of  the  inlet  is  greater 
than  the  transverse  in  early  life. 

Some  idea  of  the  difference  in  the  dimensions  of  the  pelvic  cavity  in 
the  Mare  and  Horse,  may  be  obtained  from  the  following  measurements 
of  two  animals  about  the  same  in  size  : 


Vertical  Diameters. 

Horizontal  Diameters. 

Between  the 

Sacrum  and 

Pubis. 

Between  the 

Sacrum  and 

Ischium. 

Between  the 
Pectineal  Ridges. 

Between  the 
Ischial  Spines. 

Mare     .     . 
Horse    .     . 

9  inches. 
8        „ 

6t%  inches. 
6A      „ 

*   9X  inches. 

'jYz  inches. 
6K      » 

The  differences  between  the  pelvis  of  the  two  sexes  are,  perhaps,  not  so 
marked  in  the  smaller  domesticated  animals  until  the  female  has  brought 
forth  young  several  times. 


EXTERNAL  GENERATIVE  ORGANS. 


27 


CHAPTER  II. 

Female  Generative  Organs. 

The  genital  organs  of  the  female  are  much  more  complicated  than  those 
of  the  male,  from  the  far  greater  share  they  take  in  the  process  of  genera- 
tion. They  are  usually  described  according  to  their  situation — as  external 
and  internal ;  or  from  their  function — as  copulative  2iV\d  formative. 

Proceeding  from  the  exterior  to  the  interior,  these  organs  may  be  enu- 
merated as  follows :  the  vulva  and  mammce  or  mammary  glands,  the 
vagina,  uterus.  Fallopian  tubes,  and  ovaries.  We  will  describe  these  in 
the  above-mentioned  order,  taking  the  Mare  again  as  the  type,  and 
indicating  the  differences  in  the  other  domesticated  animals. 

V 

section  i. external  generative  organs. 

The  Vulva. 

The  external  orifice  of  the  generative  organs,  the  vulva,  appears  as  a 
vertically  elongated  slit,  situated  beneath  the  anus,  between  the  perineum 
and  ischial  arch  and  the  posterior  margin  of  the  two  hind  quarters.  It 
presents  two  thick  lips  or  labia,  and  two  commissures,  externally  ;  and  in- 
ternally, it  forms  a  cavity  which  is  confounded  with  that  of  the  vagina, 


Fig.  12. 

The  Generative  Organs  of  the  Mare  in  siht. 

Body  of  the  Uterus  ;  2,  2,  Cornua  of  the  Uterus  ;  3,  Vagina  ;  4.  Bladder ;  5,  Rectum  ;  6, 
Sphincter  of  the  Anus ;  7,  Constrictor  Muscle  of  the  Vulva  ;  8,  Bulb  of  the  Vagina  ;  9,  Ovary 
and  Fimbriated  Body;   10,  Fallopian  Tube;  u,  Kidney;  12,  12,  Broad  Ligament. 


and  extends  beyond  the  meatus  urinarius.  The  limit  between  the  vulva 
and  vagina  is  not  perceptible  in  the  adult,  but  is  always  conspicuous  in 
the  fcetus. 


28  OBSTETRICAL  ANA  TOMY. 

The  lips  {labice  vidvce)  are  usually  in  contact,  and  they,  with  the  opening 
which  separates  them  {rimcE  vulvce),  vary  in  size  according  to  age  and  con- 
dition. They  are  slightly  prominent  and  thick,  being  composed  of  firm, 
flexible,  and  elastic  tissue,  which  is  covered  with  a  fine,  smooth,  unctuous 
skin  destitute  of  hair,  but  rich  in  pigment  in  the  majority  of  animals.  In- 
ternally, they  are  covered  with  mucous  membrane,  a  continuation  of  that 
lining  the  vagina,  and  which  is  constantly  lubricated  by  a  greasy  mucus 
possessing  a  special  odor,  according  to  the  species  of  animal  ;  on  the 
free  border  of  the  vulva,  this  membrane  and  the  skin  meet.* 

At  the  junction  of  the  labia  above  and  below  are  the  commissures,  due 
to  this  junction.  The  superior  commissure  is  situated  close  to  the  anus, 
from  which  it  is  only  separated  by  a  narrow  space — the.  per  if leum.  It  is 
very  angular,  and  corresponds  to  the  fourchette  in  woman.  The  ififerior 
commissure  IS  obtuse,  rounded  and  more  voluminous  ;  it  lodges  the  clitoris, 
and  is  situated  immediately  above  the  raphe.  The  cainty  of  the  vulva 
sometimes  contains  the  hymen,  which  separates  it  from  the  vagina  at  a 
certain  period  of  life ;  it  also  contains  the  meatus  urinarius  and  its  valve, 
as  well  as  the  clitoris. 

The  structure  of  the  vulva  consists  of  tho.  mucous  membrane  lining  its  in- 
terior, which  is  covered  by  pavement  epithelium  ;  an  erecticle  structure 
connected  with  it,  named  the  vaginal  bulb;  two  constrictor  muscles  ;  two 
muscular  ligaments,  fascice,  etc.  The,  mucous  membrane  is  continuous  with 
that  of  the  vagina  and  bladder  ;  it  is  usually  of  a  pink  or  rosy  tint,  but  at 
the  period  of  oestrum  it  has  a  bright-red  hue.  Near  the  margin  of  the 
labia  it  frequently  shows  black  pigmentary  patches,  which  give  it  a 
marbled  appearance.  It  is  provided  with  numerous  mucous  follicles  and 
sebaceous  glands  ;  the  latter  are  chiefly  found  near  the  free  border,  and 
particularly  around  the  clitoris  and  the  space  between  it  and  the  inferior 
commissure,  where  they  aggregate  to  form  several  small  sinuses.  This 
membrane  is  also  furnished  with  great  numbers  of  papillae.  The  vaginal 
bulb  is  wholly  composed  of  erectile  tissue  with  wide  spaces,  which  con- 
stitutes the  plexus  retiformis.  This  tissue  passes  from  the  base  of  the 
clitoris  to  the  sides  of  the  vulva,  where  it  terminates  in  a  round  salient  or 
ring-like  lobe.  Covered  by  the  posterior  constrictor  of  the  vulva,  this 
bulb  communicates  inferiorly  with  the  cavernous  veins,  and  afflux  of 
blood  into  its  meshes  diminishes  the  capacity  of  the  vulva  ;  thereby  con- 
curring to  render  the  co-aptation  of  the  copulatory  organs  more  complete 
during  coition. 

The  jnuscles  of  the  vulva  are  constrictors — an  anterior  and  posterior — 
and  are  voluntary.  The  anterior  constrictor  is  analogous  to  Wilson's 
muscle  in  the  male,  and  is  formed  of  arciform  fibres  which  surround  the 
sides  and  lower  part  of  the  vagina  at  its  commencement,  its  extremities 
being  continued  by  means  of  aponeurotic  fasciculi  as  far  as  the  sides  of 
the  rectum,  where  they  disappear.  Posteriorly,  this  muscle  is  confounded 
with  the  next  to  be  described.  The  posterior  constrictor  {constrictor  cunni) 
is  analogous  to  the  constrictor  of  the  vagina,  and  forms  a  real  sphincter  ; 
it  is  comprised  within  the  substance  of  the  lips  of  the  vulva.  Superiorly, 
its  fibres  are  mixed  with  those  of  the  anal  sphincter,  and  are  attached 
to  the  sacrum  by  means  of  the  suspensory  ligaments.  Inferiorly,  the 
most  forward  are  fixed  to  the  base  of  the  clitoris,  and  the  middle  are  pro- 
longed to  both  sides  of  the  thighs,  where  they  are  inserted  into  the  skin. 

*  The  two  lips  correspond  to  the  labia  m.%jora  of  woman  ;  there  are  no  labia  minora  in  animals. 


EXTERNAL  GEiXERATIVE  ORGANS.  29 

Inwardly,  this  muscle  is  in  relation  with  the  vaginal  bulb  and  mucous 
membrane  of  the  vulva.  Its  external  face  is  separated  from  the  skin  of 
the  lips  by  a  very  vascular  cellulo-fibrous  tissue,  which  is  capable  of  con- 
tracting, and  in  the  midst  of  which  ape  observed  some  isolated  red  mus- 
cular fasciculi — given  off  from  the  principal  muscle. 

The  posterior  constrictor  of  the  vulva  is  very  powerful,  and  in  acting 
during  copulation,  contracts  the  vagina  and  compresses  the  penis  ;  by 
reason  of  its  attachment  to  the  clitoris,  when  its  acts  it  erects  that  organ. 
In  Mares  which  are  rutting,  the  movements  of  the  clitoris  are  frequent, 
and  it  then  projects  outwards  ;  this  is  particularly  observed  after  micturi- 
tion, and  in  this  case  the  fibres  of  the  constrictor  attached  to  the  clitoris 
elevate  the  latter  by  acting  on  its  base,  those  fibres  which  are  inserted 
into  the  skin  of  the  thighs  depressing  the  inferior  commissure  of  the  vulva, 
which  exposes  that  very  sensitive  erectile  body  lodged  in  this  space. 

The  muscular  ligaments  of  the  vulva  in  reality  correspond  to  the  liga- 
mentum  suspensorium  of  the  penis  in  the  male ;  they  arise  from  the  lower 
face  of  the  sacrum,  and  descend  as  flat  bands  until  they  unite  beneath 
the  rectum,  when  they  pass  in  several  fasciculi  into  the  lips  of  this  part, 
and  mix  wdth  the  fibres  of  the  posterior  constrictor.  They  are  composed 
of  non-striated  fibres.  The  skin,  as  already  mentioned,  is  very  fine  and 
thin,  black  in  the  great  majority  of  Mares,  has  scarcely  any  hair,  and  is 
very  unctuous,  odorous,  and  elastic.  The  bulk  of  the  vulva  is  made  up 
of  subcutaneous y<7J"«'^,  to  which  the  skin  closely  adheres  ;  as  well  as  adi- 
pose and  connective  tissue,  and  blood-vessels  and  nerves. 

The  clitoris  is  an  exact,  but  miniature,  counterpart  of  the  corpus  caver- 
nosum  of  the  male  penis.  From  two  to  three  inches  in  length,  this  body 
commences  by  two  roots  attached  to  the  ischial  arch,  and  which  are  cov- 
ered by  a  rudimentary  ischio-cavernous  muscle.  After  being  fixed  to  the 
ischial  symphysis,  by  means  of  a  suspensory  ligament  similar  to  that  of 
the  male,  it  passes  backward  and  projects  into  the  vulvular  cavity,  towards 
the  inferior  commissure,  in  which  it  is  lodged.  Its  free  extremity  is  en- 
veloped in  a  mucous  cap — the  preputium,  which  is  plicated  in  different 
directions  ;  and  towards  the  centre  of  the  tubercle  is  a  follicular  cavity 
containing  sebaceous  matter,  and  which  represents  that  in  the  extremity 
of  the  male  penis.  In  every  respect  the  clitoris  resembles  that  organ, 
having  a  fibrous  framework,  erectile  tissue,  cavernous  vessels  or  "  plexus 
retiformis,"  and  a  pair  of  muscles — the  erectores  clitoridis.  This  organ  is 
more  especially  the  seat  of  venereal  excitation  during  coition.  It  is  pres- 
ent in  all  the  domesticated  female  animals,  and  is  frequently  erected 
while  they  are  in  "heat,"  as  well  as  in  the  act  of  copulation.  It  is 
abundantly  supplied  with  nerves,  which  endow  it  with  most  acute  sensi- 
bility, and  the  mucuous  membrane  enveloping  it  is  usually  dark  colored 
or  marbled,  though  in  white  horses  it  may  be  colorless. 

The  meatus  urinarius  is  the  orifice  of  the  urethra,  which  is  a  very  short 
canal  in  the  female.  This  canal  passes  immediately  beneath  the  anterior 
sphincter  muscle  of  the  vulva,  and  after  a  brief  course  (about  two  inches) 
in  the  textures  composing  the  floor  of  the  vagina,  opens  into  the  vulvular 
cavity  at  from  four  to  six  inches  from  its  exterior.  This  opening,  which 
is  on  the  floor  of  the  cavity,  is  covered  by  a  wide  duplicature  of  the  lin- 
ing membrane  that  acts  as,  and  is  designated,  the  valve  of  the  meatus  or 
vagina  {yalvula  vagi?ice)  ;  its  free  border  is  turned  backwards,  and  it  would 
thus  appear  to  direct  the  urine  towards  the  external  opening  of  the  vulva, 
and  prevent  its  reflux  into  the  vagina.      Rainard  states  that  this  valve  is 


30  OBSTETRICAL  ANATOMY. 

more  extensive  as  the  vagina  is  narrow,  and  consequently  as  the  female 
is  young ;  it  has  been  compared  to  the  hymen  of  woman.  Brugnone  was 
of  opinion  that  it  was  attached  to  the  upper  surface  of  the  vagina  by  a 
small  cord,  and  that  it  was  the  rupture  of  this  by  the  forced  entrance  of 
the  penis  which  caused  the  slight  flow  of  blood  from  the  vulva  observed 
in  Mares  put  to  the  horse  for  the  first  time.  This  is  no  doubt  the  hymen 
to  which  he  refers — a  membrane  found  generally  in  the  filly,  though  not 
often  in  the  Mare,  but  which,  when  present,  separates  the  vulvular  from 
the  vaginal  cavity.  This  membrane  forms  a  circular  partition,  fixed  by  its 
circumference  to  the  vulvo-vaginal  walls  along  with  the  valve  of  the 
meatus,  and  is  perforated  by  one  or  more  openings,  which  are  sometimes 
very  small.  Not  infrequently  old  brood  Mares  show  in  this  situation 
pediculated  appendices,  which  are  the  debris  of  this  mucous  diaphragm. 

The  urethral  orifice  of  the  Mare  is  wider  than  that  of  the  Horse,  and 
will  readily  admit  a  large  catheter.  In  passing  that  instrument,  it  is  well 
to  remember  that  the  urethral  canal  curves  forward  and  downward,  and 
that  the  valve  must  be  raised  either  with  the  point  of  the  instrument  or 
the  finger  before  the  passage  can  be  entered. 

In  ordinary  circumstances  the  vulva  is  retracted,  and  with  Mares  which 
have  foaled  several  times,  the^labia  usually  exhibit  as  many  wrinkles  or 
folds  as  parturition  has  been  frequent. 

During  oestrum,  but  especially  towards  the  termination  of  pregnancy, 
the  labia  becomes  tumified  and  soft,  the  inferior  commissure  descends, 
the  vulvular  opening  is  enlarged,  and  from  it  is  discharged  a  quantity  of 
tenacious  stringy  mucus. 


Differences  in  the  Vulva  of  other  Animals. 

Cow. 

In  the  Cow  the  lips  of  the  vulva  are  larger,  softer,  and  thicker,  and  the 
inferior  commissure,  angular  and  prolonged  into  a  curved  peak,  is  fur- 
nished with  a  tuft  of  hair.  The  meatus  tiritiarius  is  disposed  as  in  the 
Mare  \  but  in  the  interior  of  the  urethral  canal,  fixed  to  its  lower  aspect, 
is  a  valve  whose  free  margin  is  directed  backwards  ;  this  valve  surmounts 
a  cul-de-sac  about  the  third  of  an  inch.  This  valve  of  the  canal  must  be 
remembered  in  passing  the  catheter  into  the  bladder.  About  an  inch 
within  the  entrance  of  the  vulva,  and  embedded  within  the  substance  of 
its  lips,  are  the  vulvo-vaginal  glands  {glandida  vagitice,  S.  I?uverneyi,  S. 
Barlltolini) — large  almond-shaped  bodies  whose  widest  extremity  is  di- 
rected upwards,  and  the  narrow  end,  situated  near  the  clitoro-ischiatic 
muscle,  is  prolonged  into  their  excretory  canals.  These  are  conglomerate 
glands,  whose  excretory  ducts  unite  to  form  a  kind  of  sinus  that  at  last 
opens  into  the  vulva,  about  the  third  of  an  inch  from  the  labia.  The  cli- 
toris  is  longer,  and  more  tortuous  and  slender  than  in  the  Mare,  and  con- 
tains a  dense  fibrous  nucleus  of  a  spiral  shape.  The  vaginal  bulb  is  much 
more  extensive  than  in  the  Mare,  and  is  continued  to  the  clitoris,  where 
it  is  covered  by  a  thick  muscle,  which  descends  from  the  extremity  of  the 
sacrum,  and  terminates  on  the  clitoris.  The  same  changes  occur  in  the 
vulva  of  the  Cow  as  in  the  Mare  during  oestrum,  and  towards  the  termina- 
tion of  pregnancy ;  the  mucous  secretion  of  the  vagina  is  more  abundant 
in  the  Cow,  however,  and  persists  longer. 


EXTERNAL  GENERATIVE  ORGANS. 


Sheep. 


31 


In  the  Sheep  which  has  not  copulated,  a  filamentary  band,  stretching 
across  the  constriction  between  the  urogenital  canal  and  the  vagina,  rep- 
resents the  hymen.  The  Malpighian  canals  open  into  that  passage  near 
the  constriction,  and  the  crura  of  the  clitoris  are  enfolded  by  erector 
muscles  ;  while  the  clitoris  itself  protrudes  immediately  within  the  peak 
of  the  vulva. 

Pig- 

In  the  Pig,  the  urethra  opens  between  two  longitudinal  ridges  ;  but  the 
surface  of  these  and  other  similar  prominences  in  the  urogenital  passage  is 
interrupted  by  numerous  fine,  wavy,  oblique  furrows.  There  is  no  vaginal 
valve,  as  in  the  other  animals.  The  clitoris  is  comparatively  small,  and 
the  inferior  commissure  of  the  vulva  is  still  more  acute  and  pointed  than 
in  the  Cow  and  ruminants  in  general  Towards  the  meatus  are  numerous 
fine  points — the  openings  of  glands  analogous  to  the  prostates  ;  and  on  the 
sides  of  that  orifice  are  two  small  fossae  surrounded  by  a  raised  border. 

Bitch  and  Cat. 

In  the  Bitch,  the  vulva  is  triangular,  and  the  inferior  commissure  acute. 
The  clitoris  is  a  small  tubercle,  and  the  urethra  opens  between  a  little 
transverse  fold  and  the  triangular  flattened  clitoris  ;  beyond  which  is  a 
second  transverse  cresentic  fold  with  its  concavity  opposite  that  of  the 
preceding.  In  the  Cat,  a  small  cartilage  or  bone  exists  in  the  clitoris; 
this  is  not  found  in  any  other  of  the  domesticated  animals. 

The  Perineum  is  the  name  given  to  the  space  between  the  superior 
commissure  of  the  vulva  and  the  lower  margin  of  the  anus.  Its  length 
varies  in  different  species,  and  in  different-sized  animals  of  the  same 
species,  but  it  is  shorter  in  creatures  which  have  produced  young  than 
those  which  have  not.  It  is  composed  of  various  tissues  :  externally  is 
the  smooth,  fine,  and  very  elastic  skin,  with  the  vertical  prominent  line 
passing  down  its  middle — the  "  raphe  ;  "  beneath  this  are  connective  and 
adipose  tissue,  and  fascia,  with  various  muscles,  blood-vessels,  and  nerves. 

The  internal  limits  of  the  vulva  are  defined  by  the  constriction  or  bulb, 
which  forms  a  marked  prominence  in  early  life,  but  tends  to  disappear  in 
relaxed  folds  after  the  animal  has  brought  forth  young  several  times. 
The  dimensions  of  this  aperture  are  rathef  adapted  for  the  passage  of 
the  foetus  than  the  penis ;  though  its  narrowness  is  sometimes  an  obstacle 
to  the  delivery  of  a  primipara.  The  limbs,  body,  or  head  of  the  foetus 
are  at  times  arrested  at  the  superior  or  perineal  commissure,  which  they  so 
distend  as  to  threaten  rupture  of  that  part.  In  emaciated  animals,  and 
particularly  Mares,  the  vulva  is  deeply  retracted  above  the  ischia,  and 
consequently  disposes  them  to  be  injured  in  this  region  during  coitus,  by 
the  accidental  introduction  of  the  male  organ  into  the  anus,  the  mechani- 
cal action  of  which  damages,  and  may  even  rupture,  the  rectum.  Rainard 
alludes  to  several  occurrences  of  this  kind,  which  terminated  in  the  death 
of  the  Mares. 

SECTION    II. — THE   MAMM^. 

The  mammcB,  or  udders^  may  be  said  to  be  appendices  to  the  external 


32 


OBSTETRICAL  AuVATOMV. 


organs  of  generation.  They  are  the  glands  destined  to  secrete  the  fluid — . 
milk — which  is  to  nourish  the  young  animal  for  some  time  after  birth. 
In  early  life  they  are  rudimentary,  but  become  developed  with  age,  and 
attain  their  full  dimensions  when  the  female  is  capable  of  reproduction  ; 
and  especially  at  the  full  period  of  gestation,  when  their  function  is  about 
to  be  carried  on  actively.  After  parturition  their  largest  development  is 
reached,  and  when  the  )''oung  creature  has  completed  its  term  of  sucking, 
they  lose  their  activity  and  diminish  considerably  in  size.  In  the  Mare 
they  are  two  in  number,  placed  beside  each  other  in  the  inguinal  region, 
about  nine  inches  in  front  of  the  vulva,  where  they  take  the  place  of  the 
scrotum  in  the  male.  Externally,  they  appear  as  two  hemispherical 
masses  separated  by  a  shallow  furrow  ;  each  has  in  its  centre,  on  each 
side  of  the  mesian  line,  a  conical,  slightly  flattened  prolongation  named 
the  feaf  or  nipple^  which  is  perforated  by  several  orifices  from  which  the 
milk  escapes,  and  by  which  the  young  creature  obtains  that  fluid  by 
suction.  The  two  glands  are  retained  in  their  position  by  the  fine  skin 
covering  them,  and  which,  destitute  of  hair  at  the  extremity  of  the  teats, 
though  elsewhere  provided  with  a  soft  short  down,  is  smooth,  pliable,  and 
unctuous  from  the  presence  of  sebiparous  follicles.  At  the  base  of  the 
teat  are  a  number  of  small  tubercles,  which  correspond  to  the  areola  of 
the  nipple  in  woman  ;  these  are  the  glands. 

The  mammae  are  also  attached  to  the  abdominal  tunic  by  means  of 
several  wide,  short,  but  elastic  bands,  which  bear  some  analogy  to  the 
suspensory  ligaments  of  the  prepuce  in  the  male. 

In  STRUCTURE  each  udder  offers  an  envelope  of  yellow  elastic  fibrous 
tissue^  glandular  tissue^  the  sinuses  or  galactophorous  reservoirs^  and  the 
lactiferous  ducts ^  with  excretory  canals  or  niilk  ducts. 

The  elastic  envelope,  joined  at  the  mesian  line  with  that  of  the  opposite 
udder,  is  strengthened  by  wide  bands  detached  from  the  tunica  ahdominalis  ; 
it  furnishes  from  its  internal  face  numerous  prolongations  which,  crossing 
each  other  in  the  mass  of  the  gland,  form  septa  or  partitions  that  divide 
it  into  distinct  lobes  and  lobules,  which  are  in  this  way  somewhat  indepen- 
dent of  each  other ;  so  that  one  or  more  may  be  diseased  or  deranged  in 
function,  without  the  others  being  involved.  Externally,  this  envelope  is 
closely  adherent  to  the  skin,  through  the  medium  of  a  dense  layer  of  con- 
nective tissue. 

The  glandular  tissue  offers  the  same  arrangement  as  other  conglomerate 
glands,  and  is  composed  of  acini  or  caecal  vesicles  clustered,  like  grapes 
on  their  stalk,  around  the  tubuli  lactiferi,  or  ultimate  terminations  of  the 
excretory  ducts.  These,  co#imencing  by  cul-de-sac  extremities,  open  into 
one  another  to  form  dilatations  {ampullce),  and  finally  converge  into  a 
number  of  principal  canals,  which  end  in  the  galactophorous  sinuses 
{sinus  lactei).  The  acini  of  the  lobules,  as  well  as  the  ducts,  are  lined  by 
polyhedral  epithelium  ;  this  becomes  spherical  and  infiltrated  with  fat 
during  lactation. 

The  galactophorous  sinuses  or  reservoirs  are  situated  slightly  above  the 
base  of  the  teat,  and  are  generally  two  in  number — one  in  front,  the  other 
behind  ;  though  there  are  sometimes  three,  and  even  four.  They  nearly 
always  communicate  with  each  other,  and  are  prolonged  into  the  teat  by 
a  corresponding  number  of  terminal  and  independent  excretory  canals, 
whose  orifices  are  always  very  narrow,  and  are  seen  at  the  free  extremity 
of  that  body,  which  is  obtuse  and  rounded.  Collectively,  these  excretory 
canals  are  much  wider  at  the  base  of  the  teat  than  at  the  extremity  ;  the 


EXTERNAL  GENERATIVE  ORGANS.  ^^Z 

orifices  are  usually  behind  each  other,  and  are  about  aline  apart;  and 
the  canals  and  orifices  are  lined  by  a  fine  membrane  which  is  continuous 
with  the  skin,  the  latter  being  closely  adherent  at  this  part. 

The  length  of  the  teats  varies  with  use  ;  the  elastic  or  dartoid  tissues 
surrounding  them,  composed  of  non-striated  circular  and  longitudinal 
fibres,  renders  them  capable  of  a  kind  of  erection,  under  the  influence  of 
stimuli.  The  extremity  of  the  teat  is  well  provided  with  this  tissue,  which 
acts  as  a  sphincter,  and  prevents  the  passive  flow  of  the  milk. 

Connective  tissue,  blood-vessels,  nerves,  and  absorbents  complete  the 
organization  of  the  mammae.  The  arteries  are  given  off  from  the  external 
pudic  ;  the  veifis  are  of  two  orders — deep,  which  follow  the  arteries,  and 
superficial.     The  nerves  are  derived  from  the  renal  or  mesenteric  plexus. 

As  before  mentioned,  the  mammae  undergo  remarkable  modifications  at 
the  age  of  puberty  and  the  termination  of  gestation  ;  and  these  changes 
have  reference  not  only  to  their  volume  and  secretion,  but  also  to  their 
minute  structure.  In  the  young  or  virgin  Mare,  they  are  hard,  and  can 
scarcely  be  perceived  ;  and  their  dimensions  are  not  much  increased 
in  those  which  have  had  only  one  or  two  foals,  though  the  teats  are  usually 
larger  than  before  ;  but  when  they  have  borne  several  foals,  the  mammae 
continue  somewhat  enlarged  and  pendulous.  When  gestation  is  not 
going  on,  the  glandular  cul-de-sacs  are  contracted  and  wasted-looking  ; 
the  lining  membrane  is  shrivelled  on  itself,  and  covered  with  only  a 
polygonal  epithelium.  At  the  termination  of  gestation,  however,  the 
mammae  assume  the  functions  of  the  uterus  to  a  certain  extent ;  the 
vesicles  become  enlarged,  and  new  ones  are  developed  ;  the  epithelium 
presents  a  spherical  shape,  is  charged  with  fat  granules,  and  fills  the  acini ; 
the  entire  gland  has  become  progressively,  but  greatly  increased  in  size, 
and  instead  of  being  soft  to  the  touch,  it  now  feels  firm.  Shortly  before 
parturition  the  secretion  of  milk  commences,  and  soon  after  that  event  the 
glandular  cavities  become  fully  distended,  and  assume  their  maximum 
dimensions,  which  are  maintained,  with  slight  variations,  during  the  entire 
period  of  lactation.  When  this  period  is  terminated,  the  secretion 
gradually  ceases^  and  the  gland  again  assumes  its  quiescent  condition, 
and  nearly  its  ordinary  size.* 

Differences  in  other  Animals 

Cow. 

In  the  Cow  the  mammae  are  also  inguinal,  as  in  the  Mare,  and  each  lat- 
eral mass,  although  enveloped  in  a  single  fibrous  capsule,  is  made  up  of 
two  quite  distinct  glands — or  '"  quarters,"  as  the3^  are  commonly  termed — 
and  which  can  be  seen,  or  felt  as  limited  by  a  slight  depression.  Each 
gland  has  its  corresponding  teat,  much  more  developed  than  that  of  the 
Mare  ;  so  that  this  animal  really  possesses  four  mammae  and  four  teats. 
The  glands  are  compacted  into  a  roundish  mass,  which  is  more  or  less 
pendulous  when  they  are  in  active  function  ;  in  the  centre  of  each,  and 
at  the  base  of  the  teat,  there  is  a  single  large  galactophorous  sinus,  which 
is  the  general  confluent  of  all  the  lactiferous  ducts,  and  which  opens  ex- 
ternally through  the  teat  by  a  single  excretory  canal.    This  canal  is  widest 

*  In  the  male  we  find  rudimentary  teats,  which  are  concealed  within  the  prominent  annular  fold  of 
integument  towards  the  extremity  of  the  prepuce.  They  are  not  always  present,  however ;  though  they 
are  so  in  the  Ass,  which  has  them  largely  developed. 

3 


34 


OBSTETRICAL  ANATOMY. 


at  its  commencement,  and  narrow  at  its  termination  at  the  end  of  the  teat. 
The  walls  of  the  latter  are  very  thick,  elastic,  and  retractile.  Not  infre- 
quently, there  are  found  behind  the  four  teats  one  or  two  rudimentary 
teats,  which  are  generally  imperforate  ;  though  in  very  rare  instances  they 
have  been  observed  to  be  perforate  and  to  yield  milk. 

The  teats  of  the  Cow  are  generally  from  two  and  a  half  to  three  and  a 
half  inches  in  length,  and,  as  has  been  said,  this  length  varies  according 
as  the  animal  has  reared  a  large  or  small  number  of  calves.  The  two  an- 
terior are  generally  the  longest,  and  the  corresponding  quarters  furnish 
more  milk  than  the  others.  The  dartoid  tissue  around  the  free  extremity 
of  the  teat,  acting  as  a  sphincter,  prevents  the  passive  escape  of  the  milk 
from  the  orifices  of  the  excretory  ducts  ;  for  if  a  small  canula,  scarcely 
larger  than  one  of  these  ducts,  be  inserted  slightly  beyond  the  orifice,  the 
secretion  immediately  flows.  And  when  the  end  of  a  teat  has  been 
incised,  or  when  the  elastic  tissue  of  this  part  has  been  divided  in  the 
performance  of  some  operation,  there  is  no  longer  any  obstacle  to  the 
emission  of  the  milk. 

The  arteries  that  supply  the  mammae  of  the  Cow  with  blood  are  derived 
from  the  external  pudic.  The  branch  of  each  side,  on  reaching  the  lateral 
glands,  divides  into  two  principal  trunks,  one  6i  which  goes  to  a  corre- 
sponding quarter :  that  which  is  destined  for  the  posterior  gland  bends  at 
a  right  angle  backwards,  the  branch  for  the  anterior  quarter — the  largest 
— descending  perpendicularly,  to  become  subdivided  into  numerous  ra- 
muscules  and  terminal  twigs.  The  veins  and  nerves  are  derived  as  in  the 
Mare. 

In  the  Cow,  the  secretion  of  milk  can  be  excited  and  maintained  by 
regular  "  milking,"  the  only  suspension  occurring  before  the  birth  of  an- 
other calf. 

Sheep  and  Goat. 

In  the  Sheep  and  Goat  there  are  only  two  mammai,  as  in  the  Mare  and 
Ass,  though  they  are  formed  on  the  same  plan  as  in  the  Cow.  They  are 
also  inguinal,  somewhat  hemispherical  and  voluminous,  particularly  in  the 


A 


A,  Lobule  of  the  Mammae  filled  with  Milk ;  B,  Milk 
Globules  ;  C,  Colostrum:  a,  Cell  with  a  visible 
Nucleus ;  b,  Cells  from  which  the  Nucleus  has 
disappeared. 


Fig.  14. 
Section  of  the  Cow's  Teat. 
Principal    Lactiferous    Ducts ;    b. 
Lactiferous  Sinus  ;   c  c,    Acini ;  d, 
Elastic  or   Dartoid    Tissue   of  the 
Teat ;  e,  Orifice  of  the  Teat. 


INTERNAL  ORGANS  OF  GENERATION.  35 

Goat,  and  each  is  provided  with  a  single  conical,  well-detached  teat.  The 
latter  animal  has  sometimes,  in  addition,  two  posterior  rudimentary  teats, 
and  the  galactophorous  sinus  of  each  ordinary  teat  in  this  animal  is  very 
large,  the  walls  of  the  teat  being  thin  ;  it  is  capable  of  containing,  in  some 
instances,  nearly  three  ounces  of  milk. 

Pig. 

In  the  Pig  the  mammae  are  ten  or  twelve  in  number,  disposed  by  pairs 
in  two  parallel  rows  extending  from  the  inguinal  region  to  beneath  the 
thorax,  and  distinguished  as  inguinal^  abdominal,  and  thoracic  mammae. 
They  have  not,  as  in  the  larger  animals,  any  sinuses  ;  the  lactiferous  canals 
of  each  teat  joining  directly  to  form  a  variable  number  of  excretory  ducts, 
which  open  at  the  free  extremity  of  the  teat  by  from  five  to  ten  orifices. 
The  limits  of  each  gland  is  denoted,  externally,  by  a  slight  vertical  de- 
pression, and  a  trifling  convexity  corresponding  to  the  teat. 

The  mammae  of  this  animal  are  scarcely  perceptible  while  they  are  not 
active  ;  but  during  lactation  they  form  two  series  of  well-developed  emi- 
nences, divided  on  the  middle  line  by  a  wide  and  deep  furrow. 

Bitch. 

In  the  Bitch  there  are  eight  to  ten  mammae,  arranged  as  in  the  Pig. 
When  the  latter  number  is  present  they  are  disposed  on  each  side  as  two 
pectoral,  two  abdominal,  and  one  inguinal. 

The  secretion  of  milk  is  a  special  function  of  the  mammary  glands,  and 
takes  place  in  the  caecal  vesicles  of  the  lobules.  The  fluid  is  conveyed 
from  these  into  the  lactiferous  ducts  and  sinuses,  where  it  is  stored  until 
^a  certain  period:  this  retention  after  a  time  distending  the  glands  very 
much,  and  putting  the  elastic  envelope  greatly  on  the  stretch  ;  while  the 
teat  also  increases  in  size,  length,  and  firmness.  When  this  distention 
becomes  inordinate,  it  causes  the  animal  uneasiness  and  pain  ;  and  if 
not  relieved  by  natural  or  artificial  means,  it  may  occasion  mischief. 
The  pressure  of  the  envelope  on  the  contained  fluid  in  the  majority 
of  cases  overcomes  the  resistance  of  the  sphincter  at  the  end  of  the  teat, 
and  relief  is  in  this  way  afforded. 


CHAPTER  III. 

Internal  Organs  of  Generation. 

The  internal  ox  formative  organs  of  generation  are  contained  within  the 
pelvis  and  abdomen,  and  comprise  the  vagina  (which  some  writers 
include  with  the  external  organs),  icterus,  Fallopian  tubes,  and  ovaries. 

SECTION    I. THE   VAGINA. 

The  VAGINA  is  a  musculo-membranous  canal  of  variable  dimensions, 
with  thin  walls  ;  it  extends  almost  horizontally  within  the  pelvic  cavity, 
from  the  vulva  posteriorly  to  the  uterus  anteriorly,  the  cervix  or  neck  of 
which  it  embraces  in  a  kind  of  semicircular  cul-de-sac.  The  rectum  lies 
above  it,  and  the  bladder  below  ;  on  each  side  are  the  ureters  and  the 
walls  of  the  pelvis,  and  posteriorly  it  is  surrounded  by  adipose  and  loose 


36 


OBSTETRICAL  ANA  TOMY. 


connective  tissue.  When  distended  it  is  cylindrical  in  form,  but  usually 
its  sides  are  in  contact.  Its  length  is  variable  of  course,  but  in  a  full- 
sized  Mare  it  is  about  a  foot  long.  It  is  maintained  in  its  position  ante- 
riorly by  folds  of  peritoneum,  which  attach  it  to  the  rectum  above  and  to 
the  bladder  beneath,  the  attachment  to  the  rectum  being  accomplished 
through  the  medium  of  the  loose  connective  tissue  referred  to.     But  this 


Fig.  15. 

Generative  Organs  of  the  Mare:  Isolated  and  Partly  Opened. 

,  Ovaries;  2,  2,  Fallopian  Tubes;  3,  Pavilion  of  the  Tube,  External  Face  ;  4,  Ibid., 
Inner  Face,  Showing  the  Opening  in  the  Middle  ;  5,  Ligament  of  the  Ovary  ;  6,  Intact 
Horn  of  the  Uterus  ;  7,  A  Horn  Opened  ;  8,  Body  of  the  Uterus,  Upper  Face ;  9, 
Broad  Ligament ;  10,  Cervix,  with  its  Numerous  Folds  ;  11,  Cul-de-sac  of  the  Vagina  ; 
12,  Interior  of  the  Vagina,  with  its  Folds  of  Mucous  Membrane  ;  13,  Urinary  Meatus 
and  its  Valve  ;  17,  Clitoris  ;  18,  18,  Labia  of  the  Vulva ;  19,  Inferior  Commissure  of 
the  Vulva. 


V 


INTERNAL  ORGANS  OF  GENERATION.  37 

tissue,  which  also  unites  it  to  the  bladder,  is  here  close  and  firm,  and 
this  fact  may  serve  to  explain  why  the  rectum  is  so  rarely  involved 
in  displacements  of  the  uterus  ;  while  the  bladder  is  always  more  or  less 
so.  Laterally,  it  is  attached  to  the  muscular  and  aponeurotic  structures 
in  the  cavity  of  the  pelvis.  Internally^  it  is  lined  by  a  thin  mucous 
membrane,  which  is  always  abundantly  covered  with  mucus  (in  women 
this  mucus  is  acid,  while  that  of  the  uterus  is  alkaline),  and  is  disposed 
(in  the  Mare)  in  longitudinal  rugse,  which  are  more  conspicuous  after 
several  births.  These  rugae  no  doubt  favor  the  dilatation  of  the  canal 
during  coitus  or  the  passage  of  the  fcetus  ;  a  transverse  ridge,  already 
described  as  existing  on  the  lower  face  of  the  canal,  covers  the  meatus. 
This  membrane  is  continuous  with  that  of  the  vulva,  and  anteriorly,  at 
the  cul-de-sac,  it  is  reflected  over  the  cervix  of  the  uterus,  which  projects, 
like  a  cauliflower  in  shape,  into  the  cavity.  It  is  provided  with  papillae, 
and  covered  with  pavement  epithelium.  It  usually  has  a  pale  pink  hue, 
but  at  the  period  of  oestrum  its  color  becomes  heightened  to  a  bright 
red,  and  its  secretion  is  considerably  increased. 

Externally,  the  vagina  is  invested  by  a  muscular  coat  which  is  en- 
veloped by  an  abundant  layer  of  connective  tissue,  and  traversed  by  a 
large  number  of  blood-vessels  ;  in  front,  however,  this  tunic  is  invested  in 
peritoneal  membrane,  which  is  folded  in  a  circular  manner  around  it 
to  pass  over  the  uterus. 

The  vagina  is  supplied  with  blood  by  the  internal  pudic  artery;  its 
veins  are  disposed  as  a  plexus  around  it,  and  terminate  in  the  satellite 
trunk  of  the  artery.  The  vagina  serves  for  copulation  and  the  passage 
of  the  foetus.     At  the  periods  of  oestrum  and  parturition,    the  mucous 

''secretion  is  more  active  than  at  other  times.  In  youth  it  is  contracted  ; 
after  copulation  its  dimensions  are  increased,  and  these  are  greatest  dur- 
ing parturition.  In  old  age  it  is  much  diminished  ;  in  the  third  or  fourth 
months  of  gestation  in  the  larger  animals,  it  becomes  elongated  from  dis- 

gjlacement  of  the  uterus,  which  is  carried  farther  forward  into  the  abdomi- 
nal cavity;  towards  the  termination  "of  this  process,  its  length  diminishes 
as  the  uterus  acquires  increased  volume,  and  to  such  an  extent  does  this 
occur,  that  at  the  commencement  of  parturition,  if  the  fcetus  is  large,  and 
especially  if  there  be  two  foetuses,  the  posterior  wall  of  that  receptacle, 
pushed  back  into  the  pelvis,  nearly  or  entirely  effaces  the  cavity  of  the 
vagina,  and  even  in  some  instances  thrusts  it  between  the  labia  of  the 
vulva  or  beyond. 

Differences. 
Cow,  Sheep,  and  Goat. 

In  the  Cow,  the  canal  is  longer  and  wider  than  in  the  Mare ;  the  mu- 
cous membrane  of  the  vagina  is  thicker,  is  disposed  in  transverse  rugai 
as  in  the  human  species,  and  at  each  side  of  the  passage  for  a  certain 
distance,  between  the  mucous  and  muscular  layers,  there  exists  a  mucous 
canal  that  opens  into  the  vulvular  cavity,  in  front  of,  and  at  the  side  of 
the  meatus. 

The  uses  of  these  canals,  which  are  not  present  in  the  Sheep  or  Goat, 
and  rarely  in  the  Mare,  and  which  are  usually  known  as  the  "  canals  of 
Gaertner,"  are  unknown.  They  pass  backwards  into  the  broad  ligaments 
of  the  uterus,  and  terminate  in  a  cul-de-sac.  They  have  some  function 
during  foetal  life. 


J 


3B  OBSTETRICAL  ANATOMY. 

Pig. 

In  the  Pig  these  canals  are  present;  the  folds  of  mucous  membrane 
are  longitudinal,  and  gradually  subside  towards  the  line  of  separation  be- 
tween the  vagina  and  vulva.  The  vagina  is  from  eight  to  nine  inches 
long. 

Bitch  and  Cat. 

There  are  no  "  Gaertner's  canals  "  in  the  Bitch  or  Cat.  The  vagina  is 
of  comparatively  great  length,  and  has  longitudinal  rugae,  which  are  in- 
terrupted by  transverse  folds.  In  both  animals  the  canal  is  wider  towards 
the  vulva  than  the  uterus,  and  its  walls  are  rendered  very  thick  by  white 
fibrous  tissue,  in  addition  to  the  non-striated  muscular  fibres  it  contains. 

SECTION    II. — THE   UTERUS. 

The  UTERUS,  or  womb  (Figs.  12,  i  ;  15,  8),  is  an  elongated  musculo- 
membranous  sac  which  receives  the  ovum,  and  constitutes  the  receptacle 
for  the  nutrition,  maturation,  and,  finally,  after  a  certain  period,  for  the 
expulsion  of  the  foetus.  It  is  situated  in  the  sub-lumbar  region  of  the 
abdomen,  towards  the  inlet  of  the  pelvic  cavity,  into  which  its  posterior 
extremity  enters.  This  portion — the  body — represents  a  simple  cylindri- 
cal reservoir,  slightly  flattened  from  above  to  below,  while  the  anterior 
part  is  bifid  ;  and  the  two  divisions — the  cornua  or  hortis — curve  upwards 
and  forwards.  The  body  is  situated  horizontally  beneath  the  rectum, 
which  is  in  contact  with  it  after  passing  between  the  two  cornua  ;  on 
each  side  of  its  upper  external  face  it  receives  the  insertions  of  wide  lig- 
aments ;  and  its  sides  and  anterior  face  are  in  contact  with  the  intestines. 
Its  lower  surface  is  in  contact  with  the  bladder  and  the  pelvic  curvature 
of  the  colon  ;  while  its  anterior  extremity  is  continuous  with  each  of  the 
cornua,  and  the  posterior  is  separated  from  the  vagina  by  the  constriction 
named  ^the  col^  cervix,  or  neck  of  the  uterus.  The  cornua  are  cylindrical 
bodies,  and,  lodged  among  the  intestines  occupying  this  region,  proceeck 
at  an  angle  from  the  body  in  an  upward  direction,  describing  two  curves  ; 
an  inferior,  convex,  which  is  free  ;  and  a  superior,  concave,  to  which  the 
suspensory  ligaments  are  attached.  Each  horn  has  also  a  posterior  ex- 
tremity or  base,  a  continuation  of  the  body  of  the  organ  ;  and  an  anterior 
or  summit  rounded  into  a  cul-de-sac  which  is  turned  upwards,  and  has  at 
the  bottom  a  small  tubercle,  the  insertion  of  the  oviduct. 

Floating  in  the  abdominal  cavity,  like  the  intestines,  the  uterus  is  also 
attached,  as  they  are,  by  two  membranous  bands  which  suspend  them  from 
the  sub-lumbar  region,  and  are  consequently  designated  the  broad  ox  sus- 
pensory ligaments  of  the  uterus  ;  also,  from  the  general  resemblance  to  the 
wings  of  a  bat,  the  ala  vespertilionis.  These  bands,  derived  from  the 
peritoneum  of  the  abdomen,  are  larger  in  front  than  behind,  and  in  shape 
are  irregularly  triangular  ;  behind,  they  are  close  to  each  other,  but  in 
front  diverge  like  the  sides  of  the  letter  V.  They  descend  from  the 
lower  face  of  the  lumbar  region,  and  attach  themselves  by  their  inferior 
border  to  the  sides  of  the  upper  face  of  the  body  and  the  smaller  curva- 
ture of  the  cornua  ;  their  anterior  border  is  free  and  sustains  the  oviducts 
and  ovaries,  the  first  being  included  between  the  two  layers  of  the  liga- 
ment, while  the  ovary,  placed  within  it,  also  receives  a  layer  detached 
from  the  principal  one,  which  with  it  forms  a  little  cup-shaped  cavity. 
Another  small,  long,  and  narrow  band  of  peritoneum  is  observed  exter- 
nal to  the  broad  ligament ;  this  can  be  traced  posteriorly  to  the  internal 


INTERNAL  ORGANS  OF  GENERATION. 


39 


inguinal  ring,  and  anteriorly  it  presents  a  little  enlarged  appendix.  Be- 
tween the  two  layers  composing  this  band,  is  a  thin  muscle  similar  to  the 
cremaster  of  the  male  before  the  descent  of  the  testicle  into  the  scrotum  ; 
this  band  is  the  analogue  of  the  round  ligament  in  woman.  The  uterus 
is  also  maintained  in  its  position  by  the  vagina  posteriorly,  and  by  the 
peritoneum  which  at  this  part  forms  four  bands — the  redo-iiterine  and 
vesico-uterine. 

The  interior  of  the  uterus  is  divided  into  three  compartments,  corre- 
sponding to  its  divisions  into  body  and  cornua.  The  cavity  of  the  body 
communicates  with  the  vagina  by  a  narrow  canal  which  traverses  the  aon- 
striction  or  cervix  of  the  uterus,  and  is  designated  the  caiial  of  the  cervix. 
In  all  the  domesticated  animals,  except  the  Rabbit,  this  canal  is  pro- 
longed into  the  anterior  extremity  of  the  vaginal  cavity  like  the  end  of  a 
tap  into  a  barrel  j  forming  a  very  marked  protrusion — the  cervix.  In 
this  is  the  opening  {orificium  uteri  externum)  leading  from  the  vagina  to 
the  body  of  the  uterus — the  os  uteri  or  os  tincce ;  around  this  aperture 
the  utero-vaginal  lining  membrane  is  curiously  arranged  in  transverse 
rugae  disposed  in  a  circular  manner,  and  which  gives  to  this  prominent 
part  the  appearance  of  a  radiating  flower.  In  woman  the  rugae  of  the 
canal  are  differently  disposed,  and  resemble  the  branches  from  the  stem 
of  a  tree  ;  consequently,  they  have  been  named  the  arbor  vita  uterina. 

The  uterus  is  composed  of  three  membranes — an  external^  or  serous ; 
a  middle,  or  muscular ;  and  an  internal,  or  mucous  tunic.  The  serous  or 
peritoneal  membrane  envelops  all  the  organ,  and  is  in  reality  only  an  ex- 
pansion of  the  broad  ligainents  which  are  prolonged  backwards  on  the 
posterior  extremity  of  the  vagina,  which  they  encircle  and  then  pass  to 
'  the  rectum  and  bladder,  as  well  as  to  the  lateral  parietes  of  the  pelvis, 
constituting  the  four  ligaments  already  referred  to.  Between  the  two 
cornua  this  membrane  forms  a  peculiar  frasnum,  which  is  very  developed 
in  solipeds.  Owing  to  this  arrangement,  the  cervix  does  not  receive  any 
peritoneal  covering.  The  muscular  layer  is  composed  of  longitudinal  and 
circular  fibres,  analogous  to  those  of  the  small  intestines.  At  the  insertions 
of  the  broad  ligaments  into  the  uterus,  a  series  of  fasciculi  are  given  off 
from  this  layer,  which  pass  up  between  the  folds  composing  them,  and 
have  been  found  throughout  their  extent,  especially  towards  the  ovaries. 
The  fibres  composing  this  coat  belong  to  the  class  of  non-striated  or  in- 
voluntary muscles,  being  made  up  of  fusiform  nucleated  fibres  lodged  in 
a  matrix  of  exceedingly  coherent  granular  matter.  The  appearance  of 
this  coat  is  different  to  that  of  ordinary  muscle,- being  much  more  dense 
and  of  a  faint  yellowish-red  hue,  like  the  middle  coat  of  arteries  or  the 
small  intestines.  The  superficial  set  of  fibres  are  irregularly  longitudinal 
in  their  direction,  and  frequently  interlace  with  each  other  ;  the  deep  set 
is  circular,  especially  around  the  orifice  of  each  oviduct  and  the  os  uteri, 
where  they  are  thick  and  close  ;  though  even  among  these  fibres  irregu- 
lar fasciculi  pass  in  different  directions.  Both  layers  are  thicker  in  the 
cornua  than  the  body ;  their  obvious  function  is  to  diminish  the  volume 
of  the  uterus  during  parturition. 

At  an  early  period  of  life  these  fibres  are  perceptible,  but  during  gesta- 
tion they  are  greatly  increased,  and  present  a  manifest  striation.  Their 
increase  is  doubtless  to  permit  the  necessary  dilatation  of  the  uterus,  with- 
out allowing  its  parietes  to  become  too  attenuated  and  feeble ;  though  to 
some  extent  they  do  diminish  in  thickness,  according  to  the  species.  The 
inner  set  are  but  loosely  adherent  to  the  lining  or  mucous  membrane  of  the 


40  OBSTETRICAL  ANATOMY. 

uterus.  A  rich  venous  network  is  lodged  in  the  muscular  tunic  of  this 
organ. 

The  mucous  layer  is  a  thin,  delicate,  pulpy  membrane,  covered  by  ciliated 
columnar  epithelium  in  the  body  and  cornua  of  the  organ,  ordinary  cylin- 
drical squamous  or  stratified  epithelium  in  the  canal  of  the  cervix,  like 
that  on  the  intestines,  and  tessellated  or  squamous  on  the  rugae  of  the  cer- 
vix. This  differs  from  ordinary  mucous  membrane  in  the  presence  of  a 
very  delicate  sub-mucous  connective  tissue,  in  which  the  utricular  glands, 
blood  and  lymph  vessels,  as  well  as  nerves  supplying  the  membrane,  are 
situated  ;  for  this  reason  its  appears  to  receive  its  vascular  supply  directly 
from  the  muscular  coat,  it  vessels  being  continuous  with  those  of  that 
layer.  This  difference  is  probably  related  to  its  irregular,  though  higher, 
organizing  function. 

On  the  cervix,  the  basement  membrane  covers  multitudes  of  villi,  the 
points  of  which  in  woman  are  nipple-shaped,  with  a  depression  in  the 
centre  ;  within  the  cervix  these  villi  are  very  large,  but  in  the  body  of  the 
organ  there  are  no  villi.  The  membrane  here  is  remarkable  for  the  series 
of  longitudinal  rugae  formed  on  it,  and  which  are  not  effaced  by  ordinary 
distention  of  the  organ  ;  though  they  disappear  during  the  increase  in 
size  of  its  cavity  in  pregnancy.  On  these  rugae  and  in  the  fossae  between 
them,  particularly  towards  the  cervix,  are  a  great  number  of  simple  mucus 
and  special  cylindrical  glands.  The  first  are  particularly  abundant  towards 
the  cervix  ;  some  here  and  there  have  closed  mouths,  are  enlarged,  and 
form  small  vesicular  prominences,  which  have  been  named  the  "  ova  of 
Naboth  "  {ovula  Nabotht),  from  their  supposed  identity  with  the  ovarian 
ova. 

The  cylindrical,  uterine,  or  utricular  glands  {glandulce  utriculares),  are 
situated  close  to  each  other  ;  they  are  sometimes  bifurcated,  frequently 
spiral,  and  terminate  in  a  cul-de-sac  in  the  substance  of  the  mucous  mem- 
brane, something  like  the  agminate  glands.  In  the  Mare  they  are  long, 
slender,  and  tortuous,  and  divide  repeatedly  in  the  deeper  part  of  the 
mucosa,  and  in  such  a  manner  that  numerous  branching  tubes  are  con- 
nected with  a  single  stem  or  gland-duct.  They  are  lined  by  columnar 
cells,  which  project  vertically  into  the  gland  tube  ;  these  cells  have  a  ciliary 
movement.  The  utricular  glands  do  not  exist  at  birth,  and  it  is  probable 
that  they  are  only  fully  developed  when  sexual  maturity  is  reached.  At 
certain  periods,  as  during  cestrum,  they  throw  out  a  large  quantity  of  very 
viscid,  almost  transparent,  mucus.  They  are  secreting  structures,  and 
during  gestation  play  a  most  important  part,  becoming  largely  developed, 
and  furnishing  a  thin,  white,  albuminous  fluid,  the  so-called"  uterine  milk." 
This  secretion  comes  more  particularly  in  contact  with  the  intervillous 
portions  of  the  foetal  placenta,  in  which  are  curious  pockets  that  act  as 
receptacles  for  this  milk,  which  is  absorbed  by  the  vessels  on  their  walls. 

The  uterus  is  supplied  with  blood  by  the  uterine  and  utero-ovarian  arter- 
ies^ which  arise  from  the  posterior  aorta,  and  passing  between  the  layers  of 
the  broad  ligament  reach  the  uterus.  The  first  divides  into  two  branches 
— an  ovarian  and  a  uterine  ;  the  former  is  very  flexuous  and  goes  to  the 
ovary,  while  the  second  passes  to  the  cornua  of  the  uterus,  where  its  ulti- 
mate divisions  anastomose  with  those  of  the  proper  uterine  artery.  This 
vessel,  on  reaching  the  smaller  curvature  of  the  cornua,  also  divides  into 
two  portions — an  anterior,  anastomosing  its  branches  with  the  utero- 
ovarian  ;  and  a  posterior,  spreading  over  the  body  of  the  organ  and  com- 
municating with   the  vaginal  artery.     The  blood  is  conveyed  from  the 


INTERNAL  ORGANS  OF  GENERA  TION 


41 


uterus  by  corresponding  veins,  which  are  more  numerous  than  the  arteries, 
and  are  capable  of  great  distention.  They  have  no  valves.  In  animals 
which  have  bred  frequently,  the  vessels  are  greatly  enlarged  and  very 
flexuous  ;  indeed,  from  an  early  period  the  arteries  are  remarkable  for 
their  large  size,  their  tortuous  course,  and  their  frequent  anastomoses  ; 
while  the  considerable  calibre  of  the  veins,  which  have  no  valves,  is  as 
conspicuous  as  the  complex  networks  they  form. 

The  lymphatic  vessels  issuing  from  the  organ  are  as  remarkable  for  their 
large  size  as  their  number  ;  they  all  proceed  towards  the  sub- lumbar 
region. 

The  nerves  are  derived  from  the  small  mesenteric  and  pelvic  plexuses. 

Differences. 

Cow. 

The  uterus  of  the  Cow,  with  regard  to  its  general  disposition  in  the 
pelvic  and  abdominal  cavities,  does  not  offer  any  striking  differences 
from  that  of  the  Mare,  except  that  the  body  is  short,  and  it  does  not 
extend  so  far  into  the  latter  cavity.  If  the  uterus  was  perfectly  horizontal, 
a  transverse  line  drawn  across  the  abdomen,  in  front  of  the  external  angle 
of  the  ilium,  would  be  exceeded  to  the  extent  of  some  one  and  a  half  to 
two  inches  by  the  extremities  of  the  cornua  ;  so  that  if  the  animal  were 
placed  on  its  back,  the  uterus  would  only  be  found  to  reach  to  the  fourth 
or  fifth  lumbar  vertebra. 

With  regard  to  shape,  however,  the  uterus  of  this  animal  offers  some 
noteworthy  features.  For  instance,  the  concave  curvatures  of  the  cornua 
look  downwards,  whereas  in  the  Mare  they  are  in  the  opposite  direction  ; 
though  in  both  the  broad  ligaments  are  attached  to  this  concavity.  The 
consequence  is,  that  in  the  Cow,  if  the  uterus  be  considered  as  freely 
suspended  in  the  cavity  of  the  abdomen,  the  extremity  of  the  horn  is 
twisted  outwards  and  upwards  ;  while  its  base  near  the  body  of  the  organ, 
although  drawn  in  the  same  direction  by  the  ligaments,  yet  retains  its 
position,  being  firmly  maintained  in  it  by  the  body  of  the  uterus,  which 
also  receives  the  insertion  of  the  broad  ligaments  on  its  lower  plane. 
This  insertion  causes  the  uterus  to  project  above  them  ;  while  in  the 
Mare,  in  which  the  ligaments  are  inserted  at  the  upper  part  of  the  body, 
the  uterus  projects  below  them.  In  the  Cow  these  ligaments  are  very 
extensive,  particularly  at  their  anterior  border,  and  widely  separated  from 
one  another  in  front  near  their  lumbar  attachment,  which  is  prolonged  as 
far  as  the  flank.  The  ligaments,  taken  as  a  whole,  may  be  compared  to 
a  triangular  sheet,  one  angle  of  which  is  fixed  to  the  floor  of  the  pelvis, 
and  the  other  two  to  the  tuberosities  of  the  ilia  ;  on  this  sheet  rests  the 
body  of  the  uterus  and  a  portion  of  the  cornua. 

The  cornua  are  thin  and  tapering  at  their  anterior  extremity,  and  the 
body  is  short  and  narrow  ;  while  the  interior  of.  the  uterus  is  not  so  ample 
as  in  the  Mare.  Here  it  offers  a  peculiarity  which  is  not  observed  in  the 
latter  animal,  the  carnivora,  nor  the  Pig,  in  the  presence  of  rounded 
smooth  prominences,  named  cartmcles  or  cotyledofial  processes  {placefitce 
uterince),  which  increase  in  number  with  the  size  of  the  species.  These 
maternal  cotyledons  are  most  numerous  in  the  cornua,  and  few  and  small 
in  the  body  of  the  uterus  ;  in  volume  they  are  about  the  size  of  a  pea  or 
haricot-bean  in  calves ;  at  a  later  period  they  have  acquired  the  dimen- 


42 


OBSTETRICAL  ANATOMY. 


sions  of  a  button,  and  they  increase  largely  and  assume  variable  shapes 
during  gestation.  In  the  Cow  they  are  flat  or  slightly  convex  on  the 
top,  but  concave  in  the  Sheep  and  Goat,  and  their  color  is  usually  pale  ; 
after  conception,  however,  they  become  red  from  the  affluence  of  blood 
to  them.  They  are  intended  for  the  implantation  of  similar  processes 
existing  on  one  of  foetal  membranes,  the  chorion,  and  will  be  noticed 
more  fully  hereafter.  It  may  be  sufficient  now  to  mention  that  their 
number  in  the  calf  sometimes  amounts  to  thirty  or  forty ;  and  after  par- 
turition there  have  been  counted  as  many  as  from  eighty  to  one  hundred 
and  twenty.  Each  is  attached  to  the  mucous  membrane  by  a  narrow 
pedicle,  and  in  removing  the  foetal  placenta  after  parturition,  care  has  to 
be  taken  not  to  tear  them  off. 


Fig.  16. 
A,  Utricular  Gland  cf  a  pregnant  Goat. 


Fig.  17. 
B,  Utricular  Gland  of  a  pregnant  Cow. 


The  cervix  uteri  of  the  Cow  is  from  2}^  to  3^^  inches  in  length,  is  nar- 
row, almost  as  firm  as  cartilage  in  texture,  and  irregular  ;  the  mucous 
membrane  is  more  finely  plicated  over  it  around  the  os  tiiica.  than  in  the 
Mare.  The  fibres  composing  the  cervix  are  divergent  and  circular.  At 
an  early  age  this  part  is  nearly  circular  in  shape,  and  the  body  of  the 
uterus  is  so  small  that  the  cervix  and  cornua  are  close,  or  joined  to  each 
other  at  their  origin  from  it.  Towards  puberty,  however,  in  all  the  larger 
domesticated  animals,  it  becomes  fusiform,  and  shows  two  lips,  about 
two  inches  in  length — an  interior  and  posterior,  the  last  the  longest — 
which  are  pulpy  to  the  touch  ;  these  lips  are  composed  of  flattened,  dense, 
transverse  fibres.  The  orifice  or  os  uteri  is  either  circular  or  elongated 
transversely,  and  corresponds  to  the  middle  of  the  posterior  part  of  the 
vaginal  cavity.  During  pregnancy  the  cervix  is  firm  and  tense,  and  ap- 
pears to  become  shortened  in  animals  which  have  had  young  several 
times.  The  folds  of  mucous  membrane  which  we  have  described  as  ex- 
isting in  its  interior  and  around  the  os,  permit  its  dilatation  during  the 
passage  of  the  foetus.     A  knowledge  of  the  presence  of  the  two   lips  of 


INTERNAL  ORGANS  OF  GENERATION  43 

the  cervix,  and  their  position,  is  useful  when  explorations  by  hand  are 
necessary  in  cases  of  inversion  of  the  uterus. 

The  utricular  glands  are  wider  than  in  the  Mare,  and  have  lateral 
diverticuli. 

The  muscular  tunic  altogether  is  thicker  in  the  Cow  than  in  the  Mare  ; 
indeed,  the  walls  of  the  uterus  in  this  animal  are  more  dense  than  in  any 
of  the  domesticated  creatures,  the  muscles  having  a  red  tint,  and  being 
continued  well  into  the  broad  ligaments. 

Sheep  and  Goat. 

In  the  Sheep  and  Goat  the  disposition  of  the  uterus  is  similar  to  that 
of  the  Cow.     The  cornua  are  relatively  longer,  more  tortuous  and  pen- 


Fig.  18. 

Horizontal  Section  of  the  Upper  Surface  of  the  Mucous  Membrane, 
NEAR  TO  A  Cotyledon,  of  the  Uterus  of  a  non-gravid  Cow:  Magnified 
180  Diameters. 

rt,  Section  of  a  Utricular  Gland,  and  ai  its  Proper  Structure  ;  bb,  Mucous  Glands ;  cc, 
Adenoid  Tissue. 

dant,  and  expand  more  gradually  from  the  termination  of  the  oviducts  ; 
while  the  longitudinal  rugae  in  the  body  and  cervix  are  disposed  in  a  series 
of  transverse  folds  in  the  latter,  which  gives  them  the  appearance  of  so 
many  oratinccE.  The  cotyledons  we  have  mentioned  already  ;  they  are 
concave  in  their  centre  in  these  animals. 

Pig. 

In  the  Pig  the  uterine  cornua  are  long  and  tortuous,  and  flat  among 
the  intestines,  which  they  resemble  ;  the  body  of  the  uterus  is  short,  and 
the  numerous  irregular  ridges  on  the  inner  surface  of  the  cornua  gradu- 
ally subside  towards  the  cervix,  where  they  form  two  or  three  series  of 
thick,  soft  rugai.  The  os  uteri  is  marked  by  a  series  of  narrow,  close-set, 
longitudinal  laminae,  but  there  is  no  labial  or  valvular  projection  into  the 
vagina  ;  so  that  there  is  no  exact  limit  between  the  two  cavities.  The 
broad  ligaments  resemble  the  mesentery.  The  utricular  glands  divide 
repeatedly  in  the  deeper  parts  of  the  mucosa,  as  in  the  Mare. 

Bitch  and  Cat. 

In  the  Bitch  and  Cat  the  cornua  are  long,  slender,  straight,  and  slightly 
compressed,  with  a  number  of  flat  eminences  on  their  inner  surface. 
They  extend  to  the  lumbar  region,  and  unite  externally  for  nearly  two 
inches  before  they  join  the  corpus  uteri.     The  interior  of  the  latter  shows 


44 


OBSTETRICAL  ANATOMY. 


a  few  smooth  longitudinal  rugae,  and  the  os  uteri  is  a  smooth,  thick,  and 
even  prominence,  larger  almost  than  the  body  of  the  uterus,  which  is 
short.  It  projects  very  markedly  into  the  vagina.  The  utricular  glands 
are  pyriform ;  the  round  ligaments  escape  from  the  abdomen  by  the  in- 
guinal rings. 

Development. 

In  the  foetus  and  the  adult  animal  which  has  not  been  fecundated,  the 
uterus  is  comparatively  small,  narrow,  and  insignificant ;  but  it  increases 


Fig.  19. 

Uterus,  Oviducts,  and  Ovaria  of  the  Sheep. 

,  Vagina ;  b,  Os  Uteri ;  c,  Transverse  Folds  of  Cervix  Uteri  ;  d.  Body  of  Uterus ;  e  e, 
Caruncles  or  Cotyledonal  Processes  ;  _/,  Confluence  of  the  Cornua  ;  ^,  Intact  Comu  f 
k /t,  Oviducts  or  Fallopian  Tubes;  z /,  Fimbriae;  k  k.  Ovaries;  /,  Round  Ligament; 
m  m,  Broad  Ligaments  ;  n  n,  Cotyledons. 


in  volume  with  age  after  the  venereal  desires  become  manifest.  In  a  calf 
a  little  more  than  a  month  old,  the  total  length  from  the  vulva  to  the  ex- 
tremity of  the  cornua  was  about  ten  inches,  of  which  the  vagina  formed 
about  five-eighths.  In  the  lamb  the  uterus  and  vagina  only  measure  about 
six  inches  in  length.  From  this  period  until  the  animal  is  capable  of 
breeding,  the  uterus  receives  so  little  blood  that  it  may  be  removed  with- 
out much  risk. 

During  gestation  the  uterus  acquires  a  great  volume,  and  its  cavity, 
usually  less  than  that  of  the  vagina,  is  considerably  increased,  its  shape 
then  bearing  some  resemblance  to  one  of  the  large  intestines.  The  cor- 
nua vary  in  size,  according  to  the  dimensions  and  species  of  the  different 
animals.     In  those  which   are  uniparous    (one  foetusj,  as  the  Mare  and 


INTERNAL  ORGANS  OF  GENERA  TION.  45 

Cow,  they  are  short;  but  in  those  which  are  multiparous  (more  than  one 
foetus),  they  are  long  in  proportion  to  the  number  of  young  they  bear, 
while  the  body  is  diminished  in  length.  In  the  uniparous  animal  the  foetus 
is  developed  in  the  body  of  the  uterus,  and  its  posterior  extremities  only 
are  sometimes  engaged  in  one  of  the  cornua ;  but  in  the  multiparous 
females  the  cornua  resemble  the  intestines,  and  the  young  are  developed 
in  them,  the  body  of  the  uterus  seldom  containing  any.  In  the  Rabbit, 
indeed,  there  is  no  corpus  uteri,  the  cornua  opening  independently  and 
directly  into  the  vagina. 

As  gestation  proceeds,  the  uterus  of  course  increases  in  volume,  and 
pushing  the  pelvic  curvature  of  the  colon  forward  out  of  the  pelvic  cavity, 
it  gradually  descends  towards  the  floor  of  the  abdomen,  on  which  it  at 
length  rests,  towards  the  middle  line,  until  the  end  of  this  process.  Dur- 
ing this  change  of  position,  it  draws  with  it  the  cervix  and  the  vagina, 
which  becomes  notably  elongated,  and  even  the  vulva  is  carried  forwards 
until  it  appears  to  be  buried  between  the  ischiatic  tuberosities. 

After  parturition  the  uterus  gradually  diminishes  in  size,  and  some  of 
its  supplementary  structures  disappear  ;  but  it  never  resumes  its  previous 
volume. 

The  Hgaftients  of  the  uterus  suspend  it  loosely,  yet  securely,  in  the  ab- 
dominal cavity ;  and  while  allowing  it  a  certain  range  of  movement,  per- 
mit its  full  development  during  gestation.  At  this  period  they  become 
developed  in  a  peculiar  manner,  and,  as  we  have  seen,  between  their  la- 
minae appears  a  layer  of  muscular  fibres  ;  in  the  Cow  these  fibres  are 
arranged  in  fasciculi,  one  of  which,  larger  than  the  others,  extends  from 
the  ovary  to  the  cervix  uteri.  These  ligaments  would  also  appear  to 
stretch  considerably  in  version  or  inversion  of  the  uterus  in  the  her- 
bivorous animals  ;  even  in  the  carnivora  they  accompany  the  uterus  when 
hernia  takes  place  ;  and  in  the  torsions  of  this  organ  which  sometimes 
occur  in  the  herbivora,  when  its  upper  face  becomes  the  lower,  or  even 
when  it  has  made  a  complete  turn  upon  itself,  they  entangle  and  strangle 
the  uterus  at  the  cervix. 

SECTION    III. — FALLOPIAN    TUBES    OR    OVIDUCTS. 

The  Fallopian  tubes  or  oviducts  are  two  small,  cylindrical,  flexuous 
canals,  about  ten  inches  long,  white  in  appearance,  one  of  which  is  lodged 
in  each  broad  ligament  between  its  serous  layers,  and  near  its  anterior 
border.  Each  tube  commences  at  the  extremity  of  the  uterine  horn,  at  a 
small  hard  tubercle  in  its  cul-de-sac  {pstii^m  uterinum).  This  tubercle  is 
its  opening  into  the  horn,  and  from  this  it  proceeds,  more  or  less  tortu- 
ously, and  increasing  slightly  in  diameter,  towards  one  of  the  ovaries, 
upon  which  it  terminates  by  a  free,  widened  extremity  (ostium  abdominale) 
in  the  pavilion  of  the  tube.  The  calibre  of  this  canal  is  small,  and 
scarcely  admits  a  thin  straw  at  its  middle  portion,  and  it  is  still  smaller 
towards  the  uterine  extremity ;  as  it  approaches  the  ovary,  however,  it 
increases  in  width  until  it  ends  in  the  pavilion.  The  uterine  extremity 
of  the  canal  opens  through  the  small  hard  tubercle  just  referred  to  as 
existing  at  the  cul-de-sac  of  the  cornua.  The  ovarian  extremity  offers  in 
all  the  mammalia  a  peculiar  disposition.  It  opens  into  the  peritoneal 
cavity  of  the  abdomen  (the  only  instance  of  a  serous  cavity  communi- 
cating with  the  exterior),  near  the  ovarian  fissure,  in  the  middle  of  the 
pavilion,  which   is   also  named  \.\i%  fimbrica  tubarum,  or  morsus  diaboliy 


46  OBSTETRICAL  ANATOMY. 

from  its  fringed  or  dentated  border.  This  pavilion  is  fixed  to  the  ex- 
ternal side  of  the  ovary,  and  its  inner  surface  is  marked  by  numerous 
narrow,  close-set,  minutely  plicated  laminae,  while  its  circumference  is 
irregularly  disposed  into  a  number  of  unequal  prolongations  or  fringe 
(^fimbricE)  which  hangs  into  the  abdominal  cavity.  This  arrangement  is 
interesting,  from  the  fact  that  it  gives  us  a  unique  example  of  a  breach 
of  continuity  between  a  gland  (the  ovary)  and  its  excretory  canal  (the 
tube). 

Each  tube  is  composed  of  three  tunics  :  an  external  or  serous.^  formed 
by  the  broad  ligament;  a  middle  or  muscular,  constituted  by  longitudinal 
and  circular  non-striated  fibres,  continued  from  those  of  the  uterus, 
which  are  also  disseminated  in  the  pavilion  and  its  fimbriae ;  and  an 
internal  or  mucous,  which  exhibits  longitudinal  rugae  in  the  tube,  and 
radiated  in  the  pavilion ;  this  membrane  is  covered  by  ciliated  epithe- 
lium, and  its  villi  are  greatly  enlarged  after  impregnation.  It  ceases 
abruptly  at  the  margin  of  the  fimbriae,  where  it  meets  the  peritoneum. 

The  blood-vessels  supplying  the  Fallopian  tubes  are  derived  from  the 
ovarian  arteries,  and  their  nerves  are  from  the  great  sympathetic. 

T\v€\x  function  is  to  convey  the  spermatozoa  of  the  male  to  the  ovary 
in  the  first  instance,  and  afterwards  to  transmit  the  impregnated  ovum 
to  the  uterus  or  its  horn  ;  in  this  respect  they  are  the  excretory  ducts  of 
the  ovaries.  When  the  Graafian  vesicle  of  the  ovary  ruptures,  the  fim- 
briae of  the  tube  grasp  the  ovary,  and  receive  the  ovum,  which  they 
carry  to  the  ovarian  extremity  of  the  canal ;  this  act,  together  with  the 
application  of  the  pavilion  to  the  ovary,  takes  place  either  through  the 
contraction  of  the  non-striated  muscular  fibres  which  this  part  contains, 
or  from  the  swelling  of  the  bulb  of  the  ovary.  At  times,  however,  the 
act  is  not  properly  accomplished,  and  the  fecundated  ovum,  instead  of 
passing  into  the  uterine  cavity,  escapes  the  fimbriae  and  falls  into  the 
abdomen,  where  it  constitutes  that  most  remarkable  form  of  gestation 
termed  extra-uterine. 

Differences. 

Cow,  Sheep,  and  Goat. 

In  the  Cow,  Sheep,  and  Goat,  the  fimbriated  extremity  of  each  tube  is 
expanded  upon  the  outer  margin  of  the  ovarian  capsule  ;  the  inner  sur- 
face of  the  pavilion  is  beset  with  numerous  fine  oblique  striae,  and  is 
further  increased  by  narrow  folds  of  laminae  converging  toward  the  con- 
tracted opening  of  the  duct.  The  duct  itself  forms  three  or  four  wavy 
folds,  and  is  then  continued  along  the  walls  of  the  wide  ovarian  capsule 
to  the  extremity  of  the  uterine  horn,  which  makes  an  abrupt  curve  to 
meet  it. 

Pig- 
In  the  Pig  the  oviduct  has  but  few  or  no  inflexions,  but  its  length  is 
proportionately  greater  than  in  the  other  species.  The  pavilion  is  wide 
and  deep,  and  the  margin  of  its  abdominal  opening  is  almost  even  ;  its 
inner  surface  is  augmented  by  many  long,  narrow,  and  highly  vascular 
folds,  which  radiate  from  the  commencement  of  the  contracted  part  of 
the  tube  upon  the  expanded  pavilion. 

Bitch. 
In  the  Bitch  the  fimbriated  commencement  of  the  oviduct  is  attached 


INTERNAL  ORGANS  OF  GENERA  T/ON  47 

to  the  exterior  boundary  of  the  aperture  opposite  the  ovarium,  while  the 
tube  itself,  long  and  fine,  passes  in  a  wavy  course  round  the  anterior 
aspect  of  the  latter  to  the  uterus.  The  length  of  the  tube  is  from  two 
and  a  half  to  three  and  a  half  inches. 

SECTION    IV. THE    OVARIES. 

The  ovaries  (testes  muiiebres),  the  essential  organs  of  generation  in  the 
female,  and  analogous  to  the  testes  of  the  male,  are  two  ovoid  or  elon- 
gate reniform  bodies,  smaller  than  the  latter,  but  of  the  same  shape,  and 
situated  in  the  abdominal  cavity.  They  are  loosely  suspended  in  the 
sub-lumbar  region,  behind  the  Fallopian  tubes  and  the  kidneys,  among 
the  convolutions  of  the  intestines  ;  though  sometimes  their  position  is 
altered.  In  four  instances  in  the  Pig  they  have  been  found  in  the  peri- 
neal region,  occupying  small  cavities  analogous  to  the  scrotum  of  the 
male.*  Smooth  externally,  each  ovary  shows  in  the  middle  of  its  upper 
portion  a  more  or  less  oblique,  but  deep  fissure,  resembling  the  hilus  of 
the  kidney,  and  which  gives  attachment  to  the  pavilion  of  the  Fallopian 
tube.  Each  ovary  is  suspended  at  the  anterior  border  of  the  broad  liga- 
ment, and  is  also  sustained  in  situ  by  the  vessels  passing  to  and  from  it, 
as  well  as  by  a  small  cord  of  non-striated  muscular  fibres  called  the  iiga- 
mentum  ovarii,  which  connects  it  with  the  uterus. 

The  structure  of  the  ovary  comprises  a  serous  and  fibrous  membrane, 
the  proper  tissue  of  the  ovary,  and  the  Graafia7i  vesicles  embedded  in  it. 
The  serous  membrane  is  continuous  with  the  broad  ligaments — is,  in  fact, 
a  peritoneal  tunic,  which  entirely  envelops  it,  adhering  closely  to  the 
covering  beneath.  This  is  the  tunica  albuginea :  a  dense  resisting  mem- 
brane similar  to  the  structure  enveloping  the  testicle,  and  sending  lamel- 
lar prolongations  into  the  substance  of  the  ovary. 

T\\e.  proper  tissue  or  stroma  of  the  ovary  is  solid  and  hard,  and  has  a 
speckled-grey  tint.  It  is  divided  into  two  layers,  which  are  distinct  in 
appearance  and  structure.  The  medullary  layer  is  nearest  the  hilus,  and 
is  somewhat  red  and  spongy  •  it  is  formed  by  the  intercrossing  of  con- 
nective tissue,  non-striated  muscular  fibres,  and  by  a  large  number  of 
vessels  which  radiate  from  the  centre  towards  the  periphery  of  the  organ 
and  nerves.  The  cortical  layer  has  for  its  basis  connective  tissue  ;  it  is 
not  very  vascular,  but  it  contains  in  its  substance  the  Graafian  vesicles  or 
follicles,  and  for  this  reason  is  named  the  ovigenic  layer. 

These  Graafian  vesicles  are  generally  in  various  stages  of  development ; 
the  smallest  are  situated  beneath  the  tunica  albuginea,  and  they  descend 
towards  the  deeper  layer,  increasing  in  volume  as  they  do  so.  When  they 
have  reached  their  period  of  full  growth,  they  are  filled  with  a  transparent 
citron-colored  fluid,  and  the  ovigenic  layer  being  incapable  of  containing 
them,  they  form  a  more  or  less  considerable  prominence  on  the  surface  of 
the  ovary.  A  Graafian  vesicle,  when  perfect,  is  composed  of  an  envelope 
and  its  contents.  The  envelope  com^xxso^s  two  tunics — a  fibrous  membrane 
(tunic  of  the  ovisac),  which  is  confounded  externally  with  the  stroma  of  the 
ovary,  and  internally  is  rich  in  blood-vessels ;  an  inner  {ovisac),  formed 
by  a  smooth  membrane  which  derives  its  blood-vessels  from  the  latter ; 

*  A  remarkable,  if  not  unique,  case  of  displacement  of  the  ovaries  is  recorded  by  M.  Dupont,  in  the 
Journal  des  Veterinaires  du  Midi  for  1869.  In  four  female  pigs,  fifteen  days  old.  beneath  the  vulva 
were  observed  two  protuberances  exactly  like  the  testicles  of  the  male,  and  which,  on  examination  after 
death,  proved  to  be  the  ovaries.  The  other  organs  of  generation  were  normal-  The  same  Sow  which 
produced  them,  had,  in  a  previous  litter,  brought  forth  two  females  with  the  ovaries  similarly  misplaced. 


48 


OBSTETRICAL  ANATOMY. 


it  is  lined  by  an  epithelial  or  granular  membrane  {tunica  gra?iulosa),  com- 
posed of  round  or  polygonal  granular  cells.  At  the  bottom  of  the  vesicle 
this  epithelium  forms  an  aggregation  (the  cumulus,  or  discus proliger),  in 
the  centre  of  which  exists  the  ovum  or  ovulum  of  mammalia.     The  con- 


Fig.  20. 

Ovary  Opened  Vertically. 


b  b,  Graafian  Vesicles  at  different 
stages  of  development. 


Fig.  21. 

Portion  of  the  Ovary  of  a  Pig. 

a.  Point  at  which  a  ripe  Vesicle  is  about  to 
escape  ;  b,  Fissure  by  which  an  Ovule  has 
escaped. 


tents  of  the  vesicle  is  a  yellowish,  transparent,  albuminous  mass,  that 
becomes  reddened  by  an  admixture  of  blood  when  the  vesicle  ruptures. 
The  ovulum,  ovule,  or  ovum,  is  a  small  cell  imbedded  in  the  cumulus, 


Fig.  22. 

Graafian  Vesicle  in  Mare's  Ovary. 

a,  Membrana  Propria  of  the  Graafian  Fol- 
licle ;  b,  Membrana  Granulosa ;  bi,  Dis- 
cus Proligerus ;  c,  Ovum.  Magnified 
5  Diameters. 


Fig.  23- 

Ovulum  of  the  Mare. 

,  Zona  Pellucida  ;  b,  Vitellus,  containing 
the  Vesicula  Germinativa ;  c,  Cells  of  the 
Discus  Proligerus. 


and  surrounded  by  an  amorphous,  thick,  white  membrane,  which  has  been 
designated  the  zona  pellucida  ;  within  this  membrane  is  a  granular  layer, 
the  vitellus  or  yolk,  the  larger  granules  of  which  are  superficial  and  com- 
pact, while  internally  it  is  a  transparent  albuminous  fluid,  in  which  are 
but  few  granules.     Enclosed  in  this  vitellus,  though  nearer  its  circumfer- 


INTERNAL  ORGANS  OF  GENERA  TION.  49 

ence  than  centre,  is  the  nucleus — the  gsrminal  vesicle,  ox  vesicle  of  Purkifige, 
a  most  important  portion  of  the  ovum  ;  it  has  the  appearance  of  a  very 
small  clear  ring,  measuring  about  i-6oth  of  a  line  in  diameter,  and  upon 
its  surface  is  a  dark  spot,  the  macula  germinativa.  This  is  always  observed 
as  a  simple  rounded  body,  measuring  from  i-2ooth  to  i-3ooth  of  a  line  in 
diameter  ;  it  is  rarely  found  double  or  as  an  aggregate  of  granules,  except 
in  miniature  ova. 

The  large  flexuous  arteries  supplying  the  ovary,  are  from  the  utero- 
ovarian  trunk;  they  spread  over  the  spaces  in  the  tunica  albuginea, 
before  entering  the  hilus  of  the  organ  to  be  distributed  in  its  interior. 
The  veins  are  extremely  large,  and  form  a  very  close  plexus  around  the 
gland  {bulb  of  the  ovary),  emptying  themselves  into  the  vena  cava  near 
the  renal  veins.  The  lymphatics  pass  to  the  sub-lumbar  ganglia,  and  the 
nerves  come  from  the  small  mesenteric  plexus. 

Differences. 

Cow,  Sheep,  and  Goat. 

In  the  Cow  the  ovaries  are  relatively  smaller  than  in  the  Mare,  but 
their  form  and  structure  are  the  same.  Each  is  lodged  in  a  depression 
or  sacculus  of  the  broad  ligament  which  is  more  or  less  deep,  and  the 
Graafian  vesicles  are  visible  through  the  tunica  albuginea.  The  same 
arrangement  is  observable  in  the  Sheep  and  Goat. 

Pig- 
In  the  Pig  the  ovaries  are  comparatively  large,  oblong  bodies,  with  an 
irregular  tuberculated  or  lobulated  aspect,  due  to  the  Graafian  vesicles, 
which,  when  well  developed,  project  beyond  the  surface  of  the  organ, 
instead  of  remaining  within  it.  When  these  ovisacs  enlarge,  the  stroma  is 
scanty  in  proportion.  Each  ovary  is  enclosed  within  a  peritoneal  sac,  near 
the  opening  of  which  it  has  a  pedunculate  attachment.  The  posterior 
wall  of  this  sac,  as  we  have  seen,  appears  to  be  formed  by  the  wdde  and 
deep  pavilion  of  the  Fallopian  tube. 

Bitch  and  Cat. 

There  is  nothing  particular  to  indicate  in  the  ovaria  of  the  Bitch  and 
Cat,  except  that  the  ligaments  suspending  them  to  the  spine  are  very 
short,  and  they  are  contained  in  a  fold  of  peritoneum. 

Development. 

The  development  of  the  ovaria  and  the  ova  is  very  interesting.  In  the 
Mare  the  ovaria  of  the  foetus  are,  compared  wdth  the  uterus,  of  an 
immense  size,  and  at  six  months  are  almost  as  large  as  in  the  adult.  In 
aged  animals  they  become  atrophied,  and  it  is  not  unusual  in  old  Mares 
to  find  either  one  or  both  in  an  unhealthy  condition.  Not  unfrequently  they 
are  hypertrophied,  and  their  fibrous  envelope  and  stroma  are  much  thick- 
enened.  Sometimes  the  vesicles  are  greatly  enlarged,  and  converted  into 
cysts  which  contain  either  a  limpid,  sanguinolent,  or  purulent  fluid,  secreted 
from  their  walls.  Flandrin  cities  the  case  of  a  Mare,  one  of  whose  ovaries 
weighed  26)^  pounds,  andmeasured  145^  inches  in  its  long,  and  12  inches 

4 


5° 


OBSTETRICAL  ANATOMY. 


in  its  short  diameter.     Tlie  texture  of  the  ovaries  is  also  liable  to  various 
abnormal  alterations. 

The  Graafian  vesicles  are  present  in  the  ovary  of  the  foetus,  but  they  do 
not  attain  their  full  development  until  puberty  ;  neither  are  they  all  present 

at  birth,  but  are  continually  being  devel- 
oped beneath  the  tunica  albuginea.  The 
first-formed  elements  in  the  foetal  ovary 
are  cells  and  cell-nuclei  ;  these  next  ap- 
pear in  somewhat  circular  groups,  which 
are  more  opaque  than  the  other  parrs  of 
the  regularly  uniform  mass  (Fig  24,  A). 
A  kind  of  film  soon  condenses  round 
these  groups  (B),  and  upon  the  inner 
surface  of  this  there  is  fixed  an  epithelial 
precipitate  from  the  fluid  and  granules  of 
ihe  interspaces  of  the  contained  primary 
cells.  Within  the  ovisac  thus  formed, 
a  large  nucleate  cell  becomes  visible  :  this 
is  the  commencement  of  the  ovum  (C,  g). 
As  this  expands,  the  proportion  of  fluid 
to  the  formified  particles  increases,  and 
the  latter  are  attracted  to  the  contiguous 
surfaces :  some  to  that  of  the  ovisac, 
which  thus  becomes  lined  by  a  thicker 
layer  of  cells  ;  others  to  the  ovum,  ac- 
cumulating around  it.  With  the  enlarge- 
ment of  the  ovisac,  the  stroma  of  the 
ovum  condenses  around  its  delicate 
membrane  (Fig,  25,  h),  to  form  what  has 
been  called  the  "  theca  folliculi  "  of  Baer 
— the  fibrous  tunic  already  noted  ;  this 
vascular  tunic  {a),  with  the  other  {b), 
constituting  the  vesicle  ;  while  the  stratum 
of  nucleate  cells  lining  this  double  cover- 
ing is  the  membrana  granulosa,  and  those 
surrounding  the  ovum  itself  form  the/r<?- 
Hgerous  disc  (e),  the  mass  of  cells  adhering 
thereto  being  the  ciwiulus. 

The  hyalinion,  or  proper  tunic  of  the 
ovum,  thickens  into  the  clear  substance 
improperly  named  the  zotia  pellucida  (/),  which  in  reality  is  a  bag.  As 
the  cells  and  cell-nuclei  of  the  ovum  become  developed,  they  are  pushed 
deeper  into  the  stroma  by  those  of  more  recent  formation  ;  while,  as  the 
ovum  ripens,  the  cells  immediately  around  it  become  elongated  and  pyri- 
form,  the  tapering  extremity  being  attached  to  the  zona :  those  of  the 
cumulus  diverge  irregularly  into  the  fluid  intervening  between  them  and 
the  membrana  granulosa  of  the  ovisac.  What  have  been  termed  reiina- 
culce  id)  have  been  described  by  some  authorities  ;  they  are  four  processes 
formed  by  the  cells  of  the  cumulus,  and  may  be  merely  exceptional  diver- 
gences. 

Until  puberty  there  is  no  great  activity  apparent  in  the  vesicles  ;  but  at 
this  time  the  ovary  becomes  more  vascular,  and  certain  vesicles  increase 
in  volume.     At  the  period  of  "  rut "  or  "  heat,"  one  or  more  vesicles, 


Fig    24. 

Formation  of  the  Ovisac  in  the 

Bitch's  Ovary. 


INTERNAL  ORGANS  OF  GENERA  TION. 


51 


according  to  the  species  of  animal,  show  evidence  of  increased  vascularity, 
and  become  distended  ;  the  ovisac  thins  at  the  most  prominent  part  to 
which  the  ovum  tends,  and  blood  is  extravasated  into  it ;  then,  partly  by 
absorption  and  partly  by  pressure,  the  coverings  give  way,  the  proligerous 


Fig.  25. 
Graafian  Vesicle  and  Ovum- 


disc  and  ovum  escape  outwards,  and  are  either  received  into  the  Fallopian 
tube  for  conveyance  to  the  uterus,  or,  which  is  rare,  fall  into  the  cavity  of 
the  abdomen. 

The  size  of  the  mature  ovum  in  the  Cow  is  ^io*  ^^Z  2 0  o?  Bitch  t^^j  ^^.t 
^\-Q,  Rabbit  -y\-q  of  an  inch. 


Fig.  26. 
Escape  of  Ovum  from  Ovisac 


After  the  rupture  of  a  Graafian  vesicle  and  the  escape  of  the  ovum, 
the  cavity  of  the  ovisac  is  filled  with  a  clot  of  blood,  while  its  walls  are 
thickened  and  altered  in  color,  being  in  most  animals  partially  everted  at 
the  ruptured  orifice.  In  the  Cow  and  Sheep  the  follicle  has  a  brick-red 
color,  and  in  the  Pig  it  is  yellowish-brown — it  is  then  designated  in  the 
human  subject,  from  its  color,  the  corpus  luteum  ;  but  gradually  the  clot 
shrinks,  loses  its  tint,  and  the  cavity  contracts  ;  at  the  same  time  the 
walls  are  hypertrophied,  and  the  tunica  granulosa  becomes  wrinkled  and 
transformed  into  cylindrical  epithelium.  By  the  time  the  succeeding 
ovisac  with  the  ripening  ovum  has  begun  to  protrude  from  the  surface  of 
the  ovary,  the  old  ovisac  has  lost  its  color  with  much  of  its  dimensions, 
and  fallen  inwards  ;  the  cylindrical  epithelium  are  infiltrated  with  fat  and 
are  gradually  absorbed.  This  change,  with  collapse  of  the  wall,  depresses 
the  cicatrix  of  the  aperture ;  and  the  successive  shrinkings  and  cicatriza- 


s« 


OBSTETRICAL  ANATOMY. 


tions   of  the  ruptured   ovisacs  give  the  ovary  a   pitted    and    furrowed 
appearance  in  advanced  life. 

If  the  expelled  ovum  be  not  impregnated,  the  changes  of  the  ovisac  into 
the  yellow  convolute  cavity,  then  into  the  depressed  stellate  cicatrix,  occur 
somewhat  rapidly ;  but  if  impregnation  takes  place,  the  maturation  of 
successional  ova  is  delayed,  and  the  first  change  in  the  ruptured  ovisac 
goes  on  to  a  greater  extent,  the  corpus  luteiim  not  becoming  obliterated 
for  a  comparatively  long  time.  In  this  period  the  inner  coat,  or  original 
ovisac,  is  much  thickened  by  a  larger  deposit  of  yellow  oil-granules  ;  it 
becomes  more  deeply  plicated,  is  impacted  into  a  yellowish  mass,  and 
gains  an  adventitious  white  lining  membrane,  and  it  rarely  happens  that 
the  cavity  is  obliterated  before  full  gestation.  It  is  then,  in  the  human 
species,  represented  by  a  stellate  linear  figure  surrounded  by  the  corpus 
luteum,  which  is  ultimately  absorbed,  but  usually  not  before  some  weeks 
after  parturition. 


Successive  Stages  in  the  Formation  of  the  Corpus  Luteum  in  the  Graafian 

Follicle  of  a  Sow  :  Vertical  Section. 

a,  Follicle  immodiately  after  the  Expulsion  of  the  Ovum,  its  cavity  being  filled  with  blood, 

and  no  ostensible  increase  of  its  epithelial  lining  having  yet  taken  place  ;  at  ^  a  thickening  i 

of  this  lining  has  become  apparent ;  at  f  it  begins  to  present  folds,  which  are  deepened  at  d, 
and  the  clot  of  blood  is  being  absorbed  and  decolorized  ;  a  continuation  of  the  same 
process,  as  shown  at  e,f,g,  h,  forms  the  Coypus  Luteum,  with  its  stellate  cicatrix. 

It  is  this  difference  between  the  impregnated  and  unimpregnated  con- 
dition which  enables  us  to  distinguish,  in  these  ruptured  vesicles,  the  true 
znd  false  corpora  lutea. 

In  the  Mare  the  retrocession  of  the  true  corpus  luteum  is  more  rapid 
than  in  the  other  domesticated  animals,  and  it  has  not  that  deep  yellow 
color  observed  in  the  Cow  ;  but  it  is  of  a  darker,  dull  reddish-brown  hue, 
and  on  section  presents  convolutions  resembling  those  of  the  brain.  When 
recent,  the  corpus  luteum  of  the  Mare  is  voluminous,  and  drawn  towards 
the  hilus  of  the  ovary  ;  it  has  two  layers,  the  internal  being  constituted 
by  a  clot  of  blood  the  size  of  a  small  nut. 

Franck  has  convinced  himself,  hy post  mortem  examination  of  Mares, 
of  the  possibility  of  ova  being  thrown  off  from  the  ovary  during  preg- 
nancy. 

It  is  to  be  remarked  that  the  number  of  ovisacs  and  ova  which  become 
matured  at  each  "  rut  "  or  "  heat,"  depends  upon  the  multiparity  or  uni- 
parity  of  the  species  ;  in  the  Mare  and  Cow  there  is  usually  only  one,  in 
the  Sheep  and  Goat  one  or  two,  in  the  Pig  from  four  to  a  dozen,  and  in 
the  Bitch  a  variable  number. 


REP  ROD  UCTION. 


^Z 


BOOK    II. 

OBSTETRICAL   PHYSIOLOGY. 

REPRODUCTION. 

Having  described  the  situation,  structure,  and  peculiarities  of  the  ex- 
ternal and  internal  organs  of  the  female  domesticated  animals,  we  have 
now  to  inquire  into  their  functions.  These  functions  have  for  their  end 
the  conception,  development,  and  preservation  of  the  young  animal  for  a 
certain  period,  until  it  can  maintain  a  more  or  less  independent  existence, 
when  some  of  them  are  brought  into  play  in  order  to  place  it  in  direct 
relation  with  the  external  world  in  the  act  of  parturition,  while  others 
cease.  But  in  order  that  generation  should  take  place  in  the  higher 
classes  of  animals,  it  is  necessary  that  the  two  sexes  be  placed  in  favor- 
able relations  with  each  other.  This  preliminary  condition  is  indispen- 
/ sable,  as  the  essential  of  reproduction  is  the  contact  with,  and  action  of 
the  male  fecundating  fluid  on,  the  ovum  of  the  female.  Nature  has 
ordained  that  this  creative  act  should  be  accomplished  by  engendering 
in  these  animals  an  instinctive,  irresistible  desire  at  a  certain  stage  of 
existence  ;  which  desire,  continuing  only  for  a  brief  period,  is  renewed 
after  particular  intervals,  until  the  faculty  of  reproduction  ceases. 

The  advent  of  the  power  of  reproduction  in  the  male  and  female  sex  of 
animals  is  very  unequally  distributed  among  the  various  species,  and  is 
generally  in  proportion  to  the  duration  of  their  existence  :  the  creatures 
which  are  short-lived  being  capable  of  bringing  forth  young  at  an  earlier 
period  of  life  than  those  which  enjoy  a  longer  term. 

The  Elephant  only  brings  forth  one  at  birth,  and  this  occurs  but  once 
in  three  or  four  years  ;  while  the  descendants  of  the  Rabbit  in  the  same 
space  of  time  may  be  reckoned  at  more  than  a  million.  This  great  dis- 
parity has  nothing  of  chance  or  accident  in  it,  but  is  in  admirable  har- 
mony with  the  designs  of  Nature.  The  individuals  of  every  species 
produce,  as  has  been  justly  remarked  by  Verheyen,  a  total  number  of 
germs  which  amply  covers  the  losses  caused  by  death  ;  and  the  premature 
destruction  of  many  of  these  germs  is  likewise  a  providential  safeguard 
against  their  too  numerous  multiplication. 

Two  factors  regulate  fecundity  ;  these  comprise  the  nutritive  excess 
which  the  maintenance  of  the  individual  renders  disposable,  and  the  sum 
total  of  the  materials  necessary  for  the  embryonic  evolution  ;  but  the 
divergences  of  these  two  factors  are  as  extensive  as  those  of  fecundity 
itself. 

If  we  take  the  weight  of  the  foetus  at  birth  as  the  equivalent  to  the 
nutritive  matter  that  the  parent  has  endowed  it  with,  and  multiply  this 
weight  by  the  number  of  young  annually  produced,  we  shall  obtain  the 
total  amount  of  the  materials  which  have  been  derived  from  the  maternal 
organism.  Then  weighing  the  mother,  and  comparing  her  weight  with 
that  of  the  foetus,  we  shall  arrive  at  the  disposable  nutritive  excess  ;  and 
from  this,  according  to  Leuckart,  be  able  to  calculate  the  fertility  of  a 


54 


OBSTETRIC  A  L  PHYSIOL  OG  Y. 


species.  Although  this  calculation  is  only  approximate,  it  none  the  less 
demonstrates,  in  principle,  the  relations  between  fecundity  and  the  two 
before-mentioned  factors.  This  is  shown  in  the  following  table,  drawn  up 
by  Leuckart,  with  reference  to  the  domesticated  animals. 


Species. 

Weight   of 
Body. 

Annual 

Number  of 

Young. 

Weight  of 

Each    Young 

Animal. 

Annual  nu- 
tritive ex- 
cess of  the 
Maternal 
Organism. 

Relation  between 

the  living  wight  of 

the  Mother  and  that 

of  the  Young. 

Nutritive  Matter 

yielded  to  the 

Foetus. 

Per  cent,   of  the 

Gram'es. 

Grammes. 

Grammes. 

living  Maternal 
Weight. 

Horse 

325,000 

Yz 

50,000 

25,000 

100:        -],-] 

14 

Cow 

175,000 

I 

35,000 

35,000 

100 :     20,0 

20 

Sheep 

50,000 

2 

4,500 

9,000 

100 :      18,0 

9 

Pig 

90,000 

20 

2,400 

48,000 

100 :     53,0 

3 

?°^, 

22,000 

18 

0,440 

7,950 

100 :     36,0 

2 

Fowl 

• 

0,900 

100 

0,044 

4,400 

100 :  500,0 

5 

The  nutritive  reserve  of  the  Horse,  compared  with  that  of  the  other 
animals,  is  here  seen  to  be  very  limited ;  while,  on  the  contrary,  the  Fowl 
yields  in  reproductive  material  a  sum  equivalent  to  five  times  the  weight 
of  its  own  body.  When  a  balance  is  struck  between  the  profits  and  losses 
in  the  animal  economy,  it  is  found  that  the  great  difference  existing  has 
its  own  reasonable  explanation.  The  function  which  makes  the  greatest 
demand  upon  the  nutritive  capital,  is  doubtless  that  with  which  the  mus- 
cles are  charged  ;  and  their  maintenance  in  power  exacts  the  heaviest 
compensation  ;  as  they  consume  material  in  proportion  to  the  weight  of 
the  body,  and  the  energy,  extent,  and  frequency  of  the  movements.  In 
proportion  as  the  height  increases,  the  cubical  weight  augments  at  the 
expense  of  the  motive  power ;  while  the  latter,  equal  to  the  square  of  the 
transverse  section  of  the  muscles,  follows  an  arithmetical,  and  not  a  geo- 
metrical, progression. 

The  nutritive  maintenance,  then,  demands  in  an  absolute  manner  an 
expenditure  much  more  considerable  in  the  larger  than  the  smaller  an- 
imals ;  so  that  the  latter  are  more  fruitful  than  the  former,  and  their 
economy  renders  them  more  apt  to  hold  in  reserve  a  much  more  consid- 
erable nutritive  capital. 

A  rich  and  abundant  aliment,  given  regularly,  increases  reproductive- 
ness  ;  as  is  evidenced  in  the  case  of  our  domesticated  animals,  if  com- 
pared with  the  wild  creatures  of  the  same  species  ;  and  the  fecundity  in- 
creases or  declines  as  their  food  is  plentiful  and  good,  or  scarce  and  bad. 
But  this  influence  of  alimentation  on  fecundity,  and  the  faculty  of  living 
beings  to  maintain  a  nutritive  reserve,  has  its  limit ;  for  the  intestinal 
absorption  goes  on  in  direct  proportion  to  the  superficies  of  the  mucous 
membrane  lining  it,  and  this  is  definite. 

The  sum  of  materials  necessary  for  embryonic  evolution  is  also 
founded  on  the  nutritive  reserve.  In  proportion  as  the  organization  is 
simplified  and  the  various  apparatus  decrease  in  number,  so  does  the 
maturity  of  the  embryo  gain  in  precocity,  and  the  nutritive  matter  serve 
for  a  larger  number  of  germs.  Thus,  as  has  been  aptly  said,  what  would 
be  required  to  maintain  the  single  foetus  of  a  large  mammal,  whose  or- 


REPRODUCTION.  55 

ganization  is  complete  at  its  birth,  would  suffice  for  the  evolution  of  many 
millions  of  frogs.  Besides,  the  parent  having  once  evacuated  the  pro- 
duct of  her  fecundation,  has  done  with  it :  the  tadpoles  issuing  from  the 
ova  find  their  nourishment  in  the  outer  world  -,  but  the  young  mammal 
derives  its  sustenance  from  the  mammae  of  the  mother,  at  whose  expense 
it  continues,  for  a  more  or  less  protracted  period,  to  live  as  a  parasite. 
With  the  higher  animals,  which  give  birth  to  an  incomplete  being,  there 
is  observed  an  increase  in  fecundity  :  the  Bitch  only  yields  two  per  cent, 
of  its  weight,  but  the  Calf  absorbs  twenty  per  cent,  of  its  parent's  weight. 
This  unequal  distribution  of  fecundity  among  the  animal  species  is  a 
conservative  element  in  the  scheme  of  organic  nature.  The  reproduc- 
tiveness  and  the  numerous  chances  of  destruction  surrounding  the  germs, 
are  compensated  for  in  just  proportion  ;  for  out  of  many  thousand  ova 
furnished  by  the  most  prolific  species,  a  comparatively  limited  number 
only  find  all  the  conditions  favorable  for  their  development. 


chaptp:r  I. 

The  acts  by  which  generation  is  accomplished  are  four :  these  are 
copulation.,  feamdation^  gestation.,  Vixvdi  parturition ;  but  it  is  only  on  the  at- 
tainment of  a  certain  age — that  of  puberty — that  these  sexual  offices  are 
in  activity,  and  they  continue  so  for  a  variable  period,  according  to  the 
species.  During  this  time,  ova  from  the  ovaries,  fecundated  by  the  male 
seminal  fluid,  are  received  into  the  uterus,  and  remain  there  for  a  reg- 
ulated period,  until  they  have  become  transformed  into  young  creatures 
possessing  certain  physical  attributes  and  resemblances  to  their  parents. 
This  is  the  gestation  period,  and  is  followed  by  that  of  parturition,  when 
the  young  are  born. 

SECTION    I. PUBERTY. 

The  generative  organs  of  the  domesticated  female  animals  are,  like 
those  of  the  human  female,  only  in  a  state  of  activity  during  the  prime  of 
life  ;  and  the  most  notable  characteristic  of  their  functions,  as  in  woman, 
is  their  periodicity.  These  functions  commence  at  puberty,  when  cer- 
tain very  marked  modifications  occur  throughout  the  whole  organism,  but 
particularly  in  the  generative  organs  of  the  male  and  female  animals. 
In  the  first  the  testicles  become  more  voluminous,  and  in  some 
species  they  leave  the  abdominal  cavity  to  be  lodged  in  the  scrotum  ; 
they  also  begin  to  secrete  an  abundance  of  a  special  fluid — the  "  sper- 
matic," in  which  particles  of  a  definite  shape — spermatozoa — endowed 
with  motion,  appear.  This  fluid  is  stored  up  in  the  vesiculce  seminales 
which,  until  this  period,  were  small  and  wasted-looking.  The  organ  for 
the  conveyance  of  this  spermatic  fluid  to  the  female  becomes  more 
developed,  and  is  capable  of  complete  and  frequent  erection.  In  the 
female  the  mammae  enlarge,  the  ovaries  are  more  vascular  and  turgid- 
looking  than  before,  and  the  Graafian  vesicles  are  more  or  less  devel- 
oped. The  periodic  ovipont  then  begins  to  be  carried  on,  with  all  the 
distinctive  peculiarities  which  it  is  to  bear  during  the  prolific  period  of  life. 

The  age  at  which  animals  ^xnvQ  3.tpuberty  or  sexual  maturity,  is  not 
only  different  in  different  species,  but  is  influenced  to  some  extent  by  the 
rapidity  of  their  growth  and  the  duration  of  their  life.     Domestication  has 


56  OBSTETRICAL  PHYSIOLOGY. 

more  particularly  brought  about  changes  in  this  respect,  and  by  inducing 
a  more  rapid  development  of  the  organism,  has  hastened  the  advent  of 
this  period.  And  it  may  be  said  that  puberty  is  sooner  attained  in  the 
female  than  the  male,  and  that  domesticity  has  also  considerably  modified 
the  periodicity  of  the  procreative  manifestations  in  the  former  ;  though  in 
the  latter  it  may  also  be  affirmed  that  this  periodicity  is  not  so  marked, 
the  generative  functions  being  always  more  or  less  in  activity. 

The  aptitude  to  procreate,  though  generally  admitted  as  an  indication 
of  adult  age,  yet  appears  before  animals  have  attained  their  full  physical 
development,  and  is  present  in  some  creatures  at  a  comparatively  early 
period  of  life,  depending  upon  climate,  food,  and  other  circumstances  ; 
the  Pig  may  conceive  when  only  four  or  five  months  old,  or  earlier  ;  the 
Sheep  and  Goat  at  eight  to  twelve  months  ;  the  Bitch  at  seven  to  ten 
months  ;  the  Cat  at  from  eight  months  to  a  year,  though  it  is  usually  in 
"  heat "  for  about  ten  days  before  it  is  a  year  old  ;  the  Cow  at  twelve  to 
eighteen  months  ;  and  the  Mare  at  from  twelve  months  to  two  years. 

Saint-Cyr  has  seen  Mares  which  foaled  when  thirty  months  old  ;  and 
others  which,  going  at  large,  have  received  the  Horse  before  the  end  of 
their  first  year,  and  foaled  at  twenty-two  months.  Heifers  have  also  taken 
the  Bull  at  five,  six,  sev^en,  and  nine  months,  and  calved  at  fourteen,  fif- 
teen, sixteen,  and  eighteen  months.  In  the  first  volume  of  the  Lancet 
(1835-36),  there  is  mention  made  of  a  Bull  calf  less  than  three  months 
old,  which  copulated  with  a  Quey  calf  about  two  months  old,  and  within 
nine  months  the  latter  brought  forth  a  calf.     Quey  and  calf  did  well. 

With  regard  to  the  period  when  procreation  ceases  in  animals,  I  cannot 
discover  any  reliable  data  to  arrive  at  a  trustworthy  conclusion.  The 
Mare  has  not  ceased  to  breed  after  thirty  years  of  age,  and  the  Cow  and 
Sheep  have  bred  beyond  twenty  years.  I  have  notes  of  Mares  producing 
foals  at  twenty-eight,  thirty-two,  and  thirty-eight  years  of  age. 

The  changes  incidental  to  the  procreative  period  of  life  in  the  female 
are  chiefly  centred  in  the  ovaries  and  uterus :  organs  destined  to  play  a 
pre-eminent  part  in  the  perpetuation  of  the  species,  and  whose  functions 
are  inter-dependent.  The  ovary  is  doubtless  the  principal  and  essential 
agent  in  generation  ;  as  it  gives  the  necessary  and  effective  stimulus  to 
the  condition  termed  rutti7ig  ox  heat,  and  furnishes  the  germ  which  has 
been,  or  is  intended  to  be,  fecundated  ;  while  the  uterus  secretes  mucus 
and  the  peculiar  fluid  ejected  at  that  period,  receives  the  ovum,  forms  the 
decidual  temporary  or  enveloping  membranes  in  some  cases,  nourishes 
the  foetus,  and  finally  expels  it.  So  that  the  ovaries  and  uterus  co-operate 
in  the  accomplishment  of  the  four  chief  functions  of  the  uterine  system  : 
cestrum,  conception,  gestation,  and  parturition.  These  we  will  consider  in 
the  order  in  which  they  stand,  describing  the  phenomena  which  charac- 
terize or  accompany  them,  and  noting  the  conditions  upon  which  their 
evolution  mainly  depends. 

SECTION    II. CESTRUM    OR     MENSTRUATION. 

The  rutting,  heat,  oestrum,  or  veyiereal  oestrum  of  animals  is  analogous  to 
"  menstruation  "  in  woman,  and  marks  the  period  of  maturation  in  the 
ovarian  ova  or  ovum,  according  to  species.  This  condition  is  intermittent 
or  periodic,  not  continuous ;  and  is  characterized  by  a  peculiar  systemic 
excitement  that  usually  continues  for  a  somewhat  definite  period  in  the 
two  sexes.     In  the  male  and  female,  but  especially  the  latter,  the  genera- 


(E  STRUM. 


57 


five  organs  at  this.period  become  more  or  less  turgid  and  sensitive,  and 
the  uro-genital  secretions  are  increased.  In  the  female  there  is  a  deter- 
mination of  blood  to  the  ovaries,  and  changes  take  place  in  these  which 
have  already  been  described.  The  excitation  of  the  generative  apparatus 
reacts  on  the  whole  system,  and  produces  a  kind  of  fever  or  irritability  in 
the  animal ;  its  sensibility  is  increased ;  the  appetite  is  more  or  less  in 
abeyance  or  capricious,  and  usually  there  is  thirst ;  if  the  secretion  of 
milk  has  been  previously  active,  it  now  diminishes,  and  in  the  non-impreg- 
nated Bitch  milk  even  appears  in  the  mammae  ;  restlessness  is  a  notable 
feature,  and  the  movements  betray  the  prevailing  desires.  There  is  an 
uncontrollable  tendency  to  seek  the  opposite  sex  ;  with  some  animals  the 
ordinary  disposition  becomes  strangely  perverted  ;  and  in  others  again, 
certain  physical  changes  accompany  the  sexual  perturbation.  Attempts 
at  micturition  in  the  female  are  frequent,  but  only  a  small  quantity  of 
urine  is  passed  j  the  mucous  membrane  of  the  vagina  is  injected  ;  and 
with  solipeds  there  are  oft-repeated  movements  of  the  clitoris  and  vulva, 
and  an  opaque  white  secretion,  or  even  emissions  of  blood,  are  ejected 
spasmodically /<?/-  vulvam.* 

In  other  animals  this  ejection  sometimes  consists  of  a  viscid,  red- 
tinted,  or  sanguinoient  fluid.  In  all  it  has  a  special  and  powerful  odor, 
<which  attracts  the  males,  and  enables  them  to  distinguish  between  the 
females  which  are  in  "  rut  "  or  "  heat,"  and  those  which  are  not,  as  well 
as  exciting  in  them  the  most  ardent  amatory  desires. 

The  uterine  mucous  membrane  is  also  very  congested,  and  there  is 
poured  out  on  its  surface  a  fluid  containing  epithelial  debris^  mucus  cor- 
puscles and  blood  globules. 

The  existence  in  the  lower  animals  of  what  is  analogous  to  the  men- 
strual discharge  in  the  human  female,  has  frequently  been  deriied,  but 
without  any  reason  or  proof.  A  discharge  of  blood  from  the  sexual  organs 
of  woman  announces  the  advent  of  puberty;  and  its  coincidence  with  the 
maturity  and  escape  of  the  ovarian  ovule,  as  well  as  its  periodical  appear- 
ance until  the  termination  of  fertility,  establishes  between  this  phenome- 
non and  the  "  heat  "  or  "  rut  "  {oestrum)  of  animals  a  very  close  analogy. 
And  this  analogy  is  rendered  complete  by  the  fact  that  animals  also  at 
this  period  have  more  or  less  evident  sanguine  emissions.  Kahleis, 
Fuchs,  Spinola,  Numann,  and  others  have  observed  this  in  the  Cow,  and 
have  also  noted  that  the  discharge  occurs  regularly  at  intervals  of  nine- 
teen or  twenty  days  when  the  animal  is  not  giving  milk  or  in  calf.  The 
haemorrhagic  flow  appears  two  or  three  days  after  the  commencement  of 
"  rutting,"  and  when  this  is  most  intense.  The  amount  of  blood  does 
not  exceed  one  or  two  ounces,  and  the  coagulated  clot  remains  in  the 
vagina  until  it  is  expelled  with  the  urine.  There  can  be  no  doubt  as  to  its 
source.  If,  at  the  moment  when  traces  of  it  are  perceived  externally,  the 
Cow  is  killed  and  the  inner  surface  of  the  uterus  examined,  blood  will  be 
seen  exuding  from  the  cotyledons.  And  this  phenomenon  has  been 
proved  to  extend  beyond  the  bovine  species,  for  it  has  been  witnessed 
in  the  Mare,  Bitch,  Cat,  Rabbit,  etc. ;  and  in  the  red-colored  mucus  of 
the  vagina  and  uterus,  multitudes  of  blood-corpuscles  have  been  found. 

The  cause  of  menstruation  or  periodical  discharges  of  blood  in  female 
animals,  has  received  a  satisfactory  explanation  from  the  researches  of 

*  Kaiser,  in  the  Magazin/nr  die  gesammte  Thierheilkunde  for  1859,  mentions  a  Mare,  twentj'-four 
years  of  age,  which  every  three  weeks  had  a  sanguineous  emission  from  the  vulva  ;  this  discharge  ceased 
towards  the  middle  of  pregnancy,  but  returned  after  parturition.  I  have  frequently  witnessed  the  periodic 
discharge  from  Mares  either  streaked  with  blood,  or  blood-tinted. 


jg  OBSTETRICAL  PHYSIOLOGY. 

Rouget,  who  has  established  the  fact  that  the  utero-Qvarian  artery,  on 
arriving  at  the  body  of  the  uterus,  near  the  Fallopian  tube,  divides  into 
curved  or  spiral  bouquets  of  vessels  which  open  into  veins,  like  the  heli- 
cine  arteries  of  the  male  cavernous  sinus.  Along  the  inferior  border  of 
the  ovary,  this  artery  forms  a  series  of  branches  that  wind  and  twist 
exactly  like  the  arterial  ramifications  at  the  root  of  the  corpus  cavernosum^ 
penetrating  the  stroma  of  the  ovary,  and  giving  rise  to  spirial  convolu- 
tions. The  venous  system  composes  the  uterine  sinuses — contorted 
venous  canals  not  unfrequently  spiral,  like  the  arteries. 

The  uterus  is,  therefore,  an  erectile  organ  like  the  penis,  and  its  erection 
is  connected  with  the  periodic  haemorrhage  from  its  inner  surface.  The 
venous  sinuses  in  the  meshes  of  the  muscular  tissue,  crossing  each  other  at 
the  hilus  of  the  ovary,  are  partially  compressed,  and  the  immediate  result  is 
the  distending  and  erection  of  the  bulb  of  the  ovary.  This  modification  in 
the  ovarian  circwlation  extends  to  the  uterus,  so  that  both  are  in  a  state 
analogous  to  erection  ;  the  prolonged  tension  is  communicated  to  the  ves- 
sels and  capillaries  of  the  mucous  membrane  ;  the  epithelium  is  shed,  leav- 
ing the  tunic  of  the  capillaries  exposed,  and  this  soon  gives  way,  whence 
results  the  haemorrhage,  which  persists  as  long  as  the  erection  and  obstruc- 
tion to  the  free  flow  of  blood  through  the  veins  continues.  This  is  the 
case  in  the  human  female,  but  it  must  be  admitted  that,  in  several  animals, 
the  erectile  formations  are  either  in  a  rudimentary  condition  or  entirely 
absent. 

In  the  Bitch  the  bulb  of  the  ovary  is  moderately  developed  ;  but  the 
arteries  of  the  uterus,  although  contorted  in  a  spiral  form,  are  not  such  a 
vascular  mass  of  vessels  as  to  constitute  a  real  erectile  organ.  In  Rumi- 
nants, small  vascular  masses  or  formations  are  observed  near  the  cotyle- 
dons, which  may  be  taken  to  represent  the  spongy  texture  of  the  human 
uterus. 

With  regard  to  the  season  at  which  this  "  heat  "  takes  place,  it  has  been 
observed  that  it  is  usually  the  spring-time,  when  food  becomes  plentiful, 
especially  with  herbivorous  animals.  The  Carnivora  are  in  heat  during 
winter.  The  Mare  is  usually  in  heat  from  April  to  June,  or  later.  With 
the  Cow  whose  calf  is  sold  at  from  one  to  two  months  old,  with  a  view  to 
utilizing  the  milk,  the  season  of  course  is  varied :  as  care  is  taken  to  in- 
duce conception  again  as  soon  as  the  lacteal  secretion  begins  to  diminish  ; 
but  it  has  been  observed  that  midsummer  is  more  particularly  the  rutting 
period.  And  the  "  heat "  in  Sheep,  though  naturally  present  in  Septem- 
ber, is  usually  only  shown  during  summer,  because  the  Ewes  are  kept  apart 
from  the  Ram  at  the  natural  time,  in  order  that  the  lambs  may  be  born  at 
a  favorable  season — the  spring ;  and  the  period  of  suckling  over  (four  or 
five  weeks),  they  may  be  weaned  when  the  herbage  is  tender  and  nutritious. 
And  in  other  circumstances,  particularly  with  animals  bred  for  the  butcher, 
the  rut  is  induced  sooner  by  putting  the  Ewes  in  contact  with  the  Ram  at 
an  earlier  period,  so  as  to  obtain  two  or  three  lambings  in  the  year. 

The  Bitch  is  in  heat  from  December  to  February,  or  in  the  autumn  and 
spring-time. 

The  Cat  is  in  this  state  in  January  and  February,  and  also  in  the  spring 
and  autumn ;  sometimes  the  heat  appears  three  or  four  times  a  year,  and 
the  animal  may  produce  young  as  frequently,  though  in  the  wild  state  it 
seldom  does  so  more  than  twice  a  year. 

The  Pig  manifests  rutting  in  October  or  November ;  at  least  that  is  the 
period  when  it  is  usually  put  to  the  male  ;    and  it  may  be  put  a  second 


(ESTRUM. 


59 


time  towards  the  end  of  spring,  in  order  to  have  two  litters  within  the 
twelvemonth. 

The  frequency  and  duration  of  the  period  of  "  rutting  "  or  "heat "  depends 
upon  the  age,  species,  and  other  circumstances ;  but  it  may  be  said  to 
persist  in  the  domesticated  animals  from  one  to  fifteen  days  at  the  most. 
The  shortest  period  is  witnessed  in  the  Cow  and  Sheep,  and  the  longest 
in  the  Bitch.  It  is  sometimes  only  present  from  twelve  to  twenty-four 
hours  in  some  non-fecundated  animals.  With  impregnation,  however,  it 
ordinarily  ceases  until  after  parturition  ;  and  if  impregnation  does  not 
occur,  it  gradually  disappears  until  the  next  period,  which  is  somewhat 
variable.  Its  re-appearance  in  the  Cow  has  been  noted  every  month  or 
three  weeks,  and  sometimes  at  closer  intervals  ;  and  in  the  Sheep  and  Pig 
it  lasts  for  one  or  two  days,  and  again  appears  from  the  fifteenth  to  the 
thirtieth  day,  but  usually  every  month.  When  removed  from  artificial  con- 
ditions, it  is  stated  that  the  ovine  species  is  in  rut  in  September,  that  this 
persists  only  for  a  day,  but  re-appears  every  fourteen  days  until  the  end 
of  December.  From  the  spring  until  the  end  of  summer,  it  may  be  said 
the  Mare  manifests  a  desire  for  the  Horse  every  three  or  four  weeks,  and 
the  objective  phenomena  which  announce  it  continue  from  two  to  four 
days.  In  the  Bitch  they  last  for  nine  or  ten  days,  and,  as  has  been  stated, 
dnly  appear  in  the  spring  and  autumn. 

This  periodicity  is  regulated  by  Nature,  with  a  view  to  the  preservation 
of  species  ;  and  in  animals  not  influenced  by  artificial  conditions,  it  is  so 
arranged  that  the  young  creatures  may  arrive  during  the  season  when  their 
maintenance  will  be  best  assured. 

With  the  subsidence  of  venereal  excitement  in  unimpregnated  animals, 
there  succeeds  a  period  of  calm,  which  is  almost  equivalent  to  that  of  ges- 
tation in  impregnated  creatures.  And,  strange  to  say,  with  Bitches  at  the 
end  of  this  interval — from  the  fortieth  to  the  sixtieth  day — there  some- 
times appear  phenomena  allied  to  the  parturient  period  :  as  tumefaction 
of  the  mammary  glands,  followed  by  swelling  and  increase  of  the  opening 
of  the  vulva,  with  reddening  of  the  vaginal  mucous  membrane  and  the  es- 
cape of  a  viscid  fluid.  The  animal  also  acts  as  if  about  to  bring  forth  : 
making  a  bed  for  her  young  ;  moving  about  uneasily ;  neglecting  her  food 
for  three  or  four  days,  during  which  the  mammae  become  still  more  devel- 
oped, firm,  and  elastic,  the  teats  elongated,  and  the  lactiferous  sinuses 
filled  with  an  abundance  of  good  milk,  which  is  easily  obtained  by  slight 
pressure.  If  a  Bitch  in  this  state  is  presented  with  a  young  puppy,  she 
will  take  to  it  as  if  it  were  her  own,  and  rear  it  most  affectionately.  This 
strange  condition  has  been  observed,  though  more  rarely,  in  the  Cat ;  and 
Chauveau  has  also  noticed  it  in  a  Mare  which  had  been  put  to  the  Horse, 
but  did  not  prove  in  foal. 

The  years  during  which  oestrum  continues  varies  with  species,  and  par- 
ticularly with  regard  to  the  age  they  attain  ;  but  it  always  disappears  to- 
wards the  decline  of  life. 

Climate,  inseparable  from  the  conditions  of  alimentation,  exercises  a 
marked  influence  on  the  "rut,"  in  hastening  its  development  and  its  period- 
icity ;  but  the  economical  law  to  which  it  is  subordinate  does  not  vary. 
With  many  species,  the  rut  only  appears  once  a  year  ;  while  in  others  which 
are  favorably  placed  with  regard  to  alimentation,  it  persists  in  every  sea- 
son, or  at  least  during  a  large  part  of  the  year.  Domesticity,  in  assuring 
animals  food  and  shelter,  and  removing  them  from  the  risks  and  alterna- 
tions of  an  erratic  life,  multiplies  the  periodical  returns  of  this  condition. 


6o  OBSTETRICAL  PHYSIOLOGY. 

Fowls,  Pigeons,  etc.,  lay  despite  the  rigors  of  winter,  and  the  domesticated 
mammals  are  in  heat  at  short  intervals. 

Though,  as  a  rule,  oestrum  does  not  appear  until  after  parturition  is 
achieved,  and  lactation  has  nearly  or  quite  ceased,  yet  it  is  not  rare  to  find 
some  animals,  as  the  Mare  and  Pig,  manifest  a  desire  for  the  male,  and 
even  copulate  ;  and  it  is  no  less  a  fact  that  rutting  and  impregnation  may, 
and  does  occur,  soon  after  parturition.  The  Cow,  Ass,  and  Sheep,  and, 
it  is  believed,  the  Mare,  will  copulate  with  a  greater  certainty  of  success 
on  the  ninth  day  after  parturition  than  at  any  other  time. 

It  must  be  remembered  that  various  conditions  influence  the  appear- 
ance of  this  function,  and  more  or  less  change  the  period  and  the  intervals 
of  its  advent.  Warmth,  shelter  from  vicissitudes  of  weather,  an  abundance 
of  nourishment,  especially  that  of  a  stimulating  nature,  and  easy  labor, 
favor  its  more  frequent  and  early  appearance,  and  especially  a  judicious 
bringing  together  of  the  male  and  female.  It  has  also  been  induced  by 
the  injection  of  certain  substances  into  the  vagina. 

The  persistence  of  this  condition  for  longer  than  the  natural  period  is 
a  symptom  of  uterine  or  ovarian  derangement,  and  therefore  unfavorable. 
It  renders  the  animals  of  less  value,  or  even  dangerous,  constituting  the 
disturbance  designated  "  nymphomania." 

SECTION    III. MATURATION  OF  THE   GRAAFIAN    VESICLES. 

The  spontaneous  and  periodic  ripening  and  dehiscence,  or  discharge, 
of  the  ovarian  vesicle  that  marks  the  period  of  oestrum  in  the  domesticated 
animals,  though  independent  of  fecundation,  yet  is  doubtless  intended  to 
commence  the  act  of  generation.  The  peculiar  condition  which  accom- 
panies the  maturation  of  the  ovum,  the  intense  desire  of  the  female  for  the 
male,  and  the  excitation  produced  in  the  latter  at  this  period,  with  its 
aptitude  for  procreation,  conclusively  demonstrates  this.  At  this  time,  as 
we  have  seen,  particular  changes  occur  in  the  ovaries.  A  certain  Graafian 
vesicle  or  vesicles,  according  to  the  species  and  whether  the  animal  is 
uniparous  or  multiparous,  becomes  more  voluminous  than  the  others, 
raises  the  enveloping  membrane  of  that  body,  and  makes  a  more  or 
less  salient  projection  on  its  surface,  as  is  witnessed  in  the  ovary  of  the 
Pig.  Around  this  vesicle  the  blood-vessels  enlarge,  and  the  stroma 
is  congested  ;  while  in  its  interior  an  effusion  of  blood  takes  place ;  the 
capsule  becomes  greatly  distended  and  injected,  and  at  a  particular  point 
gives  way,  leaving  an  irregular  gap  through  which  the  ovum  (Fig.  21,  <^) 
escapes.  In  the  Pig,  during  the  evolution  of  the  vesicle,  the  corpus 
luteum  is  red,  deep  red,  blue,  or  nearly  black.  It  is  probable  that  the 
Graafian  vesicles  open  at  any  part  of  the  surface  of  the  ovary,  in  those 
animals  in  which  the  pavilion  of  the  Fallopian  tube  is  large  enough  to 
envelop  it  more  or  less  completely.  But  in  those  creatures,  such  as  the 
Mare,  in  which  the  ovary  is  so  voluminous,  the  pavilion  cannot  cover  it ; 
and  it  is  not  at  all  unlikely  that  in  this  case  the  rupture  of  the  vesicles 
occurs  at  the  hilus  of  the  ovary,  as  the  corpora  lutea  have  only  been 
observed  at  this  part.  In  multiparous  animals,  the  rupture  of  the  vesicles 
at  one  period  of  rutting  does  not  appear  to  take  place  simultaneously,  but 
successively. 

The  number  of  Graafian  vesicles  which  come  to  maturity  and  rupture 
at  each  period  of  oestrum,  depends,  with  some  exceptions,  upon  the  num- 
ber of  young  each  female  brings  forth  at  a  birth.     The  Mare,  Cow,  and 


FECUNDATION.  6i 

Sheep,  having  usually  only  one  offspring  at  a  time,  only  one  vesicle  ripens 
during  oestrum  ;  the  Goat  has  most  frequently  two  young,  and  in  this  case 
a  vesicle  ruptures  in  each  ovary  ;  while  the  Pig  and  Carnivora  having 
several  at  a  birth,  a  corresponding  number  of  vesicles  open  and  their 
contents  occupy  each  cornu  of  the  uterus. 

The  ovum  liberated  by  the  bursting  of  the  vesicle  is  seized  by  the  pavil- 
ion of  the  oviduct,  which  is  applied  somewhat  closely  to  the  surface  of  the 
organ,  and  is  carried  down  the  tube  to  the  uterus,  where,  if  fecundation 
does  not  ensue,  it  remains  only  a  brief  period  before  it  is  expelled  or 
perishes.  The  seizure  of  the  ovum,  as  has  been  stated,  is  all  the  more 
certain  in  proportion,  as  the  pavilion  is  large  enough  to  grasp  a  large 
surface  of  the  ovary  :  this  condition  is  found  most  developed  in  the 
Carnivora. 


CHAPTER  II. 
Fecundation. 


The  effective  intercourse  of  the  male  with  the  female  is  followed  by  cer- 
tain remarkable  changes  in  the  ovum  and  generative  apparatus  of  the 
latter,  which,  at  first  known  as  fecundation,  conception,  or  impregnation^ 
ultimately  results  in  the  formation  of  a  new  creature  possessed,  to  a  cer- 
tain degree,  of  individual  or  independent  life.  The  intercourse,  to  be 
effective,  depends  upon  the  presence  of  a  healthy  ovum  in  the  apparatus 
of  the  female,  and  the  introduction  into  this  apparatus  of  the  seminal 
fluid  by  the  special  organ  of  the  male.  This  fluid  contains  the  essential 
elements  known  as  "  spermatozoa " — organic  particles  of  a  particular 
shape,  and  endowed  with  motion.  For  conception,  it  is  absolutely  neces- 
sary that  the  ovum  of  the  female  should  be  brought  into  contact  with 
these  particles  ;  though  whether  this  contact  can  occur  in  the  ovisac, 
prior  to  its  escape,  has  not  yet  been  definitely  ascertained.  It  is  certain 
that  by  reason  of  their  particular  movements,  and  also  doubtless  through 
the  aid  they  receive  from  the  special  motion  of  the  ciliated  epithelium 
covering  certain  portions  of  the  lining  membrane  of  the  uterus,  these 
spermatozoa,  when  the  uterine  opening  is  patent,  are  diffused  soon  after 
coitus  to  the  most  distant  parts  of  that  cavity,  and  high  up  in  the  Fallopian 
tubes  ;  though  they  have  never  been  traced  so  far  as  the  ovisac.  Never- 
theless, a  very  strong  argument  in  favor  of  their  attaining  this  region, 
and  producing  what  is  called  "  ovarian "  or  "  tubal  impregnation,"  is 
afforded  in  the  occurrence  of  extra-uterine — ovarian  or  tubal — gestation  -, 
for  in  this  case  the  spermatozoa  must  have  reached  both  oviduct  and  ovary. 
Before  the  ovum  leaves  the  ovary,  changes  occur  in  it  which  may  be 
noted  here.  The  germinal  spot,  previously  at  the  inner  surface,  passes  to 
the  centre  of  the  germinal  vesicles  ;  and  this,  which  was  before  at  the 
surface,  goes  to  the  centre  of  the  yolk  or  vitellus ;  while  the  membrane 
investing  the  latter,  from  being  thin,  suddenly  thickens.  When  the  ovum 
is  discharged,  the  tunica  granulosa  and  retinacu/a  accompany  it  through 
the  small  opening  in  the  visicle  ;  the  whole  being  received  into  the  pavilion 
or  infundibulum  of  the  Fallopian  tube,  which  at  this  time  is  firmly  applied 
against  the  ovar}'.  Arrived  at  this  part,  the  ovum  is  carried  along  by  the 
slow  vermicular  motion  or  contraction  of  the  tube,  as  well  as  by  the  ciliary 
movement  of  the  cells  covering  the  mucous  membrane  lining  this  duct 
until  at  last  it  reaches  the  uterus. 


62  OBSTETRICAL  PHYSIOLOGY. 

CHAPTER  III. 

Sterility. 

Hitherto  we  have  been  treating  of  successful  fecundation  as  if  it  was 
always  a  sure  result  of  the  coupling  of  the  male  and  female  sexes  at  a 
certain  period.  Successful  fecundation,  however,  is  not  always  the  case, 
and  in  some  species — particularly  the  equine — sterility,  temporary  or  per- 
manent, in  the  female  is  far  from  being  uncommon,  and  is  sometimes 
serious.  Sterility  or  infecundity  depends  on  numerous  causes,  to  some 
of  which  we  must  allude,  as  in  distinguishing  their  presence  we  may  be 
able  to  remove  or  counteract  them. 

It  is  difficult  to  ascertain  the  extent  to  which  it  prevails,  especially  in 
the  larger  and  more  important  animals.  In  the  Stud  Book,  it  is  shown 
that  among  thorough-bred  Mares  the  percentage  of  those  which  carry  foal 
is  73*36,  and  those  which  abort  or  are  infecund  26*64.  I^  the  studs  of 
France  the  fruitful  Mares  are  59*57,  and  the  unfruitful  ones  40*43  per 
cent.  The  Duke  de  Guiche  gives  68  per  cent,  of  fecund  Mares.  At  the 
haras  of  Pin,  during  a  period  of  twenty  years,  there  was  a  percentage  of 
68*27  fecund  Mares,  abortions  5*06,  non-fecund  26*67  \  while  at  the  Pom- 
padour haras,  where  oriental  horses  were  chiefly  bred,  the  births  in  three 
years  were  79*55,  abortions  2*27,  and  non-fecunds  20*45. 

In  the  Cow,  the  fecundations  appear  to  average  about  79  per  cent. 

With  the  Sheep,  sterility  or  infecundity  is  not  so  common.  Rueff,  at 
Hohenheim,  found  among  8500  sheep,  only  740,  or  8  per  cent,  unfruitful. 

Sterility  may  depend  upon  organic  or  physical  causes,  and  may  amount 
to  permanent  impotence,  more  particularly  when  congenital,  and  located 
in  the  generative  apparatus.  Monstrosities,  hermaphrodites,  animals  in 
which  one  or  more  important  organs  of  the  sexual  apparatus  are  absent, 
and  hybrids,  are  generally  permanently  sterile.* 

Prolonged  continence  and  old  age  is  not  an  unfrequent  cause  of  infe- 
cundity, as  is  witnessed  in  Mares  which  have  worked  for  many  years  in 
towns,  and  then  been  transferred  for  breeding  purposes. 

Change  of  climate  has  in  many  cases  a  marked  influence  on  fecundity ; 
sometimes  putting  it  altogether  in  abeyance,  and  at  others  rendering  the 
animals  infecund  for  only  a  longer  or  shorter  period.  It  may  also  be  im- 
paired, or  suspended  temporarily  or  permanently,  by  abuse  of  the  gener- 
ative functions,  bad  hygiene,  etc. 

It  may  likewise  be  due,  though  temporarily,  to  premature  or  tardy 
coition  when  the  generative  organs  are  not  in  a  physiological  condition 
for  conception,  or  when  they  are  in  an  irritable,  abnormal  state.  Under- 
fed or  over-fed  animals  generally  do  not  breed  so  readily  as  those  which 
are  in  moderate  condition  ;  fat  animals  are  especially  unfruitful.  Excit- 
able, vicious  Mares  are  less  likely  to  procreate  than  those  which  are  of  an 
equable  and  gentle  disposition.  The  latter  are  often  impregnated  at  one 
attempt ;  and  it  has  been  observed  that  with  Mares  accustomed  to  work, 
active  exertion,  even  to  produce  fatigue,  before  being  put  to  the  horse,  is 
favorable  to  conception.     So  it  is  that  the  Arab  submits  his  Mare  to  a 

*  There  are  exceptions  to  this  rule.     Several  well-authenticated  instances  are  recorded  in  which  the 
soliped  mule  has  bred,  as  well  as  other  hybrids. 


STERILITY. 


^l 


sev^ere  gallop,  and  brings  her  almost  breathless  before  the  stallion,  when, 
the  act  being  accomplished,  he  leaves  her  quietly  at  rest  for  some  hours. 

Various  diseased  conditions  of  the  generative  or  other  organs,  as  well  as 
general  derangements,  may  also  prove  antagonistic  to  fecundity.  There 
may  be  disease  or  alterations  in  the  ovaries.  Fallopian  tubes,  uterus,  or 
vagina,  which  will  hinder  conception  ;  and  if  any  material  obstacle  to  the 
contact  of  the  spermatic  fluid  with  the  ovule  be  present  in  these  parts, 
fecundation  cannot  take  place.  Tumors  of  various  kinds  in  this  region 
are  not  an  infrequent  cause  of  sterility. 

Rueff  and  others  have  observed  an  imperforate,  dense,  and  tough 
hymen  to  be  a  cause  of  infecundity  in  the  Mare. 

In  all  these  conditions  a  careful  examination  should  be  made,  as  removal 
of  the  obstacle  to  generation  may  be  quite  within  the  scope  of  surgical  or 
medical  measures.  More  particularly  is  this  the  case  when  the  obstacle 
is  related  to  some  abnormal  condition  of  the  cervix  uteri — a  circumstance 
more  common  than  is  generally  supposed. 

Occlusion  of  the  canal  leading  to  the  cavity  of  the  uterus — the  os — has 
been  known  as  a  cause  of  sterility  in  the  Mare  and  Cow  from  the  earliest 
times.  This  occlusion  may  be  complete  during  coition,  and  prove  fatal 
to  conception  ;  it  may  be  due  merely  to  a  spasmodic  condition  of  the 
Vnuscles  of  the  cervix.  The  oiled  hand  should  be  introduced  into  the 
vagina  to  ascertain  the  state  of  the  part ;  when,  if  the  closure  is  suspected 
to  be  owing  to  muscular  defect,  the  cervix  may  be  smeared  with  extract 
of  belladonna.  If,  however,  this  does  not  exceed,  or  if  there  be  hyper- 
trophy, disorganization,  or  rigidity,  then  an  operation  will  be  necessary. 
Hypertrophy  from  plastic  exudation,  and  the  formation  of  false  mem- 
branes, is  a  frequent  cause  of  sterility,  and  usually  occurs  during  or  after 
the  first  birth,  particularly  in  the  Cow.  In  many  cases  the  morbid  closure 
of  the  OS  can  be  remedied  in  a  very  safe  and  simple  manner.  The  animal 
is  secured — if  a  Mare  by  the  "  side-line,"  if  a  Cow  by  fastening  the  two 
hind  legs  together,  though  not  too  close — and  the  oiled  hand,  in  the  form 
of  a  cone,  passed  up  the  vagina  to  the  cervix  in  a  half-rotary  or  screwing 
manner  ;  on  reaching  this,  the  tips  of  the  fingers  are  to  be  gently  insinu- 
ated, by  the  same  movement,  into  the  os,  and  pushed  on  until  the  cavity 
of  the  uterus  is  reached.  A  simple  sound,  well  greased,  and  the  size  of 
an  ordinary  catheter,  may  be  employed  with  the  same  object  as  the  fin- 
gers, and  appears  to  answer  quite  as  well.  Various  instruments  have 
been  devised  to  dilate  the  cervix,  but  nothing  is  equal  to  the  fingers  or 
the  sound.  The  animal  may  be  put  to  the  male  on  the  same  or  the  fol- 
lowing day.  This  simple  operation  for  the  cure  of  sterility  has  been  very 
often  practised,  and  is  well  known  to  the  Arabs  of  the  Sahara,  who  treat 
their  barren  Mares  in  this  manner,  and  in  the  majority  of  cases  with 
success. 

In  rare  instances  dilatation  may  require  to  be  effected  by  a  cutting 
instrument,  but  this  should  never  be  resorted  to  until  the  simpler  and  safer 
means  have  failed. 

Disease  of  the  mucous  membranes,  with  altered  secretions,  must  be 
treated  according  to  their  indications. 


64 


OBSTE  TRIG  A  L  PH  YSIOL  OGV. 


CHAPTER  IV. 

Changes  in  the  Ovum 

During  the  progress  of  the  ovum  towards  the  uterus,  and  soon  after  its 
reception  into  that  cavity,  some  remarkable  alterations  occur.  The  ovum 
has  encountered  the  fructifying  element  of  the  male  semen — the  sperma- 
tozoa ;  at  least,  this  has  been  established  in  the  Rabbit,  in  whose  oviducal 
ovum  they  were  found  to  have  passed  through  the  zona  pelhuida,  though 
no  opening  has  yet  been  discovered  in  that  extremely  fine  evanescent 
film.  The  germinal  vesical  disappears,  or  has  changed  its  character,  and 
a  somewhat  more  opaque  embryonal  cell  succeeds,  which  may  be,  or  in- 
cludes, a  combination  of  the  nuclear  matter  of  the  sperm-cell  with  that  of 
the  germ-cell.  Then  the  vitellus,  escaped  from  its  enveloping  membrane, 
becomes  depressed  in  a  circular  manner,  and  breaks  up  into  independent 
masses. 

This  change,  and  others  to  be  described,  takes  place  during  the  course  of 
the  impregnated  ovum  through  the  Fallopian  tube.     It  may  chance,  how- 


Fig.  28. 

Ovum  from  Oviduct  of  Rabbit, 
penetrated  by  spermatozoa  in 
ITS  Vitelline  Layer. 


Fig.  29. 

An   Ovum   more   advanced 
Oviduct. 


ever,  that  impregnation  takes  place  in  the  uterus  ;  for  it  is  probable  that 
the  ovum  may  be  retained  there  for  a  certain  time  previous  to  perishing 
or  being  ejected,  and  that,  should  it  meet  the  spermatic  fluid,  impregna- 
tion will  ensue  and  the  usual  results  follow.*  But  it  is  more  likely  that 
the  initial  changes  are,  in  the  majority  of  instances,  accomplished  in  the 
tube.  There,  the  ovum  is  bathed  and  moved  about  in  the  clear  fluid 
containing  the  spermatozoa,  by  the  peristaltic  action  of  the  walls  of  the 
duct,  in  order  to  enable  the  largest  number  of  the  fertilizing  particles  to 
obtain  access  to  the  yolk,  and  thus  ensure  fecundity. 

With  the  formation  of  the  embryo-cell,  the  vitellus  becomes  separated 

*  It  may  be  remarked  that,  with  multiparous  animals,  the  number  of  young  in  the  cornua  are  not  in 
proportion  to  the  corpora  lutea  of  the  same  period.  Franck  mentions  an  instance  in  which  there  were 
eleven  corpora  lutea  and  only  five  foetuses ;  from  which  it  might  be  inferred  that  six  ova  had  perished,  or, 
if  they  had  been  impregnated,  that  the  foetuses  must  have  died  at  a  very  early  period,  and  been  absorbed. 
It  has  also  been  stated  tj-.at  an  ovum  from  the  right  ovary  (which  bore  recent  traces  of  the  rupture  of  a 
Graafian  vesicle),  has  been  found  in  the  left  cornu,  whither  it  must  have  wandered.  This  has  been 
observed  in  woman,  in  the  Bitch,  the  Guinea-pig,  and  also  in  the  Sheep.  Kehrer  mentions,  in  the 
Monatsschrift  fiir  Geburtskunde  (vol.  xxii.,  p.  225),  finding  a  fcetus  in  each  horn  of  the  uterus,  and  in 
the  right  ovary  two  true  corpora  lutea.  One  ovum  had  migrated  to  the  left  cornu  by  means,  probably,  of 
the  uterine  contractions. 


CHANGES  IN  THE  OVUM.  65 

or  retracted  by  fluid  from  the  zona  pellucida,  and  begins  to  rotate 
therein  ;  while  one  or  two  minute  granular  or  oil-like  bodies  may  appear 
in  the  surrounding  fluid  (Fig.  28). 

A  division  or  segmentation  of  this  primary  embryo-cell  into  two  portions 
(Fig.  29),  each  provided  with  a  nucleus,  is  the  next  step  ;  then  there  is 
mutual  repulsion  of  these  secondary  globes,  and  further  cleavage  of  each 
into  two  portions  (Fig.  30),  and  these  again  into  other  binary  divisions 
(Fig.  30)  of  the  germ  yolk,  through  attraction  round  each  cell  of  the 
particles  contiguous  thereto,  until  the  whole  is  worked  up  into  a  mass  of 
finely  'nucleated  corpuscles — the  ultimate  segmentations  of  the  impreg- 
nated parent  embr3^o-cell.  Each  of  these  corpuscles  contains  a  colorless 
pellucid  nucleus,  and  each  of  these  again  a  nucleolus.  The  eight-fold 
cleavage  of  the  yolk  has  been  observed  three  days  after  impregnation  in 
the  Rabbit,  four  days  in  the  Guinea-pig,  and  ten  days  in  the  Bitch  ;  and 
always  in  the  ova  found  towards  the  uterine  extremity  of  the  oviduct.  In 
the  latter  animal  the  smooth  surface  of  the  zona  pellucida  becomes 
irregularly  flocculent,  as  if  a  granulo-mucus  substance  had  been  deposited 


Ovum    from   the    Uterine  half  of 
Oviduct. 


Fig.  31- 

Ovum  from  the  Uterine  end  of  the 
Oviduct,  with  an  additional  layer 
OF  Albumen. 


thereon  ;  in  the  Rabbit  the  ovum  acquires  a  thick  adventidous  layer  of 
albumen  before  entering  the  uterus  (Fig.  31,  <7)  ;  in  the  Guinea-pig  the 
zona  continues  smooth.  After  entering  the  uterus,  on  the  fourth  day  the 
zona  grows  fainter,  as  the  final  segmentation  or  mulberry  state  of  the 
yolk  is  attained,  and  it  disappears  altogether  when  the  germ-mass  is 
completed.  The  act  of  impregnation  is  thus  consummated,  and  a  series 
of  new  changes  begin,  which  are  replete  with  interest  and  importance. 

When  arrived  in  the  uterus,  a  layer  of  very  small  vesicles  makes  its 
appearance  on  the  whole  of  the  inner  surface  of  the  membrane  now 
investing  the  yolk.  The  mulberry  structure  then  passes  from  the  centre 
to  a  certain  part  of  that  layer,  the  vessels  of  the  latter  coalescing  with 
those  of  the  former,  where  the  two  sets  are  in  contact,  to  form  a  mem- 
brane— the  future  amnion  ;  while  the  interior  of  the  mulberry-like  body 
is  now  seen  to  be  occupied  by  a  large  vesicle,  containing  a  fluid  and 
dark  granules.  In  the  centre  of  this  fluid  is  a  spherical  body,  com- 
posed of  a  substance  having  a  finely  granular  appearance,  and  containing 
a   cavity   filled   with   a   colorless  and  pellucid  fluid  ;  this  hollow   and 

5 


66  OBSTETRICAL  PHYSIOLOGY. 

spherical  body  seems  to  be  the  true  germ.  The  vesicle  containing  it 
disappears,  and  in  its  place  is  seen  an  elliptical  depression,  filled  with  a 
clear  fluid,  and  in  the  centre  of  this  is  the  "germ,"  still  presenting  the 
appearance  of  a  hollow  sphere. 

The  fluid  presses  the  nucleate  corpuscles  of  the  yolk  outwards  against 
the  inner  face  of  the  enveloping  membrane,  and  as  it  increases  the 
pressure  from  within  flattens  these  corpuscles,  until  they  resemble 
pavement  epithelium  ;  and,  finally,  they  all  coalesce  to  compose  a  mem- 
brane lining  the  zona,  which  has  been  named  the  blastoderm.  This 
blastodermic  vesicle  divides  into  two  layers — an  external  and  internal — 
the  first  of  which  is  pale  and  only  slightly  granular,  while  the  cells  of  the 
second  are  filled  with  fat  granules;  it  is  consequently  of  a  deeper  tint. 

Though  the  foregoing  changes  in  the  impregnated  ovum  have  been 
chiefly  observed  in  the  Rabbit  and  Guinea-pig,  yet  there  can  be  little 
doubt  that  they  are  of  the  same  character  in  the  domestic  creatures 
whose  embryology  we  are  now  studying. 

It  is  only  to  be  remarked  that,  in  hoofed  animals,  no  envelope  of  the 
ovum  is  superadded  to  the  zona  pellucida  before  it  enters  the  uterus  ; 
impregnation  of  the  ovum  taking  place  in  the  Fallopian  tube,  where  it 
meets  the  spermatozoa,  the  first  stages  of  cleavage  in  its  interior  go  on 
there,  but  the  germ-mass  is  completed  in  the  uterus.  In  this  process 
the  zona  thins  away  and  finally  disappears,  and  a  mass  of  albuminoid 
matter  accumulates  around  the  ovum,  which  affords  material  for  imbibi- 
tion. The  germ-mass  becomes  fluid  at  the  centre,  and  expands  into  a 
hollow  sphere,  whose  wall  offers  two  layers  :  both  consisting  of  coherent 
cells,  and  only  differing,  as  just  remarked,  in  the  size  and  proportion  of 
the  oil-globules. 


H 

Fig.  32- 

Blastoderm  and  Primitive  Trace- 

a.  Vitelline  Membrane  with  its  commencing  Villosities ;  b,  External  (or  Serous)  Layer  of  the 
Blastoderm;  c,  Internal  (or  Mucous)  Layer;  d,  Body  of  the  Embryo;  ^i,  bi.  Earliest 
Cephalic  and  Caudal  Elevation  of  the  External  Layer. 

SECTION  I. DEVELOPMENT    OF    THE    EMBRYO. 

The  ovum  having  been  lodged  in  the  uterus,  and  the  germ-membrane  or 
blastoderm  having  divided  into  two  layers — an  upper  or  serous^  and  a  lower 
or  mucous — and  between  which,  at  a  later  period,  a  vascular  layer  is  de- 
veloped, another  modification  occurs  by  which  the  outline  of  the  embryo 
becomes  evident. 


ft 

CHANGES  IN  THE  OVUM.  67 

In  the  centre  of  the  blastoderm,  where  it  is  supposed  to  divide  into 
these  layers,  there  is  observed  a  clear  space  which  has  been  designated 
the  area proligera  or  pellimda'vcv  the  centre  of  which,  and  in  the  trans- 
verse axis  of  the  vitellus,  there  is  going  on  a  multiplication  of  loosely  con- 
nected cells  in  a  small  rounded  mass,  which  forms  the  germinative  area, 
primitive  streak,  or  trace  of  Von  Baer  ;  while  around  this  another  space — 
the  area  vasculosa — is  developed.  The  ''  primitive  streak  "  is  the  centre 
where  the  blastoderm  commences  to  be  separated  into  the  external  and 
internal  layers  ;  the  middle  layer,  which  is  to  form  the  foetal  organs,  not 
extending  beyond  the  "germinative  area  "  or  "streak." 

By  a  proliferation  of  the  elements  of  the  outer  and  middle  layers  of  the 
blastoderm,  the  primitive  trace  increases  in  surface  and  thickness,  be- 
coming clearly  defined  and  prominent,  in  the  form  of  a  shield,  and  is 
named  the  opaque  area,  which,  when  it  grows  transparent  in  its  centre,  is 
named  the  transparent  or  pellucid  area  ;  the  clear  spot,  narrowing  or  con- 
stricting in  its  middle  part,  is  named  the  area  vasculosa  or  embryojiic.  In 
the  middle  of  this  embryonic  area  appears  a  dark  line,  or  median  fur- 
row, due  to  changes  occurring  in  the  primitive  streak ;  and  below  it  a 
sound  cord — the  chorda  dorsalis — the  axis  of  the  future  embryo,  and 
which  is  to  develop  the  spine  ;  on  each  side  of  the  streak  is  the  lamina 
dorsalis,  and  the  portion  of  fluid  separating  them  from  the  chorda  dor- 
salis is  the  future  spinal  cord  and  brain.  The  inner  layer  of  the  blas- 
toderm, at  the  points  corresponding  to  the  embryo,  becomes  doubled,  so 
as  to  form  a  new  layer — the  middlle  layer.  The  chorda  dorsalis  thickens 
at  the  front  part,  to  form  the  first  appearance  of  the  skull,  and  the  fluid 
between  the  dorsal  laminae  is  in  larger  quantity,  in  correspondence  with 
it  ;  so  that  the  central  parts  of  the  nervous  system  and  their  coverings 
are  laid  down  at  the  same  time  and  grow  simultaneously.  The  separa- 
tion between  the  spinal,  cord  and  brain  takes  place  early,  being  coinci- 
dent with  a  curving  downwards,  towards  the  yolk,  of  the  anterior  part  of 
the  laminae  dorsalis,  which  defines  the  limit  between  the  skull  and  spine, 
brain  and  cord. 

Next  follows  the  closing  of  the  dorsal  laminae  over  the  fluid  which  is 
to  constitute  the  brain  and  cord.  Two  other  laminae  are  in  the  mean 
time  proceeding  from  the  axis  of  the  embryo,  one  on  each  side.  They 
grow  out  laterally,  and  tend  to  converge  in  the  median  line,  as  did  the 
dorsal  laminae  ;  but  they  form  a  larger  curve,  and  follow  a  different 
direction,  converging  to  meet  below  the  axis,  where  they  join,  except  at 
the  umbilicus. 

After  the  rudiments  of  organic  life  have  been  commenced  in  the  cen- 
tral portion  of  the  serous  layer,  a  fold  of  its  peripheral  portion  arches 
over  the  dorsal  surface  of  the  embr}'0,  so  as  to  represent  a  sack  whose 
opening  is  at  the  edge  of  the  fold.  The  opening  gradually  decreases 
until  the  opposing  folds  of  membrane  are  in  contact ;  it  then  disappears, 
leaving  the  foetus  surrounded  by  two  membranes.  The  one  next  the 
foetus  is  the  amnion,  and  the  other  is  gradually  separated  from  the  amnion 
and  joins  the  serous  lamina  of  the  blastoderm,  forming  the  "false 
amnion"  of  Pander,  or  the  "  serous  covering  "  of  Von  Baer.  The  mem- 
brane surrounding  the  vitellus  or  yoke  is  very  vascular  ;  it  becomes  oval 
in  shape,  and  more  pointed  when  it  is  in  contact  with  the  embr3'o,  until 
at  length  it  contracts  into  a  narrow  duct,  constituting  the  vesicula  alba 
and  duct.  Thus,  then,  we  have  seen  the  embryo  developed  in  the  layers 
of  the  blastoderm,  and  formed  by  a  gradual  closing  in  of  the  laminae  to- 


4 

68  OBSTETRICAL  PHYSIOLOGY. 

wards  the  median  line ;  the  brain  and  spinal  marrow,  which  are  its  ear- 
liest rudiments,  are  covered  in,  and  the  parts  anterior  to  the  spine — the 
thorax,  abdomen,  etc. — are  formed.  * 

We  will  now  direct  our  attention  to  changes  occurring  elsewhere,  and 
return  to  the  development  of  the  embryo  again. 

Towards  the  twelfth  day,  in  the  higher  orders  of  animals,  the  chief 
modifications  which  have  just  been  described  as  occurring  in  the  condi- 
tion of  the  ovum  after  fecundation,  are  accomplished.  The  ovum  then 
measures  from  one-third  to  one-fourth  of  an  inch  in  diameter,  and  is 
composed  in  reality  of  four  layers  or  shells,  enclosed  one  within  the 
other,  but  only  three  of  which  are  complete  ;  they  are  :  (i)  the  yolk 
membrane  ;  (2)  the  external  layer  of  the  blastoderm  ;  (3)  the  middle 
layer  ;  (4)  the  inner  layer. 

By  ulterior  modifications,  the  layers  of  the  blastoderm  form  the  various 
organs  of  the  foetus,  and  what  have  been  termed  its  anfiexes,  or  envelop- 
ing membranes.  The  different  layers  have  also  received  other  names 
than  those  mentioned,  according  to  their  functions  ;  thus,  the  external  or 
serous  has  been  named  the  sensitive  layer,  because  it  originates  the  epi- 
dermis and  the  organs  of  sense  ;  the  middle  layer  has  l3een  named  the 
vascular  or  germifiative,  as  it  contains  the  principal  vessels  of  the  em- 
bryo, and  the  locomotory  organs  are  developed  in  its  substance  ;  while 
the  internal  layer  is  known  as  the  mucous  or  intestino-glandular,  from  its 
constituting  the  mucous  membranes,  its  principal  portions  forming  the 
intestines  and  glands.     Each  of  these  layers  furnishes,  in  the  course  of 


J 


Fig.  33. 
Ovum  Twekty  to  Twenty-five  Days  Old. 


I,  Villosities  of  the  yitelline  Membrane;  2,  External  Layer  of  the  Blastoderm,  or  Second 
Chorion,  with  its  Villosities ;  3,  Umbilical  Vesicle,  formed  by  the  Inner  Layer  of  the  Blasto- 
derm ;  4,  Vessels  of  the  Umbilical  Vesicle  ;  5,  Cephalic  and  Caudal  Processes  ;  6,  Embryo  ; 
7,  Allantoid  Vesicle. 

its  development,  the  intra-foetal  and  the  extra-foetal  parts.  We  shall  ex- 
amine the  latter  first ;  merely,  noting  in  the  mean  time,  that  the  intra- 
foetal  parts  of  the  external  or  sensitive  layer  of  the  blastoderm  form  the 
epidermis  and  its  appendages — as  the  hair,  claws  or  hoofs,  glands  of  the 
skin,  etc. — the  central  nervous  system,  and  the  organs  of  sense — such  as 
the  retina  and  the  labyrinth  of  the  ear;  while  the  extra-foetal  parts  it 
forms  are  due  to  its  alteration  in  shape. 

The  foetus,  as  we  have  seen,  is  a  circular  body  applied  against  a  certain 
point  of  the  blastoderm,  whose  outer  layer  is  continuous,  and  extends 


CHANGES  IN  THE  OVUM. 


69 


over  the  internal  face  of  the  chorion  and  the  surface  of  the  embryo  with- 
out any  limit.  But  the  inflection  or  bending  of  the  latter  at  its  two 
extremities  causes  the  external  layer  to  become  depressed,  and  to  consti- 
tute two  folds  ;  one  investing  the  head,  the  other  the  opposite  extremity 
of  the  body.  The  lateral  parts  of  the  embryo  are  also  inflected  towards 
each  other  to  form  the  thoracic-abdominalcavity,  and  it  is  thus  enclosed 
in  the  serous  layer,  whose  sides  soon  meet  above  the  back  of  the  young 
creature,  and  a  short  pedicle — the  superior  umbilicus — ^joins  the  two 
portions  of  the  blastoderm  This  pedicle  soon  disappears,  and  the 
embryo  is  then  inclosed  in  an  independent  sac — the  amnion  already 
alluded  to.  The  sensitive  layer  is,  therefore,  decomposed  into  two  sec- 
tions :  an  internal,  the  amnion ;  and  an  external,  the  serous  vesicle,  which 
is  applied  against  the  inner  face  of  the  zona  pellucida,  and  concurs  to 
form  the  chorion. 

The  middle  layer  will  be  noticed  hereafter,  and  now  we  go  to  the  internal 
layer.  The  intra-fcetal  parts  of  this  so-called  "  mucous  layer  "  form  the 
epithelium  of  the  intestines  and  the  glands  belonging  thereto,  the  respira- 
tory apparatus,  the  kidneys,  and  the  bladder.  These  organs  are  developed 
it  the  same  time  as  the  extra-foetal  parts. 


Fig.  34- 

Ovum  about  a  Month  Old. 

I,  Vitelline  Membrane  or  Primitive  Chorion,  which  has  almost  disappeared  ;  2,  External  Layer 
of  the  Blastoderm  or  Second  Chorion  ;  3,  Allantois  penetrating  the  Villosities  ;  4,  Umbilical 
Vesicle  ;  5,  Union  of  the  Caudal  and  Cephalic  Processes,  and  Formation  of  the  Cavitv  of  the 
Amnion  ;  6,  Embryo ;  7,  Allantois. 

In  curving-in  upon  itself,  the  embryo  encloses  a  portion  of  the  internal 
blastodermal  layer,  but  the  union  between  the  free  and  the  imprisoned 
parts  is  at  first  largely  maintained ;  soon,  however,  it  contracts,  and  in  a 
brief  period  is  only  represented  by  a  somewhat  narrow  canal,  the  inferior 
umbilical  ring.  The  mucous  layer  is  therefore  divided  into  two  distinct 
portions :  the  intestinal  furrow  or  intrafoetal  portion  ;  and  the  umbilical 
vesicle,  vesicula  alba,  or  extra  foetal  portion.  These  two  divisions  com- 
municate by  the  omp  halo -mesenteric  or  vitelline  duct.  The  "  umbilical 
vesicle  "  is  filled  with  a  granular  fluid,  which  is  conveyed  by  the  omphalo- 
mesenteric vessels  for  the  nutrition  of  the  foetus  ;  when  this  alimentary 
reserve  is  nearly  expended,  the  allantois  appears.     This  begins  by  a  small 


70 


OBSTETRICAL  PHYSIOLOGY. 


enlargement,  which  the  intestinal  furrow  pushes  towards  the  inferior  part 
of  the  abdominal  cavity  ;  the  enlargement  becomes  elongated  and  vesicu- 
lar-looking, and  gradually  increases  in  size  by  bringing  the  umbilical 
vessels  towards  its  borders.  Becoming  still  more  elongated,  it  passes 
through  the  umbilicus  and  spreads  itself  over  the  inner  face  of  the 
chorion,  between  the  latter  and  the  amnion.  It  is  divided  into  two  sacs 
by  a  constriction,  the  urachus,  at  the  umbilical  ring  ;  the  inner  sac  is  the 
smallest,  and  forms  the  bladder;  while  the  external,  the  most  voluminous, 
composes  the  proper  allantois. 

We  have  now  seen  that  the  vitelline  membrane,  lined  by  the  serous 
vesicle,  forms  a  complete  shell  around  the  ovum  in  process  of  develop- 
ment ;  and  that  the  layers  of  the  blastoderm  eventually  constitute  three 
membraneous  sacs,  two  of  which  envelop  the  embryo.  These  various 
membranes  constitute  the  "  envelopes  "  or  "  annexes  "  of  the  young  crea- 
ture during  utero-gestation,  and  in  describing  them  it  is  usual  to  include 
the  "  cord  "  composed  of  blood-vessels,  as  well  as  the  capillary  ramifica- 
tions which  establish  and  maintain  such  important  relations  between  the 
mother  and  its  offspring  during  this  period. 


Fig-  35- 
Chorion  of  the  Mare  at  Mid-term 


Inflated. 


A,  Posterior  portion  occupying  the  body  of  the  Uterus  ;  B,  Left  Comu  plicated  and  sacculated 
C,  Right  Comu,  longer  than  the  left,  and  containing  a  portion  of  the  Foetus. 


SECTION    II. ANNEXES    OF    THE    FCETUS. 

The  annexes,  then,  comprise  the  chorion^  a  membraneous  envelope 
exactly  adapted  to  the  uterus ;  the  amnion,  a  second  ovoid  sac  included 
within  the  latter,  and  containing  the  foetus  ;  the  allantois,  a  membrane 
composed  of  two  layers,  which  are  spread  over  the  external  face  of  the 
amnion  and  the  inner  surface  of  the  chorion,  and  thus  lines  the  cavity 
formed  by  these  two  envelopes  \  'a  small  bladder  of  a  pyriform  shape,  the 
umbilical  vesicle ;  the //«<r^«/rtr,  a  collection  of  vascular  tufts  grafting  the 
foetus  to  the  mother  ;  and  the  umbilical  cord,  composed  of  vessels  that 
attach  the  foetus  to  the  envelopes  which  contain  it,  and  which  ultimately 
ramify  in  the  placental  tufts.  We  will  describe  each  of  these  in  detail,  as  a 
correct  knowledge  of  their  anatomy  is  essential  to  the*  comparative  ob- 
stetrist.     As  before,  we  will  take  solipeds  as  the  type  of  comparison. 


CHANGES  IN  THE  OVUM. 


71 


» 


Chorion. 

The  chorion^  the  outer  envelope  proper  to  the  ovum,  is  found  covering 
it  loosely  at  the  earliest  period  of  its  existence,  and  corresponds  to  the 
membrane  lining  the  ^gg  in  oviparous  animals.  It  is  a  vast  membraneous 
sac,  completely  closed,  and  which,  being  moulded  upon  the  uterine  cavity, 
resembles  the  uterus  in  form,  having  a  body  and  two  cornua ;  the  latter, 
however,  are  not  co  extensive  with  those  of  the  uterus.  When  the  chorion 
is  distended,  its  cornua  show  fine   and  deep  plicae  or  bulgings,  like  the 


Fig-  36. 

FtETAL  Membranes  of  the  Cow  at  Mid-term. 

A,  Uterus  opened  on  its  left  side  ;  B,B,  Cotyledons  of  the  Uterus  ;  C,C,  Placentulse  ;  D,D, 
Allantois  ;  E,  Vesicle  of  the  Urachus  ;  F,  Amnion  ;  G,  Umbilical  Cord. 

caecum  ;  the  cornua  are  always  unequal  in  size,  that  in  which  the  foetus 
is  developed  being  of  course  the  largest.  The  external  surface,  otherwise 
smooth,  is  studded  with  innumerable  small,  red,  short  papillae  or  "  pro- 
cesses," which  are  formed  by  the  placental  villous  tufts.  This  papillary 
face  adheres  slightly  to  the  internal  surface  of  the  uterus,  and  between 
the  two  surfaces  a  trifling  quantity  of  brown  or  blood-colored  fluid  is 


72 


OBSTE  TRIG  A  L   PH  YSIOL  OG  Y. 


found.  The  inner  face  is  lined  by  the  external  layer  of  the  allantois, 
to  which  it  is  closely  adherent  except  at  the  insertion  of  the  vascular 
cord,  where  there  exists  a  kind  of  conical  infundibulum  occupied  by  the 
umbilical  vesicle.  On  this  surface  the  umbilical  arteries  and  veins  ramify, 
their  minute  divisions  traversing  the  membrane  to  form  the  placental 
villosities.  The  chorion  may  be  divided  into  two  laminae,  the  outer  of 
which  has  been  called  the  exochorioii^  and  the  inner  the  endochorion. 
From  the  endochorion  are  derived  the  vessels  which  pass  to  the  villi,  the 
chorion  itself  being  destitute  of  vessels  until  the   allantois   is  developed. 


FiZ-  37- 

IcETAL  Membranes  of  the  Goat  at  Full  Time:   Twins. 

A,  Cervix  of  the  Uterus ;  B,  Left  Cortiu ;  C,  Right  Cornu  ;  D,  Allantois  of  one  of  the 
Foetuses  ;  E,  Amnion  of  ditto  ;  F,  Portion  of  the  Uterine  Wall  left  at  the  middle  of  its 
Body,  where  the  Foetuses  come  in  contact ;  G,  Union  of  the  Two  Chorions  at  the 
Cervix  Uteri. 


The  structure  of  this  envelope  is  that  of  a  delicate  cellular  membrane, 
traversed  by  the  vascular  ramifications  of  the  placenta.  In  many  places 
its  cellular  arrangement  closely  resembles  that  of  vegetables,  each  cell 
containing  a  distinct  nucleus  ;  the  villi  have  the  same  texture,  but  their 
cells  are  filled  with  a  granular  matter.  The  strength  of  the  membrane 
is  greatest  in  the  early  ovum  ;  it  is  formed  by  the  zona  pellucida^  which  is 


CHANGES  LV  THE  OVUM, 


73 


lined  by  the  external  layer  of  the  blastoderm.  It  is  thought  that  the 
primitive  chorion  disappears  by  resorption,  and  that  this  blastodermic 
layer  becomes  the  definitive  chorion  ;  also  that  when  the  allantois  has 
spread  itself  between  the  amnion  and  the  external  envelope,  carrying 
outward  the  umbilical  vessels,  this  definitive  chorion  becomes  vascular, 
and  furnished  with  its  numerous  villosities. 

Differences.  / 

Ru7ninaiits. 

In  Ruminants,  the  chorion  corresponds  to  the  internal  face  of  the  ute- 
rus, whose  form  it  repeats,  and  with  w^iose  surface  it  is  more  or  less  in 
contact.  The  middle  of  its  inner  surface  is  united  to  the  amnion  and  the 
allantois  by  loose  gelatinous  connective  tissue,  so  laminated  that  it  might 
be  mistaken  for  different  layers  of  membrane.  It  is  only  covered  by  the 
allantois  in  the  portions  corresponding  to  the  cornua,  which  are  longer 
than  those  of  the  uterus.  It  offers  numerous  small  red  masses,  studded 
at  variable  distances  from  each  other  on  the  surface  next  the  uterus,  and 
which  effect  a  very  important  connection  between  the  latter  and  the  cho- 
rion.    These  are  the  placentulce  to  which  we  shall  allude  presently. 

In  the  Sheep  and  Goat,  when  there  are  two  young  creatures,  the  two 
cornua  of  the  chorion  are  joined,  so  as  to  look  externally  like  one  sac. 


Fig.   3?- 
Foetus  and  Fcetal  Membranes  of  the  Cat. 
a^.  Chorion  ;  b,  Zonular  Placenta  ;  d,  Umbilical  Vesicle,  with  its  Expansions,  y,  between 
Amnion  and  Placenta,  and  ^,  its  Pedicle  of  attachn.ent  to  a  loop  of  small  intestine ;  k, 
Allantois ;  k,  Fcetus. 

Pig. 

In  the  Pig  there  are  no  cornua,  but  the  whole  appears  as  an  elongated 
sac,  whose  two  extremities,  much  exceeding  those  of  the  embryos,  are  in 
relation  with  the  envelopes  of  the  contained  progeny.     Its  internal  face 


74 

is  similar  to  that 
villous  spots. 


OBSTE  TRICA L   PH YSIOL OG  Y. 
of  ruminants  \  on   its  external  face   are  smooth  non- 
Bitch  and  Cat. 


In  the  Bitch  and  Cat,  the  arrangement  of  the  chorion  is  similar  to  that 
of  the  Pig ;  it  has  no  cornua,  its  extremities  are  obtuse,  and  its  inner  face 
is  everywhere  in  contact  with  tht?  allantois,  though  it  does  not  adhere 
closely  to  it. 


Fig.  39- 

FcETUs  OF  Mare  and  its  Envelopes. 

A,  Chorial  Sac;  C,  Amniotic  Sac  withdrawn  from  the  Allantoid  Cavity,  and  opened  to 
expose  the  Foetus ;  D,  Infundibulum  of  the  Urachus ;  B,  Allantoid  portion  of  the 
Umbilical  Cord:  b.  Portion  of  the  External  Surface  of  the  Chorion  destitute  of  Pla- 
cental Villosities,  and  corresponding  to  the  point  of  insertion  of  three  pediculated 
Hippomanes. 

Amnion. 

The  amnion  is  the  second  complete  sac  enveloping  the  foetus.  It  floats 
freely  in  the  chorial  sac,  to  which  it  is  only  attached  at  a  single  point, 
through  the  medium  of  the  umbilical  cord  ;  and  it  contains  the  foetus, 
which  is  fixed  to  its  inner  face  by  the  same  means.     It  is  formed  by  the 


CHANGES  IN  THE  OVUM.  yj 

external  layer  of  the  blastoderm.  It  envelops  the  embryo  very  closely  at 
an  early  period,  and  is  continuous  with  the  common  integument  of  the 
foetus  at  the  open  abdominal  parietes.  At  a  later  period  it  is  distended 
with  fluid,  and  so  is  separated  from  the  foetus  ;  and  after  being  reflected 
upon  the  funis,  of  which  it  forms  the  outer  coat,  it  terminates  at  the  umbil- 
icus. In  shape  it  is  at  first  spherical,  but  is  afterwards  ovoid,  and  it  has 
thin  transparent  walls.  The  external  face  is  covered  by  the  inner  layer 
of  the  allantois^  to  which  it  slightly  adheres.  The  internal  face  is  quite 
smooth,  and  applied  more  or  less  directly  to  the  skin  of  the  foetus.  It 
exhales  or  secretes  a  fluid — the  liquor  amnii — which  bathes  the  foetus, 
and  serves  an  important  purpose  in  intra-uterine  life. 

In  the  foetus,  as  above  mentioned,  the  amnion^  is  continuous  with  the 
skin  around  the  umbilicus,  and  is  constituted  by  two  superposed  layers  : 
one,  a  very  fine  fibrous  membrane  that  adheres  to  the  allantois ;  and 
another,  an  epithelial  layer,  which  lines  the  inner  face  of  the  latter.  At 
certain  points  of  its  internal  surface  in  solipeds,  according  to  some  au- 
thorities, though  denied  by  others,  there  are  small  white  opaque  masses 
of  what  are  supposed  to  be  epidermic  cells  ;  hence,  this  membrane  has 
Deen  designated  a  true  epidermis  of  the  blastoderm.  Though  thin  and 
transparent,  it  is  nevertheless  of  a  firm  texture,  and  resists  laceration 
better  than  the  other  membranes.  It  does  not  exhibit  either  vessels  or 
nerves  when  in  a  healthy  condition.  When  the  amniotic  sac  is  inflated, 
there  is  observ^ed,  at  the  portion  adjoining  the  infundibulum  of  the 
urachus,  a  kind  of  vascular  plexus,  having  the  shape  of  a  goose's  foot, 
between  the  branches  of  which  the  two  superposed  layers  are  much  less 
transparent  than  elsewhere.  At  this  part,  between  the  amnion  and  the 
allantois,  is  the  small  membraneous  pouch,  quite  empty,  in  which  the  um- 
bilical vesicle  terminates  ;  and  here  also  the  amniotic  sac  forms,  opposite 
the  cord,  a  little  conical  cul-de-sac.  Towards  the  termination  of  gestation, 
one  of  the  extremities  of  the  sac  corresponding  to  the  posterior  limbs  of 
the  foetus,  is  stretched  into  a  very  short  wide  horn. 

Liquor  Amnii. 

The  liquor  amnii  is  an  albuminous  alkaline  fluid  contained  in  the  am- 
niotic sac,  and  in  which  the  foetus  is  suspended  as  in  a  hydrostatic  bed. 
It  is  in  greater  or  less  quantity,  according  to  the  period  of  gestation  : 
being  abundant  and  limpid,  or  slightly  lactescent,  at  an  early  period  ;  and 
becoming  scantier,  viscid,  and  citron  or  reddish-tinted,  at  an  advanced 
stage,  when  it  is  adhesive  and  agglutinates  the  hair.  In  a  Mare,  twenty- 
one  weeks  pregnant,  Gurlt  found  two  pounds  twelve  ounces  of  fluid  ; 
in  another,  at  thirty-six  weeks,  four  pounds  five  ounces  ;  and  finally,  in 
one  about  the  fortieth  week,  the  allantoid  and  amniotic  fluids  weighed 
collectively  nineteen  pounds  and  half  an  ounce.  Its  color  during  this 
period  may  be  due  to  the  meconium  thrown  out  from  the  digestive  pas- 
sages of  the  foetus  ;  and  its  composition  doubtless  varies  with  the  devel- 
opment of  the  latter.  It  is  somewhat  salt  to  the  taste,  and  contains  99 
per  cent,  of  water,  as  well  as  albumen,  mucosine,  kreatin,  glycose,  and 
salts,  the  chief  of  which  are  chlorides  of  sodium  and  potassium,  and  the 
sulphate  and  phosphate  of  lime.  There  is  also  a  yellow  matter  analogous 
to  bile,  as  well  as  urea.  A  peculiar  acid,  the  a7niiiotic,  has  also  been 
found  in  it,  in  addition  to  fragments  of  meconium  from  the  intestines  of 
the  foetus,  epithelial  cells  and  their  nuclei,  besides  portions  of  the  thick 
epidermis  which  covers  the  plantar  face  of  the  hoof  of  solipeds.  Towards 


76  OBSTETRICAL  PHYSIOLOGY. 

the  end  of  gestation  the  albumen  diminishes.  Probably  the  formation  of 
the  mucus  covering  that  invests  the  young  animal  at  birth,  is  due  to  the 
precipitation  on  its  skin  of  the  mucus  and  yellow  matter  contained  in  this 
fluid.  Hoppe-Seyler  gives  its  chemical  composition  as  water,  holding  in 
solution  a  small  quantity  of  casein,  kreatin,  lactic  acid,  grape  sugar,  and 
saline  matter  ;  and  therefore  resembling  very  dilute  serum. 

The  uses  of  the  liquor  amjiii  are  varied  and  important.  It  is  not  very 
probable  that  it  serves  as  nutriment  for  the  foetus  in  the  early  period  of 
intra-uterine  life  ;  though  it  has  been  found  in  the  stomach  of  those  young 
animals  which  had  been  purposely  frozen  in  their  membranes,  and  then 
dissected  ;  portions  of  the  hoof  epithelium  have  also  been  discovered  in 
the  foetal  stomach.  It  preserves  an  equable  temperature  for  the  young 
creature  ;  maintains  the  integrity  of  its  exterior  before  the  skin  is  covered 
by  the  peculiar  sebaceous  coating ;  favors  its  movements  and  its  devel- 
opment, by  removing  it  from  unequal  pressure  ;  diminishes  the  impres- 
sion from  sudden  external  movements  and  shocks,  thus  preserving  it  from 
injury  ;  and  allows  it  to  obey  the  laws  of  gravitation.  It  also  protects 
the  mother  from  injury  by  the  foetus,  towards  the  termination  of  gesta- 
tion. During  parturition,  it  protrudes  the  membranes  ;  is  the  primary 
agent  in  dilating  the  os  uteri ;  shields  the  foetus  from  the  direct  action  of 
the  uterine  contractions,  whose  violence  might  compromise  its  existence  ; 
renders  the  dilatation  of  the  os  easy  and  prompt ;  and  finally,  by  lubrica- 
ting the  vagina,  causes  the  passage  of  the  foetus  through  it  to  be  more 
gentle  and  expeditious  than  it  would  otherwise  be. 

Differences  in  the  Amnion  of  other  Animals. 

Ruminants. 

The  amnion  in  Ruminants  is  similar  to  that  of  the  Mare.  It  is  easily 
separated  into  two  layers,  and  shows  on  its  inner  surface,  particularly 
near  where  it  invests  the  umbilical  cord,  a  large  number  of  white  or  yel- 
lowish-white bodies.  In  the  Cow  these  are  sometimes  elongated  in 
the  form  of  papillae ;  at  other  times  they  exist  in  flattened,  slightly 
raised  patches,  about  one-fourth  of  an  inch  long.  Sometimes  they  are 
single;  occasionally  they  are  in  clusters.  They  consist  of  large,  flat, 
nucleated  cells,  resembling  a  squamous  epithelium  ;  it  is  concluded  that 
they  are  the  seat  of  formation  of  a  glycogenic  material.  Up  to  a  certain 
period  of  intra-uterine  life,  they  increase  in  size  and  then  degenerate  : 
their  organization  and  development  being  in  inverse  relation  to  the 
development  of  the  liver,  whose  function  they  assume,  with  regard  to 
glycogenation.  Externally  the  amnion  is  altogether  in  contact  with  the 
allantois  and  chorion. 

Pig. 
It  does  not  differ  in  the  Pig. 

Bitch  and  Cat. 

In  the  Bitch  and  Cat  the  amnion  is  entirely  covered  by  the  amniotic 
layer  of  the  allantois,  to  which  it  adheres  in  the  same  manner  as  in  the 
Mare  ;  the  two  membranes  are  only  separated  by  the  umbilical  vesicle, 
and  there  is  no  trace  of  the  pouch  and  vascular  plexus  seen  in  that  animal. 
In  the  amniotic  liquid,  crumbs  of  meconium  are  found  towards  the  end 
of  gestation. 


CHANGES  IN  THE  OVUM. 
AH.AKTOIS. 


77 


The  allantois  arises  on  the  front  part  of  the  posterior  extremity  of  the 
mucous  layer  which  is  closing  to  form  the  intestine,  as  a  growth  of  the 
intestine,  which  proceeds  very  rapidly.  It  passes  out  where  the  ventral 
lamina  are  still  unclosed,  in  the  region  of  the  umbilicus,  and  reaches, 
either  mediately  or  immediately,  the  inner  surface  of  the  exochorion. 
By  the  constriction  of  the  umbilicus,  it  is  separated  into  two  portions 
which  communicate  :  that  within  the  body  of  the  embryo  is  the  sacculated 
urinary  bladder,  with  the  urachus  or  tube  of  communication.  It  receives 
its  vessels  from  the  hypogastric  artery  ;  these  are  spread  out  as  a  vascular 
layer,  especially  upon  that  portion  of  its  surface  which  faces  the  exochorion. 
The  vessels  form  a  distinct  layer — the  endochorion.  As  a  membrane  it 
lines  the  inner  face  of  the  chorion,  and  is  reflected  around  the  point  of 
insertion  of  the  umbilical  cord,  to  be  spread  over  the  outer  face  of  the 
amnion ;  in  this  way  it  transforms  the  chorionic  sac  into  a  kind  of  serous 
cavity,  in  which  the  amniotic  sac  is  enclosed  like  a  viscus. 


Fig.  40. 

Plan  of  the  Fcetal  Envhlopes  in  the  Mare. 

A,  Foetus;  B,  Cavity  of  the  Amnion;  C,  Cavity  of  the  Allantois;  D,  Umbilical  Vesicle: 
1,  Chorion  ;  2,  Chorial  Layer  of  the  Allantois ;  3,  Amniotic  Layer  of  the  Allantois  ;  4, 
Amnion  ;  5>  Urachus,  the  expansion  of  which  forms  the  Allantois  ;  6,  Pedicle  of  the  Um- 
bilical Vesicle. 

The  inner,  or  amniotic  layer,  is  so  loosely  united  to  the  amnion,  that  a 
slight  dissection  or  inflation  will  readily  detach  it.  When  inflation  is 
practised,  the  separate  membrane  presents  a  wavy  appearance,  from  the 
presence  of  numerous  cellular  attachments  it  has  with  the  amnion  ;  as  the 
inflation  is  forced  these  bands  tear  with  a  noise  like  the  crackling  of 
parchment,  and  with  care  the  whole  of  this  portion,  which  is  equal  in 
extent  to  the  amnion,  may  be  removed.  The  chorial  allantois  adheres  much 
more  firmly,  and  in  some  parts  it  can  scarcely  be  dissected  away.  Infla- 
tion, however,  demonstrates  its  existence  and  continuity  with  that  on  the 
amnion ;  for  if,  after  opening  the  allantoid  sac  by  cutting  through  the 
chorion  and  the  layer  covering  it,  we  introduce  a  tube  between  the  two 
membranes — which  is  easily  done  near  a  large  vessel,  a  slight  inflation 
causes  the  air  to  penetrate  between  the  allantois  and  chorion,  though 
only  in  the  track  of  the  vessels  of  a  certain  size,  where  the  adherence  is 
slight  ;•  a  more  powerful  inflation  will  cause  the  air  to  follow  the  smaller 


78  OBSTETRICAL  PHYSIOLOGY. 

vascular  ramifications,  and  render  the  membrane  still  more  apparent,  but 
not  at  the  points  where  the  vessels  have  almost  become  capillaries.  If, 
instead  of  forcing  the  air  towards  the  ramifications,  it  is  sent  in  the 
contrary  direction,  it  will  be  seen  to  pass  to  that  portion  of  the  membrane 
covering  the  umbilical  cord,  and  insinuate  itself  between  the  amnion  and 
the  layer  of  allantois  covering  it,  thus  proving  the  continuity  of  the 
membrane. 

As  has  been  stated,  the  cavity  of  this  sac  is  in  communication  with 
the  interior  of  the  bladder  by  means  of  the  urachus  :  a  narrow  canal  in 
the  amniotic  portion  of  the  umbilical  cord,  and  which  widens  at  the  origin 
of  the  allantoidean  portion,  where  its  walls  are  continuous  with  the 
amniotic  layer  of  the  membrane,  as  well  as  the  chorial  layer^  after  being 
prolonged  as  a  sheath  around  the  cord.  These  arrangements  show  the 
allantoid  cavity  to  be  a  kind  of  urinary  reservoir  or  dependency  of  the 
bladder,  the  fundus  of  which  is  prolonged  in  an  infundibular  manner  as 
far  as  the  umbilicus,  to  constitute  the  urachus,  which  follows  the  umbili- 
cal vessels  in  the  amniotic  portion  of  the  cord,  and  ends  by  forming  the 
allantoid  cavity. 

The  structure  of  this  membrane  is  slightly  fibrous,  with  a  layer  of 
epithelium  ;  it  is  thin  and  pellucid,  and  appears  to  be  destitute  of  vessels 
at  a  late  period  of  foetal  life.  It  bears  on  its  surface  the  umbilical 
vessels,  from  the  umbilicus  to  the  chorion. 

The  allantois  contains  a  fluid — the  allantoic  liquid — the  quantity  of 
which,  like  that  of  the  amnion,  is  greatest  at  an  early  period.  It  is  then 
colorless  or  slightly  turbid  ;  but  with  the  growth  of  the  foetus  it  gradually 
assumes  a  yellowish  Jiue,  until  near  parturition,  when  it  is  brown.  It 
presents  somewhat  the  same  physical  properties  as  the  liquor  amnii,  and 
contains  albumen,  osmazone,  a  nitrogenous  mucilaginous  matter  insoluble 
in  alcohol,  a  particular  principle  named  allantome,  which  appears  to  be 
the  urate  of  urea,  with  lactic  acid,  lactate  of  soda,  and  phosphates  of 
soda,  lime,  and  magnesia.  Allantoic  acid  is  not  found  in  this  fluid  in 
solipeds.  In  addition  to  the  large  percentage  of  water,  there  is  a  notable 
proportion  of  sugar  at  an  early  epoch  of  foetal  life  ;  this,  however, 
gradually  and  finally  disappears  towards  the  termination  of  gestation. 

It  is  probable  that  before  the  foetal  circulation  is  fully  established,  the 
allantoid  fluid  serves  to  nourish  the  young  creature,  but  that  towards  the 
end  of  gestation  it  is  a  product  of  the  urinary  secretion  of  the  foetus.  It 
is  certain  that  as  gestation  approaches  its  termination,  the  renal  excretion 
of  the  young  animal  passes  from  the  bladder  along  the  urachus,  and 
deposits  near  the  allantoic  orifice  of  that  tube  a  thick  fluid  of  reddish 
color,  and  possessing  an  urinous  odor  ;  it  contains  uroerithrrin  and  hip- 
puric  acid. 

The  fluid  contains,  besides,  whitish  filaments,  and  small  oval  or  discoid 
masses  of  a  brownish  color  from  the  size  a  pea  to  that  of  a  hen's  Qgg, 
either  floating  about  in  the  cavity  or  attached  to  the  allantois  by  a  narrow 
pedicle.  Sometimes  they  are  very  numerous,  and  at  other  times  there  is 
only  one.  From  the  fanciful  notions  attached  to  them  in  ancient  times, 
they  were  named  the  ''''  hippomanesy  Usually  they  have  the  consistency 
and  elasticity  of  gluten,  are  flattened,  and  are  thinner  at  the  border  than 
the  centre.  Those  attached  to  the  allantois  are  generally  pyriform,  and 
their  pedicle  is  narrower  as  they  are  more  developed  :  proving  that  the 
loose  bodies  in  the  fluid  were  originally  appendages  of  the  allantois.  It 
is  not  improbable  that  they  are  inspissated  parts  of  the  allantoic  fluid 


CHANGES  IN  THE  OVUM.  79 

which  were   originally  deposited  upon   the    membrane.      They  contain 
much  oxalate  of  lime. 

Differences. 

Ruminants. 

In  Ruminants  the  allantois  is  different  to  that  of  the  Mar^,  being  less 
complex.  It  represents  a  very  elongated  cavity,  the  middle  portion  of 
which  is  not  extensive,  and  receives  the  insertion  of  the  urachus  ;  while 
its  extremities,  which  are  unequal,  are  prolonged  into  the  cornua  of  the 
chorion,  where  they  are  attached  by  a  small  ligament.  This  sac  is  in 
reality  an  expansion  of  the  urachus  ;  it  is  always  thrown  back  on  one  of 
the  sides  of  the  amnion.  In  the  completely  developed  foetus,  even  at 
birth,  the  allantois  still  communicates  directly  with  the  bladder  by  means 
of  the  urachus.  Frequently  in  the  Sheep  this  membrane  exceeds  the 
chorion,  and  in  the  case  of  twin  embryos,  although  the  two  chorial  sacs 
unite  by  one  of  their  cornua,  there  is  only  a  simple  external  union 
between  the  two  allantoid  membranes,  the  cavities  remaining  isolated. 

, Laminated  deposits,  like  the  hippomanes^  are  found  in  the  allantoic 
fluid  of  ruminants,  though  not  very  frequently.  These  deposits  are  less 
dense,  smaller,  and  of  a  lighter  color. 

Pig. 

In  the  Pig  the  allantois  does  not  offer  any  marked  difference  from  that 
of  ruminants,  except  that  it  is  less  sacculated,  and  shows  at  the  extremity 
of  each  cornua  a  small  portion  projecting  beyond  the  chorion,  which 
it  seems  to  pierce,  while  it  is  strangled  by  a  kind  of  rings  formed  by  that 
envelope.  In  the  gelatinous  tissue  connecting  the  allantois  to  the 
chorion,  are  numerous,  small,  white,  spherical  bodies,  each  possessing  a 
distinct  capsule ;  they  are  composed  of  multitudes  of  circular  cells,  the 
size  of  lymph  corpuscles,  and  quantities  of  granular  particles — being, 
in  fact,  histologically  the  same  as  the  hippomajies.,  with  which  they  are 
probably  homologous. 

Bitch  and  Cat. 

In  the  Bitch  and  Cat  it  is  disposed  in  the  same  fashion  as  in  solipeds. 
Its  external  layer  adheres  less  closely  to  the  chorion,  except  at  the  part 
corresponding  to  the  placenta,  where  it  is  more  intimately  united. 

Umbilical  Vesicle. 

The  umbilical  vesicle^  saccus  intestinalis,  or  vesicula  alba,  is  a  small 
fusiform  or  pyriform  pouch  lodged  in  the  infundibulum  at  the  extremity 
of  the  umbilical  cord.  Its  fundus  adheres  to  the  chorion,  while  the  oppo- 
site end  is  prolonged  to  a  certain  length  in  the  substance  of  the  cord, 
being  even  continued,  in  the  very  young  foetus,  to  the  abdominal  cavity  by 
a  narrow  canal  that  communicates  with  the  terminal  portion  of  the  small 
intestine. 

This  pouch  has  a  red  color,  due  to  its  great  vascularity,  its  walls 
receiving  a  special  vessel  from  the  anterior  mesenteric  artery  ;  the  ter- 
minations of  this  vessel  give  rise  to  a  corresponding  vein  that  terminates 
in  the  vena  portae.  These  are  the  two  omphalo-mesenteric  vessels.  The 
umbilical  vesicle  in  solipeds  is  constantly  present  as  a  normal  formation 
in  the  earlier  months  of  foetal  development,  being  formed  from  the  extra- 
foetal  portion  of  the  internal  layer  of  the  blastoderm.     It  is  connected 


8o  OBSTETRICAL  PHYSIOLOGY. 

with  the  intestinal  canal  of  the  foetus  ;  being  in  reality  the  vitellus 
surrounded  by  the  blastoderm  upon  which  the  embryo  is  first  formed  ; 
and  it  bears  a  perfect  analogy  to  the  yolk  of  the  &gg,  except  that  it  is  not 
ultimately  enclosed  within  the  foetal  abdomen,  It  is  a  transitory  organ, 
and  in  the  last  months  of  foetal,  though  in  solipeds  traces  of  it  continue 
until  parturition,  it  is  always  more  or  less  atrophied,  its  cavity  has 
disappeared,  and  nothing  is  left  of  it  but  a  small  reddish-brown  cord, 
adhering  to  one  of  the  sides  of  the  infundibulum.  Its  vessels  also  atrophy 
in  the  same  manner,  the  artery  being  nearly  always  found  reduced 
to  the  dimensions  of  a  thread. 

Its  use  is  evidently  to  contain  nutriment  for  the  foetus,  before  the 
development  of  the  placenta  ;  though  it  may  also  serve  other  purposes. 
It  is  the  first  organ  which  elaborates  and  supplies  blood  to  the  foetus. 
In  some  instances  the  chorion  has  been  found  perforated  at  its  junction 
with  the  umbilical  vesicle,  which  was  therefore  in  communication  with 
the  cavity  of  the  uterus. 

Differences. 

Ruminants  and  Fig. 

In  Ruminants  and  the  Pig,  the  umbilical  vesicle  is  longer  than  in 
solipeds )  it  also  bulges  in  the  middle,  and  its  ends  terminate  in  a  canal. 
It  is  longest  about  the  twenty-fifth  day,  and  disappears  very  early  ;  no 
traces  of  it  can  be  observed  between  the  second  and  third  month,  after 
the  abdominal  parietes  have  been  formed. 

BiUh  and  Cat. 

In  the  Bitch  and  Cat,  however,  it  remains  very  developed  up  to  the 
time  of  parturition,  and  in  form  resembles  the  allantois  of  the  Pig.  It 
is  a  transversely  elongated  sac  (Fig.  38,  ^),  extending  into  the  pointed 
cornua  (^)  comprised  between  the  amnion,  the  inner  layer  of  the  allan- 
tois (h),  and  the  placenta  {U)  ;  it  is  provided  at  its  middle  part  with  a 
narrow  pedicle  (^),  which  is  prolonged  into  the  umbilical  cord  and  has 
very  vascular  walls. 

The  Placenta. 

The //d;^/?^/^  varies  extremely  in  different  species.  In  solipeds  it  is 
constituted  by  a  multitude  of  short  villosities  or  filiform  papillae,  which 
are  spread  in  a  uniform  manner  over  the  whole  external  surface  of  the 
chorion  {diffused  villi  or  placenta,  constituting  a  chorion  fro?idosum)  ; 
though  there  is  sometimes  observed  a  tendency  to  bare  patches,  one 
especially  being  noticed  opposite  the  os  uteri,  where  there  is  no  mucous 
membrane  for  the  villi  to  penetrate.  These  villi  are  received  into  cor- 
responding depressions  or  follicles  in  the  lining  membrane  of  the  uterus. 
The  villi  are  very  red  in  color,  and  consist,  like  the  chorion  itself,  of  an 
epithelial  and  a  vascular  layer,  they  being,  in  fact,  the  terminal  rami- 
fications of  the  vessels  of  the  umbilical  cord.  They  are  slender  and 
easily  torn  ;  and  each  is  composed  of  a  small  quantity  of  delicate  nu- 
cleated connective  tissue,  covered  by  a  simple  epithelial  layer,  enclosing 
the  capillary  vessels,  which  are  arranged  in  loops  made  up  of  a  principal  . 
arteriole  and  two  veins,  there  being  generally  only  a  single,  or  at  most, 
a  double,  capillary  loop. 

The  villosities  of  the  foetal  placenta,  penetrating  the  newly  formed 


CHANGES  IN  THE  OVUM.  8i 

crypts  in  the  uterine  mucous  membrane,  bring  the  capillary  systems  of 
mother  and  foetus  into  the  closest  relationship  :  only  the  very  thin  coats 
of  the  vessels  and  the  epithelium  intervening  in  the  two  circulations. 
There  is  no  fusion,  vascular  continuity,  or  direct  communication  be- 
tween the  maternal  and  foetal  systems,  as  was  at  one  time  taught  \  all 
the  important  changes  that  occur  taking  place  through  the  walls  of  the 
capillaries  by  virtue  of  osmotic  force. 

The  function  of  the  placenta,  then,  is  to  administer  to  the  nutrition 
and  development  of  the  foetus  by  means  of  its  intimate  relations  with 
the  uterine  vascular  system,  until  the  time  has  arrived  for  the  expulsion 
of  the  young  animal.  Notwithstanding  their  close  apposition,  the  ad- 
herence of  this  papillary  layer  of  the  chorion  with  the  inner  surface  of 
the  uterus  is  so  slight,  that  this  organ  can  scarcely  be  opened  w^ithout 
more  or  less  destroying  it.  A  small  quantity  of  a  brownish  fluid  is  found 
between  the  two. 

At  an  early  stage  of  gestation  there  is  no  placenta  \  a  temporary  mass 
of  albuminoid  substance  accumulating  around  the  ovum  in  the  uterus, 
affords  material  for  its  nourishment  until  the  vascular  intussceptive  re- 
lations between  the  chorion  and  uterine  lining  is  established.  When 
gestation  is  terminated,  the  placenta  becomes  remarkably  rigid,  the  ves- 
sels are  obliterated  and  transformed  into  fibrous  tissue,  and  the  external 
face  of  the  chorion  is  wrinkled  and  withered-looking. 


I 


Fig.  41. 

Portion  of  Chorion  with  Placentul.*:  :  Cow. 

1,  Chorion  ;  2,  Placentulse. 

DiFFERENOeS. 

Cow. 


In  Ruminants,  there  is  an  important  difference  m  the  arrangement  of 
the  placenta  from  that  just  described.  In  the  Cow,  the  villi  of  the 
chorion  are  developed  and  agglomerated  in  large  numbers  at  certain 
points  of  its  surface,  to  constitute  a  multiple  or  tufted  placenta,  which  is 
composed  in  this  way  of  from  sixty  to  oXghty placentulcz,  or  "foetal  coty- 
ledons." These  are  of  a  bright  red  color,  of  various  sizes,  and  gen- 
erally oval  in  shape  ;  they  correspond  to  the  prominences  on  the  lining 

6 


82  OBSTETRICAL  PHYSIOLOGY. 

membrane  of  the  uterus  from  which  the  deciduous  maternal  parts  of  the 
placenta  grow,  and  which  have  been  already  described  as  the  "  maternal 
cotyledons  "  or  "  placentae  ; "  into  these  latter  the  foetal  processes  are 
received.  The  maternal  cotyledons  are  nothing  more,  as  has  been 
stated,  than  appendages  or  thickened  points  of  the  mucous  membrane, 
whose  utricular  follicles,  more  numerous  than  elsewhere,  have  become 
enormously  enlarged,  and  crypts  have  been  formed.  They  are  perma- 
nent, as  before  conception  they  are  certainly  present  on  the  inner  sur- 
face of  the  uterus,  and  traces  of  them  may  be  already  found  in  the  fcetus 
of  four  or  five  months  ;  observation  also  appears  to  have  demonstrated 
that  they  may  be  increased  in  number,  or  regenerated,  when  accidental 
circumstances  render  those  in  existence  insufficient*  They  have  been 
discovered  in  the  foetus  in  process  of  formation,  and  regularly  disposed, 
beside  the  ordinary  cotyledons. 

When  gestation  has  commenced,  the  surface  of  the  maternal  caruncles, 
previously  smooth,  becomes  convex,  and  is  covered  ^yith  reticulate  pro- 
cesses which  border  the  crypts,  and  give  it  a  finely  cribbled  appearance. 

*  In  the  Jdurnalde  Mid  VHerhiaire  de  Lyon,  M.  Strebel,  of  La  Tour,  Switzerland,  gives  an  instance 
in  which  there  ^yas  absence  of  the  uterine  cotyledons  in  a  Cow,  and  the  placenta  was  like  that  of  the 
Mare.     Conception  took  place,  gestation  went  on  favorably,  and  parturition  was  normal. 

Chauveau's  experiments  have  proved,  that  after  all  these  placentulse  have  been  extirpated  from  the 
uterus  of  the  pregnant  Cow,  sterility  does  not  necessarily  follow  ;  but  if,  on  the  contrary,  the  animal  sur- 
vives the  operation,  it  is  still  capable  of  breeding.  In  such  circumstances,  accessory  cotyledons  are  de- 
veloped upon  the  surface  of  the  uterine  mucous  membrane,  where  previously  none  existed.  Chauveau 
has  also  stated,  in  the  same  journal  for  185 1,  that  during  pregnancy  the  number  of  cotyledons  is  in- 
creased ;  and  Colin,  in  his  Physiologie  Comparee,  makes  a  similar  statement.  Professor  Franck,  of 
Munich,  in  his  dissections  of  the  gravid  uterus  of  bovines,  has  found,  in  a  large  number  of  instances,  a 
more  or  less  abundant  quantity  of  accessory  caruncles  (karunkeht)  on  the  mucous  membrane,  and  which 
had  no  corresponding  relations  with  the  chorion.  In  one  instance  the  ordinary  cotyledons  were  entirely 
absent  in  an  unimpregnated  cornu,  and  in  their  stead  were  thousands  of  the  accessory  processes  grouped 
together  in  small  clusters.  The  whole  of  the  lining  membrane  of  this  cornu  had  a  peculiar  mossy  or  vel- 
vety appearance.  In  a  number  of  instances  Franck  has  observed,  in  the  immediate  neighborhood  of  the 
OS  uteri,  where  cotyledons  proper  were  absent,  groups  of  the  so-called  accessory  cotyledons,  in  their  form 
r&\)X&%^r\.\AW%7i  placenta  preevia.  Certainly,  this  VmA  oi  placenta  pravia  in  cattle  has  not  the  disadvan- 
tages it  offers  in  woman  ;  for  although  a  premature  delivery  may  occur,  a  sufficiency  of  the  placenta 
always  remains  to  maintain  the  nourishment  of  the  fcetus.  Serious  hjemorrhage  is  likewise  little  to  be 
apprehended  in  such  cases  ;  and  even  the  disconnection  between  the  placenta  foetalis  and  the  placenta 
uterina  in  the  Cow,  causes  no  injury.  This  is  not  the  case  with  the  human  female  and  the  Bitch.  Small 
haemorrhagic  streaks  at  the  summit  of  the  finer  tufts,  or  on  their  upper  surface,  are  often  noticed  in  the 
uterus  of  Cows  which  have  been  slaughtered  and  bled.  Birnbaum  attributed  these  streaks  to  a  plethora 
ex  vacuo  {Untersuchu7ige7i  iiber  de7t  Ban  der  Eih'dute  der  Saugethiere,  p.  90). 

The  accessory  placentulae  are,  both  in  shape  and  situation,  as  well  as  in  development,  different  from  the 
cotyledons  propei;  for  while  the  latter,  and  of  course  also  the  foetal  cotyledons,  are  arranged  in  four 
regular  rows,  in  the  gravid  uterus,  through  the  rapid  increase  of  the  amnion  towards  the  poles  of  the 
ovum,  they  lie  somewhat  closely  together,  and  the  accessory  processes  are  placed  between  these  rows  in 
an  irregular  manner.  In  their  highest  development,  the  latter  are  so  disposed  as  to  constitute  a  variable- 
sized  felt-like  patch  ;  the  largest  and  widest  are  usually  observed  behind  the  ordinary  cotyledons,  and 
their  form  is  very  irregular,  but  normal.  As  a  rule,  the  largest  are  not  so  big  as  a  walnut,  and  they  are 
widest  at  their  base.  In  structure  they  resemble  the  ordinary  cotyledons,  their  blood-vessels  being  ar- 
ranged in  the  same  manner,  while  they  are  covered  externally  by  a  sheath  of  epithelium.  In  the  early 
period  of  pregnancy — about  the  second  or  third  month— they  are  found  in  largest  number  on  the  entire 
upper  surface  of  the  chorion,  also  likewise  on  the  parts  between  the  ordinary  cotyledons  and  the  finest 
caruncles.  It  may  here  be  mentioned  that  the  ovum  of  the  Cow,  in  the  first  week  of  pregnancy,  is 
smooth.  Franck  has  never  been  able  to  discover  the  vascular  semi-detached  caruncles  which  are  after- 
wards developed  through  the  prolongation  of  the  blood-vessels  ;  though  they  are  found  in  the  canine 
species.  He  has,  however,  observed  definitely-formed  vascular  chorion-cotyledons  between  the  fourth 
and  sixth  weeks  of  pregnancy.  The  interposed  cotyledons  observed  by  Franck  have  been  noticed  by 
other  anatomists.  Birnbaum  mentions  them,  but  he  is  in  error  with  regard  to  their  development,  inas- 
much as  he  believed  that  they  arose  from  the  uterine  glands,  which  is  certainly  not  the  case.  The  chorial 
tufts  penetrate  the  uterine  mucosa  by  four  digitations,  fixing  themselves  in  the  so-called  simple  follicles, 
according  to  Franck  {Deutsche  Zeitschri/t  fur  T/iiermedicin).  This  excellent  authority  also  points  out, 
with  regard  to  this  circumstance,  that  in  the  vicinity  of  the  uterine  glands  there  are  found  small  follicles 
which  are  nearly  always  unobserved.  The  connection  between  these  chorial  tutts  and  the  uterine  mucosa 
is  extremely  slight. 

At  a  later  period  of  pregnancy,  there  appear  other  caruncles  tn  the  torm  ot  toeta/  tutts  ana  cotyledons, 
which  the  previously  developed  and  prominent  maternal  cotyledons  and  caruncles  lie  opposite  to  and  in 
contact  with.  The  reason  tor  this  tact  is  to  be  sought  tor  in  the  circumstance,  that  the  tcetal  caruncles 
pass  into  the  most  developed  uterine  cotyledons,  and  in  consequence  bring  the  larger  tutts  ot  the  allantois 
into  contact  with  the  opposite  parts  ot  the  chorion.  The  intermediate  caruncles  become  entirely  wasted. 
Nevertheless,  with  isolated  tufts,  sometimes  in  a  great  many,  we  find  an  increased  development,  wllich 
gives  rise  in  the  corresponding  uterine  mucosa  to  a  similar  formation,  and  a  close  co-aptation,  or  even  an 
inter-penetration  ot  these  accessory  tcetal  and  maternal  cotyledons. 


CHANGES  IN  THE  OVUM. 


83 


The  largest  are  found  in  the  body  of  the  uterus,  and  they  become  smaller 
as  they  approach  the  extremity  of  the  cornua.  They  spring  from  the 
uterine  surface  by  a  somewhat  narrow  pedicle,  through  which  they  receive 
their  blood-vessels,  and  their  color  is  nearly  always  dark  yellow  ;  alto- 
gether, in  shape,  hue,  and  general  appearance,  they  are  not  unlike  a 
morel  mushroom. 

The  "foetal"  or  "chorial  cotyledons"  repeat  the  disposition  of  the 
maternal  cotyledons.  They  are  bright-red  concave  patches,  each  exactly 
fitting  into  the  sinuses  of  the  corresponding  uterine  processes,  with  which 
they  strikingly  contrast  in  hue  ;  on  their  surface  they  offer  a  multitude 
of  long,  conical,  ramifying  or  branched  villi,  measuring  from  4  to  6-ioths 


^B 

MM 

HI 

^^^^^^^^9 

^m 

■■HH 

i^^^l 

^^^^^H^ 

y^i^^^^^jfi'MS&' 

^^^H 

i^BI 

B 

^9 

^H 

B^aMH 

^b 

^^P 

^H 

^ 

^ 

Hi 

Fig.  42. 

Maternal  A>fD  Fcetal  Cotyledons  of  the  Cow. 

A,  Pedicle  of  the  Maternal  Cotyledon  ;  BB,  Maternal  Cotyledon ;  C,  Foetal  Cotyledon ; 
Placental  Villi ;  E,  Chorion. 


D, 


of  an  inch,  which  are  received  into  the  depressions  of  the  maternal  cot- 
yledons. This  ramifying  or  racemose  disposition  of  the  chorial  villi  is 
peculiar  to  the  bovine  and  ovine  species.  The  chorial  cotyledons  are 
attached  to  the  chorion  by  a  very  short,  thick,  and  vascular  pedicle  ; 
between  them  and  the  maternal  cotyledons  there  is  always  to  be  found 
a  small  quantity  of  thick,  white,  milky-looking  fluid — the  so-called  "  cot- 
yledonous  "  or  "uterine  milk." 

According  to  Schlossberger,  this  uterine  milk  should  be  considered  as 
a  fluid  analogous  to  milk  or  chyle.  It  contains  88  per  cent,  of  water, 
I  "5  of  fat,  07  of  salts,  and  9*6  of  a  protein  substance.     In  the  cotyledo- 


84  OBSTETRICAL  PHYSIOLOGY, 

nal  fluid,  as  well  as  in  that  on  the  surface  of  the  uterine  mucous  mem- 
brane of  a  Mare  towards  the  end  of  pregnancy,  Ercolani  has  demon- 
strated the  presence  of  albumen  ;  in  the  same  fluid  he  has  also  proved 
the  existence  of  amidon,  dextrin,  and  sodium  chloride.* 

The  reticulated  surface  of  the  maternal  cotyledons  is  hornologous  with 
the  decidua  serotina  or  other  mammals ;  but  it  possesses  a  firmer  texture, 
and  usually  remains  attached  until  the  termination  of  gestation — allowing 
the  foetal  villi  to  be  withdrawn  from  it  at  birth  ;  it  is  afterwards  shed  or 
disappears  in  some  obscure  manner,  and  the  caruncle  again  assumes  its 
smooth  surface. 

As  in  solipeds,  there  is  no  direct  vascular  communication  between  the 
maternal  and  foetal  cotyledons,  the  villi  of  each  being  distinct,  though  in 
close  contact ;  being  only  separated  at  points  by  the  lattescent  fluid  just 
alluded  to.  This  fluid,  which  is  present  in  all  the  domesticated  animals, 
can  be  readily  discovered  by  carefully  withdrawing  a  chorionic  tuft  from 
the  alveolar  cavities  of  the  uterine  cotvledon. 


Pig-  43- 

Cotyledon  of  a  Cow's  Uterus. 

aa,  Surface  of  Foetal  Chorion  ;  bb.  Blood-vessels  of  Foetal  Chorion  ;  cc.  Surface  of  Uterine 
Mucous  Membrane  ;  dd.  Blood-vessels  of  ditto  ;  /,  Secretion  from  Utricular  Glands — Cotyle- 
donous  Milk — between  Maternal  and  Foetal  Vessels,  and  which  is  necessary  to  the  Mutual 
Interchange  of  Gases,  and  Nutrient,  Effete,  and  other  Matters  between  Parent  and  Offspring. 

Sheep  and  Goat. 

In  the  Sheep  and  Goat  the  arrangement  of  the  placenta  is  essentially- 
the  same  as  in  the  Cow,  except  that  the  maternal  cotyledons  are  deeply 
concave  or  cup-shaped  in  the  middle,  and  into  this  cavity  the  foetal 
placentula  is  received  and  closely  retained.  This  placentula  is  not  so 
wide  as  that  of  the  Cow,  though  it  is  thicker  and  the  villi  are   more 

♦  We  must  not  overlook  the  fact,  that  the  existence  of  the  "  uterine  milk  "in  the  living  pregnant 
animal  has  been  denied  by  M.  CoWn  (Traite  de  Fhysiologie  Comparie  des  A nimaux,  1872,  vol.  II.,  P- 
870),  who  states  that  this  fluid  is  simply  a  product  of  cadaveric  decomposition,  and  is  not  found  during 
life  ;  as  he  has  assured  himself  in  the  most  evident  manner,  by  opening  the  uterus  of  a  pregnant  Mare  and 
Cow.  It  is  not  found  immediately  after  death,  as  he  has  demonstrated  on  m^ny  occasions,  in  Cows  and 
Sheep  slaughtered  in  the  abbatoirs  at  all  periods  of  gestation  ;  it  is  not  even  observed  six,  twelve,  or 
twenty-four  hours,  or  longer,  when  the  surrounding  temperature  does  not  favor  decomposition.  It  is  only 
when  the  placentas  spontaneously  separate,  or  are  disunited  by  slight  traction,  at  a  greater  or  less  time 
after  death,  according  to  circumstances,  that  the  white  or  yellowish-red  colored  fluid  appears  between  the 
chorion  and  uterine  mucous  membrane.  In  proportion  as  decomposition  has  advanced,  the  fluid  is  abun- 
dant. Colin  therefore  concludes  that  it  is  a  product  of  softening  and  progressive  dissolution  of  the  uterine 
mucous  membrane  and  its  cotyledons,  as  well  as  the  placentae  themselves. 


CHANGES  IN  THE  OVUM.  85 

-delicate.     The  mode  of  termination  of  the  placental  vessels  in  the  Sheep 
is  villous  ;  in  the  Goat  it  is  pilose. 

Pig. 

In  the  Pig  the  placenta  maybe  designated  as  "diffused,"  not  "  polycot- 
yledonary  "  as  in  Ruminants;  though  the  tufts  do  not  form  a  continuous 
layer  as  in  the  Mare,  the  papillae  being  collected  in  small  but  closely- 
grouped  clusters,  which  give  the  chorion  a  mottled  aspect.  When  unin- 
jected  they  appear  as  white  masses  or  spots  scattered  over  the  external 
surface  of  the  chorion,  thus  giving  it  a  mottled  aspect,  caused  by  the 
presence  of  feebly  vascular  and  non-vascular  areas  ;  but  when  the  allantoic 
veins  are  filled,  these  are  seen  to  form  plexuses  in  the  centre  of  each  spot. 
The  uterine  veins  have  a  corresponding  disposition,  and  the  arterial 
capillaries  form  a  fine  network,  the  meshes  receiving  the  villosities  which 
carry  the  fcetal  arterial  capillaries ;  whence  it  might  seem  that  the  nutri- 
tion of  the  fcetus  was  effected  principally  at  the  points  of  contact  of  the 
foetal  with  the  maternal  venules,  while  the  respiratory  process  took  place 
at  the  surface  of  contact  between  the  foetal  and  maternal  arterial  capil- 
laries. The  chorion  is  destitute  of  these  villosities  at  the  extreniities, 
which  are  in  contact  with  the  chorion  of  others  foetuses  in  the  uterus. 

Bitch  and  Cat. 

In  the  Bitch  and  Cat  the  placenta  forms  a  thick  annular  band  or  zone, 
about  one  or  one  and  a  half  inch  wide,  passing  round  the  middle  of  the 
chorion  ;  it  is  therefore  said  to  be  "  zonular."  This  zone  is  concave 
within,  of  a  mixed  grey-and-red  color  when  uninjected,  livid  or  dark 
brown  during  gestation  ;  its  foetal  surface  is  lobulated,  and  the  zone  is 
limited  at  each  side  by  a  dark  green  border,  the  coloring  matter  of  which 
can  scarcely  be  removed  by  repeated  washings. 

The  placenta  is  studded  with  ramified  villi  of  a  leaf  or  plate  shape, 
which  are  implanted  in  the  uterine  mucous  follicles.  The  mucous  mem- 
brane in  which  these  are  situated,  and  which  corresponds  to  the  placenta, 
presents  a  kind  of  vascular  fungus  development  that  appears  after 
parturition,  but  which  at  an  early  stage  of  pregnancy  has  a  quantity  of 
fluid  along  its  margin;  the  maternal  placenta,  ovserotine  decidua,  is 
present  during  gestation,  and  can  be  separated  as  a  distinct  layer. 
There  cannot  be  a  doubt  that  the  uterine  mucous  membrane  in  car- 
nivora  secretes  a  kind  of  plastic  lymph,  which  forms  this  caducous 
lining  or  membrana  decidua ;  but  it  is  only  present  at  a  certain  period 
of  foetal  life,  and  forms  the  base  of  the  uterine  placenta. 

Functions. 

The  functions  of  the  placenta  are  obvious:  it  is  the  nutrient  and 
respiratory  apparatus  during  a  portion  of  intra-uterine  existence  ;  and  for 
the  accomplishment  of  these  functions  it  must  rely  upon  its  intimate  and 
healthy  relations  with  the  uterine  surface.  The  special  and  temporary 
processes  of  development  being  completed  and  the  task  of  providing 
capillary  superficies  being  terminated,  whether  on  the  part  of  the  mother 
or  foetus,  the  placenta  of  the  latter  disappears,  as  well  as  the  decidua ; 
though  they  may  not  be  thrown  off  together,  and  the  maternal  decidua 
may  not  be  shed  all  at  once,  but  in  successive  portions.  Th#  long  period 
of  gestation  necessary  to  endue  the  young  of  defenceless  hoofed  animals 
with  sufficient  strength  before  birfh,  is  perhaps   a  reason  for  the  firmer 


86  OBSTETRICAL  PHYSIOLOGY. 

texture,  better  organization,  greater  extent,  and  more  persistent  character 
of  their  "  deciduous  "  formations. 

The  comparative  study  of  the  disposition  of  the  different  kinds  of 
placentae,  may  furnish  valuable  indications  as  to  the  procedure  which 
ought  to  be  adopted  in  artificial  delivery ;  the  surgical  manipulation 
necessarily  varying  with  the  extent  and  arrangement  of  the  points  of 
union  existing  between  the  uterus  and  the  foetal  envelopes. 

It  has,  therefore,  been  thought  useful  to  arrange  the  domesticated 
animals  into  two  groups  ;  those  with  a  single  placenta,  and  others  with  a 
multiple  placenta ;  the  first  group  being  again  subdivided  according  as 
the  placenta  is  "  diffused  "  or  "  localized."  This  arrangement  and  subdi- 
vision may  be  expressed  as  follows  : — 


Single  Placenta 
Multiple  Placenta 


Diffused 


Horse. 
Pig. 
Cow. 
Localized     -^      Sheep. 
Goat. 


S 


Zonular 


Dog. 
Cat. 


UiTBiLicAL  Cord. 


The  umbilical  cord^  funis ^  or  navel-string,  is  a  collection  of  vessels  which 
forms  the  means  of  communication  between  the  mother  and  foetus,  during 
the  uterine  existence  of  the  latter,  and  which  loses  its  functions  when 
birth  occurs.  It  is  visible  at  the  earliest  period  of  pregnancy,  and  is 
formed  by  the  vessels  which  convey  the  blood  between  the  foetus  and  its 
envelopes — chiefly  the  placenta.  It  is  divided,  for  facility  of  description, 
into  two  portions  :  an  amniotic,  the  longest,  always  twisted  on  itself  like 
a  rope,  and  covered  by  the  amnion,  which  passes  along  it  to  become  con- 
tinuous with  the  skin  at  the  umbilicus  ;  and  an  allantoic  portion,  much 
shorter,  less  twisted,  and  covered  by  the  sheath  that  continues  the  two 
layers  of  the  allantois  until  it  is  inserted  into  the  upper  wall  of  the  chorial 
sac,  between  the  two  cornua. 

Three  vessels  enter  into  the  composition  of  the  cord  :  two  arteries  and 
a  vein,  which  are  embedded  in  embryonic  connective  tissue  (  Whartonian 
gelatine^  that  makes  them  appear  more  voluminous  than  they  really  are. 
This  "  Gelatine  of  Wharton  "  consists  of  a  mucus  basis,  in  the  substance 
of  which  is  fibrillar  tissue.  The  umbilical  arteries  arise  from  the  internal 
iliac  artery,  and  pass  along  the  sides  of  the  bladder  ;  reaching  the  umbil- 
icufs,  they  pass  through  it  and  arrive  at  the  terminal  extremity  of  the 
amniotic  portion  of  the  cord,  where  they  give  off  some  branches  to  the 
amniotic  sac,  and  then  continue  to  the  end  of  the  allantoic  portion,  where 
they  terminate  by  an  expansion  of  placental  branches.  The  amniotic 
divisiojis  of  these  arteries  are  extremely  flexuous  and  few  in  number  ; 
they  are  included  between  the  allantoic  layer  and  the  membrane  of  the 
amniotic  sac,  within  which  they  are  prominent. 

The  placental  or  chorial  divisions  are  infinitely  more  numerous  and 
larger,  and  starting  from  the  terminal  extremity  of  the  cord,  pass  in  every 
direction  bftween  the  chorion  and  the  external  layer  of  the  allantois, 
beneath  which  they  can  be  seen.  By  their  anastomoses  they  form  a 
beautiful  network,  whence  proceed  the  capillary  vessels  that  form  the 


CHANGES  IN  THE  OVUM. 


87 


placental  villosities.  As  we  have  already  stated,  these  capillaries  have 
no  direct  communication  with  the  maternal  vessels,  but  after  attaining 
their  finest  dimensions  pass  into  the  veins  which  finally  constitute  the 
UMBILICAL  VEIN.  This  vessel,  then,  owes  its  origin  to  the  capillary 
radicles  of  the  placental  villosities;  which  radicles,  by  their  union  be- 
tween the  chorion  and  amnion,  form  a  voluminous  network  whose  rich- 
ness is  even  greater  than  the  arterial  arborization.  Two  chief  trunks 
finally  issue  from  this  plexus,  and  these  soon  join  to  form  a  single  trunk, 
which  accompanies  the  two  corresponding  arteries  in  the  cord.  On 
reaching  the  umbilicus,  this  vessel,  now  the  tujibilical  van,  bends  forward 
on  the  inner  surface  of  the  abdominal  wall,  where  it  is  covered  by  peri- 
toneum, and  on  gaining  the  liver  enters  that  organ  to  open  directly  into 
the  vena  portai.  Owing  to  this  junction,  it  happens  that  the  two  vessels 
compose,  in  the  interior  of  the  liver,  a  single  canal,  from  which  proceed 
the  hepatic  veins.  In  other  animals  than  solipeds,  this  single  canal  sends 
off  a  particular  vessel  of  considerable  size — the  ductus  venosus — that 
passes  directly  into  the  posterior  vena  cava.  The  umbilical  vein  has  no 
valves. 

Besides  these  three  principal  vessels,  the  cord  contains,  in  its  amniotic 
portion,  the  duct  of  the  umbilical  vesicle,  the  urachus,  and  the  omphalo- 
mesenteric vessels,  as  well  as  the  extremity  of  the  foetal  intestine  at  an 
early  period.  The  urachus  is  an  irregularly  bulging  canal,  continued 
from  what  is  eventually  the  fundus  of  the  bladder,  and  on  reaching  the 
umbilical  opening  it  passes  between  the  chorion  and  the  amnion  to  form 
the  allantois. 

After  birth  it  rapidly  contracts,  especially  at  the  fundus  of  the  bladder, 
until  it  is  quite  closed,  and  nothing  is  left  but  the  fold  of  peritoneum 
that  sustained  it,  and  which  now  becomes  the  middle  ligament  of  the 
bladder.  It  sometimes  happens,  however,  with  the  foal,  but  more  fre- 
quently the  calf,  that  it  persists,  the  urine  in  this  case  escaping  by  the 
umbilicus. 

The  omphalo-meseiiteric  vessels  are  an  artery  and  a  vein.  The  first  is 
given  off  from  the  anterior  mesenteric  artery,  and  passes  to  the  amniotic 
extremity  of  the  umbilical  vesicle  \  while  the  vein  arising  from  this  vesi- 
cle terminates  in  th^  vena  portse.  These  two  very  thin  vessels  become 
obliterated  with  the  vesicle. 

DIFFERENCES. 

Rumijiants. 

In  Ruminants,  the  two  veins  passing  from  the  chorion  remain  separate 
in  the  umbilical  cord  until  they  enter  the  umbilical  ring,  where  they 
become  one  vessel.  There  are,  therefore,  two  veins  and  two  arteries  ; 
the  latter  unite  at  the  umbilicus,  the  resulting  vessel  entering  the  vena 
cava  and  vena  portae,  between  which  it  establishes  a  communication  by 
means  of  the  ductus  venosus.  The  chorion  and  the  amnion  being  in 
immediate  contact  over  a  wide  surface,  the  umbilical  vessels  are  re- 
flected over  the  inner  face  of  the  first-named  membrane  on  their  leaving: 
the  amniotic  sheath  ;  they  do  not  have  a  fold  of  allantois,  as  in  solipeds* 
No  traces  of  the  omphalo-mesenteric  vessels  have  been  found. 

Fig. 
In  the  Pig  the  arrangement  of  the  cord  is  the  same  as  in  ruminants. 


88  OBSTETRICAL  PHYSIOLOGY. 

Bitch  and  Cat. 

In  the  Bitch  and  Cat  the  cord  resembles  that  of  solipeds,  in  having  an 
allantoic  portion,  but  it  is  extremely  short,  and  enveloped  in  a  large  fold 
of  allantois.  The  omphalo-mesenteric  vessels  are  very  apparent  until 
the  end  of  gestation,  and  are  proportionately  larger  than  in  solipeds  ; 
this  is  due,  in  all  probability,  to  the  persistence  of  the  umbilical  vesicle. 
These  are  an  artery  and  a  vein  ;  the  former  arises  from  the  anterior 
mesenteric,  descends  in  nearly  a  direct  line  to  the  umbilical  opening, 
and  is  expended  in  the  umbilical  vesicle.  The  vein  originates  from  the 
terminal  divisions  of  the  artery,  passes  towards  the  abdomen,  and  ter- 
minates in  the  vena  porta. 

The  dimensions  of  the  umbilical  cord  vary  with  the  species  of  animals. 
Compared  with  that  of  the  human  foetus,  it  is  short  in  solipeds  and 
ruminants.  At  the  commencement  of  gestation  in  the  Mare  and  Cow,  it 
is  not  so  long  as  at  a  later  period,  though  it  is  thicker  ;  towards  the 
termination  of  gestation,  it  is  at  least  as  long  as  the  young  animal  is  tall. 
Its  length  in  the  Mare  has  been  variously  estimated.  Immediately 
before  birth  it  has  been  found  to  measure  three  feet  four  inches  long, 
and  three  and  a  half  inches  in  circumference  (three-fourths  in  diameter). 
Daubenton  found  it  to  be  in  one  instance,  from  the  umbilicus  to  the  am- 
nion, eighteen  inches,  though  the  period  of  gestation  is  not  mentioned. 
Bourgelat  gives  it  as  about  two  and  a  half  feet ;  Blaine,  from  two^  to 
two  and  half  feet.  Goubaux  found  it  to  measure,  when  untwisted,  at  six 
months'  pregnancy,  thirty-four  inches  ;  but  it  was  so  very  twisted  (twelve 
turns)  that  in  this  state  it  was  only  twenty-nine  inches  in  length. 

In  the  Cow,  Vitet  gives  it  as  from  nine  to  ten  inches  ;  but  Goubaux,  in 
a  Cow  at  the  eighth  month  of  pregnancy,  found  it  to  be  about  sixteen 
inches ;  while  Colin,  in  another  Cow  at  the  same  period,  gives  eighteen 
inches. 

In  the  Sheep,  at  two  months'  gestation,  it  has  barely  measured  one 
inch  ;  Rainard,  at  the  end  of  gestation,  gives  it  at  from  three-fourths  to 
one  and  a  quarter  inches.    Daubenton  says  it  is  two  inches  at  parturition. 

In  the  Pig  it  is  comparatively  very  long,  sometimes  stretching  the  whole 
length  of  the  Pig.  Daubenton  found  it  to  be  one  incli^in  length  in  a  foetus 
measuring  three  inches,  and  three  lines  from  nose  to  anus. 

In  the  Bitch  and  Cat  it  is  very  short,  and  measures  from  one  to  two 
inches  at  birth ;  or  about  two-fifths  of  the  length  of  the  body. 

In  the  early  days  of  foetal  life,  the  cord  contains  a  portion  of  the  intes- 
tines, but  as  the  cavity  of  the  abdomen  is  formed  and  closes,  the  viscus 
is  retracted  within  it.  Very  rarely,  however,  this  retraction  is  not  com- 
plete, and  hernia  of  the  intestines  exists  at  birth,  or  even  some  time  after 
that  event. 

With  regard  to  the  curious  torsion  of  the  cord  on  itself,  it  has  been  held 
by  some  authorities  that  this  is  only  accidental,  and  depends  on  the 
movements  of  the  foetus  during  the  latter  stages  of  gestation,  or  the  dis- 
placement it  undergoes  on  leaving  the  uterus;  consequently,  that  the 
spiral  twisting  of  the  vessels  is  not  normal.  Examination  of  non-dis- 
placed foetuses  jDroves  that  it  is  far  from  being  constant. 

At  birth,  the  umbilical  cord  is  usually  torn  or  gnawed  through,  at  a 
short  distance  from  the  umbilicus  of  the  foetus  ;  the  remaining  portion 
drying  up,  dying,  and  falling  off  in  a  few  days. 


CHANGES  IN  THE  OVUM.  89 

SECTION    III. DEVELOPMENT   OF    THE    FCETUS. 

Having  studied  the  conception  and  partial  development  of  the  young 
■creature,  and  described  the  envelopes  which  surround  it,  we  will  proceed 
to  notice  the  various  changes  which  occur  in  it  until  gestation  is  com- 
pleted and  parturition  is  about  to  take  place. 

This  division  of  our  subject  is  of  much  importance  in  several  respects, 
but  more  especially  with  regard  to  the  relation  it  bears  to  teratology — the 
branch  of  science  which  treats  of  congenital  malformations  and  mon- 
strosities. 

The  transition  from  the  condition  of  the  embryo,  when  the  young  an- 
imal has  scarcely  assumed  a  definite  form,  to  that  of  the  foetus,  when  it 
presents  the  lineaments  of  the  species  to  which  it  belongs,  is  very 
gradual. 

The  dorsal  cord,  as  has  been  stated,  is  a  cylindrical  body  developed 
above  the  primitive  furrow,  with  slightly  attenuated  extremities,  and  at 
each  side  small  opaque  quadrangular  masses,  the  vertebral  lamincE,  which 
are  in  reality  the  protovertebrce,  or  first  rudiments  of  the  vertebrae.  Each 
of  these  masses  is  perforated  by  a  small  opening,  and  is  resolved  into 
three  portions  :  theprotovertebral  cavity,  the  miisctilar  la7nma,si\M2i\.ed2ihovQ 
the  cavity,  and  the  protovertebra  placed  below  the  cavity.  The  muscular 
lamince,  increasing  in  volume,  are  inflected  upwards  and  at  last  unite  on 
the  median  line  of  the  back,  chiefly  forming  the  muscles  of  the  vertebral 
furrows  ;  they  also  send  off  prolongations  downwards,  which  concur  in 
the  development  of  the  intercostal  and  abdominal  muscles,  as  well  as 
those  of  the  limbs.  The  protovertebrce  bend  upwards  and  downwards  on 
each  side,  so  as  to  enclose  the  protovertebral  cavity  or  spinal  canal,  and 
the  dorsal  cord  ;  the  upper  ring  represents  the  rudiments  of  the  annular 
portion  of  the  vertebrae  ;  while  the  lower  ring  and  the  dorsal  cord  consti- 
tute the  vertebral  bodies  and  the  discs  uniting  them. 

The  lateral  la7}iince  arise  from  the  portion  of  the  middle  layer  of  the 
blastoderm  placed  on  each  side  of  the  vertebral  laminae.  In  the  region 
of  the  trunk,  these  laminae  are  separated  for  a  certain  time  from  the  lat- 
ter ;  but  in  the  cephalic  region  they  are  always  adherent  to  them,  and  at 
this  part  they  are  usually  designated  the  cephalic  lamince.  The  proper  lat- 
eral lamiiKB  are  divisible  into  two  layers,  external  and  internal,  united  by 
a.middle  layer;  they  comprise  between  them  a  space  which  becomes  the 
pleuro-peritoneal  cavity,  after  the  formation  of  which  the  lateral  are  joined 
to  the  vertebral  lamina.  The  internal  or  Jibro-intestinal  layer  envelops 
the  deeper  portion  of  the  blastodermic  layer  or  intestinal  furrow,  the  um- 
bilical vesicle,  and  the  allantois  ;  it  constitutes  the  fibrous  and  vascular 
parts  of  these  membranes,  and  carries  the  vessels  to  the  inner  face  of  the 
chorion.  The  external  or  cutaneous  layer  is  developed  in  two  ways :  above, 
it  glides  between  the  muscular  laminae  and  the  foetal  portion  of  the  exter- 
nal layer  of  the  blastoderm  to  form  the  cutaneous  envelope  on  the  back  j 
below,  it  separates  into  two  leaves,  which  receive  between  them  the  pro- 
longations of  the  muscular  laminae  destined  to  constitute  the  intercostal, 
abdominal,  and  other  muscles  of  this  part  of  the  body.  Of  these  two 
secondary  leaves,  the  external  forms  the  skin  of  the  trunk,  and  the  inter- 
nal the  parietal  layer  of  the  peritoneum.  The  cutaneous  laminae  also  fur- 
nish an  extra-fcetal  prolongation — the  fibrous  layer  of  the  amnion. 

The  middle  or  tnesenteric  lanwice  join  at  the  median  line,  and  in  their 
substance  are  developed  the  Wolffian  bodies,  or  antecedent  deciduous 
kidneys,  and  the  principal  vessels  of  the  trunk. 


go  OBSTETRICAL  PHYSIOLOGY. 

The  cephalic  lamincB  always  remain  adherent  to  the  vertebral  laminae^ 
and  are  inflected  inwards  with  them  to  form  the  anterior  part  of  the 
cephalo-intestinal  cavity,  which  is  divided  into  two  compartments — the 
pharyngeal  and  oesophageal  cavities.  The  pharyngeal  cavity  opens  exter- 
nally by  the  mouth,  and  is  partly  enclosed  on  the  sides  by  the  pharyngeal 
arches.  The  oesophageal  cavity  soon  shows  a  diverticulum,  which  is  not 
long  in  communicating  with  the  pleuro-peritoneal  cavity,  and  subse- 
quently contains  the  heart ;  it  is  therefore  named  the  cardiac  cavity.  The 
cephalic  laminas  also  form  the  derm  of  the  cranium,  and  the  fibrous  layer 
in  which  are  developed  some  of  the  cranial  bones. 

The  Nervous  System. 

The  development  of  the  nervous  system  comprises  the  growth  of  the 
brain,  spifial  cord,  and  nerves.  The  initial  steps  in  the  development  of 
the  brain  and  cord  have  been  already  indicated.  At  each  extremity  of 
the  medullary  cavity,  which  is  a  modification  of  the  median  furrow,  is  a 
slight  bulging.  From  the  posterior,  or  rhomboidal  sinus,  the  sacro-lumbar 
nerves  are  given  off,  v/Iiile  the  anterior  gives  origin  to  the  brain.  This 
anterior  enlargement  appears  as  three  successive  dilatations,  named  the 
cerebral  vesicles  or  cells,  which  are  distinguished  as  anterior,  middle,  and' 
posterior.  They  are  filled  with  fluid,  and  the  middle  slightly  surmounts 
the  other  two,  which  gives  the  whole  the  figure  of  a  small  triangular  mass. 
The  vesicles  increase  irregularly  in  volume,  and  their  walls,  in  develop- 
ing, form  the  nervous  tissue  ;  while  their  cavity  persists  and  becomes  the 
space  observed  in  each  portion  of  the  encephalon.  The  a.fiterior  vesicle^ 
represents  the  cerebral  hemispheres,  the  thalami  optici  and  the  lateral 
ventricles.  The  middle  vesicle  forms  the  crura  cerebri,  corpora  quadrigem- 
ina,  and  the  aqueduct  of  Sylvius  or  middle  ventricle.  The.  posterior  vesicle 
gives  rise  to  the  medulla  oblongata,  pons  varolii,  cerebellum,  and  fourth 
ventricle.  The  middle  vesicle  increases  more  rapidly  in  volume  at  first 
than  the  others,  but  it  soon  stops  and  allows  the  anterior  cell  to  develop  ; 
from  this  time  the  encephalon  assumes  its  oval  shape,  with  predominance 
of  the  anterior  part. 

Towards  the  end  of  their  first  third  of  intra-uterine  life,  nearly  all  the 
parts  of  the  encephalon  are  distinct ;  the  two  hemispheres  are  separated 
by  the  development  of  the  septufn  lucidem,  and  the  convolutions  are  ap- 
parent on  their  surface  ;  while  the  corpora  quadrigemina  and  crura  are 
well  defined.  At  a  later  period  the  cerebellum  is  seen,  as  well  as  the 
pons  varolii,  corpora  restiformia,  and  corpora  pyramidalia. 

With  regard  to  the  development  of  the  spinal  cord,  we  have  observed 
that  the  medullary  canal  is  the  first  trace  of  this  part.  It  occupies  the 
whole  length  of  the  vertebral  stalk,  and  its  cavity  communicates  anteri- 
orly with  the  fourth  ventrical.  When  the  spine  is  developed,  the  cord 
only  increases  longitudinally  to  a  certain  degree,  and  appears  to  ascend 
in  the  canal  \  it  stops  at  the  middle  of  the  sacrum  in  the  equine  foetus, 
but  ascends  higher  in  the  other  species.  During  this  apparent  ascensional 
movement  is  developed  the  Jilum  terminale,  and  the  nerves  of  the  tail  of 
the  Horse  {cauda  equina).  The  parietes  of  the  medullary  canal  are  at 
first  very  thin,  but  increase  in  thickness  with  the  appearance  of  the  ner- 
vous substance  of  the  cord,  and  soon  divide  into  two  layers :  an  internal,, 
the  epithelium  of  the  central  canal ;  and  an  external,  the  grey  substance  of 
the  cord.  Gradually  the  canal  contracts,  and  the  cord  shows  longitudinal 
furrows.     At  the  end  of  the  first  month  the   inferior  roots  of  the  nerves 


CHANGES  liY  THE  OVUM.  ^X 

are  in  existence,  as  well  as  the  spinal  ganglia,  which  are  developed  at  the 
expense  of  the  protovertebrae  ;  the  superior  roots  are  not  distinguishable 
for  some  time  after.  The  envelopes  of  the  nervous  centres  are  furnished 
by  the  protovertebral  laminae,  and  are  developed  after  the  sixth  week,  fol- 
lowing the  formation  of  the  parts  they  are  destined  to  cover. 

The  fierves  are  not  so  definite  in  their  development,  and  some  obscurity 
prevails  with  regard  to  them.  It  would  appear  that  the  motor  roots  origi- 
nate in  the  cord,  but  that  the  ganglia  are  formed  separately  in  the  proto- 
vertebrae, and  perhaps  become  the  point  of  departure  of  the  sensitive 
roots.  The  nervous  ramifications  grow  from  elongated  ramified  cells, 
which  are  joined  by  their  extremities.  The  nuclei  of  the  cells,  joined  to 
the  periphery,  become  the  nuclei  of  the  sheath  of  Schwann,  and  the  nerve 
tissue  is  afterwards  deposited  gradually  between  the  axis-cylinder  and 
the  envelope.  The  great  sympathetic  nerve  is  perceived  at  an  early  date 
as  a  nodulated  cord  ;  it  is  probably  developed  in  the  same  manner  as  the 
other  nerves. 

The  Organs  of  Sense. 

The  principal  portion  of  the  organs  of  sense  belong  to  the  nervous  sys- 
tem, and  are,  of  course,  developed  with  it ;  the  other  portions  belong  to 
the  external  epithelial  layer,  and  to  the  derm  or  germinative  layer.  With 
regard  to  the  organs  of  vision,  two  tubulous  prolongations  arise  from  the 
anterior  cerebral  vesicle  and  passing  forward  terminate  in  the  primary 
ocular  vesicles,  traces  of  the  ocular  globes ;  the  hollow  prolongments 
forming  the  optic  nerves,  and  the  vesicles  furnishing  the  choroid  and 
retina.  The  crystalline  lens,  vitreous  body,  cornea,  and  sclerotica  are 
derived  from  the  external  blastodermic  layer.  The  part  of  the  integu- 
ment not  required  to  form  the  lens  constitutes  the  envelope  of  the  globe. 
The  latter  forms  the  sclerotica  and  cornea  ;  while  the  epiderm  furnishes 
the  epithelium  to  the  latter,  which  becomes  distinct  from  the  sclerotica 
in  about  the  fourth  month.  A  slit  occurs  at  the  lower  part  of  the  fibrous 
envelope  of  the  globe  ;  this  is  related  to  the  development  of  the  vitreous 
humor,  a  prolongation  of  the  derm  passing  through  this  slit  and  enter- 
ing between  the  lens  and  the  anterior  wall  of  the  secondary  ocular  vesi- 
cle which  appeared  shortly  before.  There  this  prolongation  becomes 
developed  and  transformed  into  the  vitreous  humor,  which  at  one  period 
is  surrounded  by  vessels,  but  shows  none  immediately  before  gestation. 
It  exhibits  in  its  centre  a  transverse  canal,  which  lodges  a  branch  of  the 
arteria  centralis  of  the  retina. 

The  optic  nerve  is  developed  in  the  pedicle  connecting  the  ocular  vesi- 
cle with  the  anterior  cerebral  vesicle,  and  the  reti?ia  is  formed  by  the  in- 
ner la3^er  of  the  secondary  ocular  vesicle  ;  it  extends  to  the  lens  in  chang- 
ing its  character  in  front.  The  choroid  coat  is  constituted  by  the  posterior 
layer  of  the  ocular  vesicle  ;  it  extends  as  far  as  the  lens,  and  is  then  in- 
flected in  front  of  that  body  to  form  the  iris.  The  borders  of  the  pupil 
embrace  the  vascular  envelope  of  the  lens,  and  the  anterior  face  as  well 
as  this  pupil  are  covered  by  a  very  vascular  membrane,  the  membrana 
pupillaris  ;  behind  it  is  the  equally  vascular  covering,  the  membrana  cap- 
sulo-pupillaris,  that  passes  through  the  pupil  to  the  lens  to  envelop  it  in  a 
kind  of  sac  that  disappears  towards  the  end  of  gestation.  Previous  to 
this  time  this  aperture  is  very  wide  ;  but  as  the  iris  is  developed  the  pupil 
contracts,  and  the  vessels  of  the  vascular  or  pupillary  membrane  dimin- 
ish in  size  and  number,  until  at  last  only  a  few  are  seen  crossing  the 
transparent  membrane. 


92 


OBSTETRICAL  PHYSIOLOGY. 


The  protective  and  motor  apparatus  of  the  eye  are  gradually  developed 
around  the  globe.  The  eyelids  are  small  cutaneous  folds  which  are 
formed  in  the  first  third  of  uterine  life,  and  grow  and  unite  by  their  mar- 
gins until  a  short  time  before  or  after  birth,  according  to  the  species, 
when  they  separate.  They  are  maintained  closed  by  a  thin  membrane, 
which  disappears  in  solipeds,  ruminants,  and  the  Pig,  before  birth  ;  but  in 
carnivora  it  remains  until  some  days  (eight  or  ten)  after  that  event.  So 
long  as  the  lids  are  closed,  the  conjunctiva  is  only  a  sac  communicating 
with  the  lachrymal  canal.  The  crystalline  lens  in  the  foetus  and  new- 
born animal  distinctly  shows  the  three  septa  peculiar  to  it ;  three  diverge 
from  each  pole  at  angles  of  120°.  The  lachrymal  gland  is  an  appendage 
of  the  epithelial  layer  which  is  intruded  above  the  globe  ;  at  first  com- 
pact, it  becomes  gradually  excavated  into  cavities,  from  which  arise  the 
excretory  ducts. 

The  auditory  apparatus,  consisting  of  the  internal  ear,  auditory  nerve, 
and  middle  ear,  is  developed  separately.  The  labyrinth  appears  in  the 
form  of  a  vesicle  which  is  not  in  direct  relation  with  the  posterior  cere- 
bral cell,  but  is  constituted  by  a  depression  of  the  epidermic  layer — the 
auditory  fossa — that  becomes  more  and  more  marked  until  it  is  finally  a 
closed  cavity.  At  this  time  the  wall  of  the  labyrinth  is  only  a  simple 
epithelial  membrane  ;  but  this  is  soon  increased  externally  by  a  connec- 
tive membrane  which  vascularizes  it,  and  then  gives  rise  to  three  layers  ; 
an  internal,  which  adheres  to  the  epithelium  to  form  the  membrane  of 
the  labyrinth  ;  an  external,  that  lines  the  labyrinthic  cartilage  ;  and  a 
middle,  whose  soft  embryonic  connective  tissue  disappears  and  is  re- 
placed by  a  fluid,  the  perilymph.  At  the  same  time  that  these  changes 
of  structure  are  taking  place,  the  vesicular  shape  of  the  labyrinth  is  mod- 
ified, and  shows  the  cochlea,  semicircular  canals,  utriculus,  and  sacculus. 
The  middle  and  external  e^r  are  formed  by  the  first  pharyngeal  slit,  which 
is  never  completely  closed,  while  the  others  disappear.  At  first  there  is 
a  cavity  communicating  externally  by  the  pharynx  ;  this  cavity  contracts, 
then  divides  into  two  portions  by  a  septum  in  its  middle  ;  this  septum 
becomes  the  tynipa?ium,  while  the  inner  cavity  forms  the  middle  ear  and 
Eustachian  tube ;  and  the  external  portion  the  external  auditory  canal  ox 
meatus.  The  ossicula  audittis  are  at  first  cartilaginous,  and  appear  to- 
wards the  third  month  ;  after  which  they  gradually  ossify,  and  have  nearly 
assumed  their  definitive  shape  at  birth. 

The  co?icha  is  developed  beneath  the  integument  after  the  second 
month. 

The  07'gans  of  sinell  begin  by  two  depressions  in  the  epidermic  layer, 
analogous  to  the  crystalline  lens  and  auditory  fossettes.  These  two  olfac- 
tory fossa  appear  below  the  ocular  vesicles,  and,  becoming  deeper,  their 
depth  is  further  increased  by  granulations  which  spring  up  on  their  bor- 
ders. Behind,  they  communicate  with  the  pharynx,  and  the  formation  of 
the  palate  separates  them  in  front  from  the  buccal  cavity.  From  this  time 
the  nasal  fossae  are  constituted  and  completed  by  the  development  of  the 
bones  of  the  face.  The  olfactory  lobes  and  nerves  are  at  first  tubular,  and 
are  related  to  the  anterior  cerebral  vesicle.  In  the  young  foetus  the  nos- 
trils are  formed  by  a  collection  of  mucus  and  epithelium ;  they  open 
towards  the  middle  period  of  gestation. 

The  Skill  and  its  Appendages. 
The  skiji  and  its  appendages,  which  might  be  designated  the  tactcle  ap- 


CHANGES  IN  THE  OVUM. 


93 


paratus,  are  developed  by  the  epidermic  and  middle  layer  of  the  blastoderm. 
The  cutaneous  laminae,  by  the  modification  of  their  elements,  form  the 
derm^  in  which  vessels  are  readily  seen  after  three  months.  In  the  epiderm 
it  is  not  long  before  the  mucous  and  horny  layers  can  be  distinguished ; 
in  the  first,  pigment  cells  are  observed  at  the  commencement  of  the  fifth 
month  in  the  larger  quadrupeds.  The  epiderm  is  easily  detached  from 
the  derm  ;  it  forms  a  peculiar,  white,  completely-enveloping  pellicle  on  the 
surface  of  the  latter,  apparently  separated  from  it  by  the  growing  hairs. 
Frequently  we  find  the  integument  covered  by  a  special  coating  that  looks 
like  varnish  (the  varnix  caseosd)  ;  this  would  appear  to  be  intended  to 
protect  the  epidermic  epithelium  from  the  destructive  solvent  action  of 
the  alkaline  amniotic  fluid.  It  is  very  abundant  on  the  human  foetus  at 
all  periods,  but  is  not  found  on  that  of  animals  so  long  as  the  skin  is  gla- 
brous. As  soon  as  the  hairs  begin  to  appear,  the  epiderm  is  partially  de- 
tached in  the  form  of  the  thin  pellicle  just  alluded  to,  and  the  decomposi- 
tion of  which  gives  rise  to  an  appearance  like  varnish.  It  is  best  seen  in 
the  foetal  Pig,  the  hairs  on  the  skin  appearing  all  at  once  over  the 
body;  in  the  other  domesticated  animals  they  are  only  developed  success- 
ively, and  consequently  the  shedding  of  the  epiderm  occurs  partially  and 
in  patches,  which  are  insensibly  confounded  with  the  normal  epidermic 
layers.  Microscopically,  these  flakes  off^er  the  same  characters  as  epider- 
mis removed  by  a  vesicant ;  the  points  where  the  hairs  have  passed  appear 
as  regular  infundibuliform  openings.  When  the  foetus  increases  in  volume, 
the  epiderm  desquamates  and  the  debris  floats  in  the  amniotic  fluid. 

In  the  third  month,  the  hairs  are  perceptible  on  the  foetus  of  the  Mare 
and  Cow.  Hair  follicles  have  been  observed  in  embryos  of  the  Pig  which 
did  not  measure  more  than  two  inches  in  length.  They  first  appear  about 
the  eyebrows,  lips,  and  joints  of  the  limbs,  and  the  whole  of  the  body  is 
covered  at  the  sixth  or  seventh  month ;  they  are  usually  observed  in  the 
foetus  of  the  Mare  and  Cow,  around  the  lips,  towards  the  eighteenth  week 
of  gestation.  The  hair  maybe  shed  and  renewed  before  birth  ;  for  it  has' 
been  found  in  the  amniotic  fluid  and  in  the  stomach  of  the  foetus.  Each 
hair  is  developed  in  a  prolongation  of  the  epidermic  layer  which  is  im- 
bedded in  the  substance  of  the  derm  :  which  prolongation  is  constituted 
by  a  bottle-shaped  mass  of  cells.  In  the  centre  the  cells  are  modified 
and  heaped  up,  so  as  to  form  a  small  cone  whose  base  covers  the  grow- 
ing papilla  ;  this  cone  elongates,  until  it  touches  the  superficies  of  the 
epidermis,  when  it  becomes  bent  in  the  effort  to  push  itself  through  ;  but 
finally  it  issues  beyond  the  surface,  where  it  may  grow  freely. 

The  sebaceous  and  perspiratory  glands  are  developed  in  a  similar  man- 
ner, at  the  middle  period  of  uterine  life.  The  horny  productions,  such  as 
the  claws,  hoofs,  ergots,  and  chesnicts,  are  apparent  at  an  early  stage.  To- 
wards the  end  of  the  second  month  there  can  be  perceived  in  the  foetus 
of  the  Cow,  at  the  extremity  of  each  digit,  a  small,  pale,  and  transparent 
conical  tubercle  ;  this  is  the  rudiment  of  the  claw.  The  hoofs  of  solipeds 
appear  towards  the  twelfth  week,  and  about  the  commencement  of  the 
fourth  month  they  are  more  developed  ;  their  texture  has  become  firm  and 
opaque,  whereas  before  it  was  gelatinous  and  transparent,  and  has  assumed 
a  fine  yellow  tint.  They  are  always  soft,  however,  until  birth,  in  order  to 
guarantee  the  integrity  of  the  foetal  envelopes.  At  mid-term,  brown  or 
black  patches  appear  in  it,  if  the  coronet  is  provided  with  pigmentary 
stains  ;  but  it  is  not  until  about  the  end  of  gestation  that  the  horn  begins 
to  show  the   greenish  tint  proper  to  it  when  destitute  of  pigment ;  though 


94 


OBSTETRICAL  PHYSIOLOGY. 


the  remainder  of  this  production,  particularly  its  lower  part,  preserves  its 
yellow  color  until  the  young  animal  is  born.  In  solipeds  the  chesnuts 
are  seen  at  mid-term,  in  the  form  of  thin  brownish  plates,  which  soon  be- 
come darker.  The  structure  of  the  hoof  is  not  tubular  until  after  birth, 
when  the  foetal  hoof,  gradually  disappearing,  the  horn  that  replaces  it  is 
fibrous  and  tubular,  and  much  more  consistent. 

The  corneous  substance  is  developed  at  the  expense  of  the  blastema 
which  the  capillaries  of  the  modified  derm  throws  out  on  its  surface.  In 
this  material  appear  nucleated  cells  which,  pressing  against  each  other, 
become  at  first  polygonal  in  shape  and  flattened,  then  lose  their  nucleus 
and  are  confounded  with  each  other.  At  a  later  period,  cells  of  a  new 
formation  are  moulded  on  the  papillae  of  the  coronary  cushion  and  plantar 
surface  of  the  foot  of  solipeds  and  ruminants,  giving  it  that  fibrous  ap- 
pearance which  is  so  striking  during  extra-uterine  life. 

The  Locomotor  ^   Apparatus. 

The  development  of  bone,  and  with  it  the  locomotory  apparatus  in  gen- 
eral, next  demands  our  attention.  Bone  is  developed  in  the  blastema  or 
primitive  basis — a  transparent  glairy  mucus  matter  containing  numerous 
minute  corpuscles.  This  progressively  acquires  increased  firmness  ;  some- 
times assuming  a  membraneous  or  ligamentous  condition^  usually  a  gristly 
consistence,  before  its  conversion  into  bone.  The  change  into  cartilage 
is  noted  by  the  appearance  of  minute  nucleated  cells,  which  increase  in 
number  and  size,  and  are  aggregated  in  rows,  with  intercellular  tracts 
where  the  ossification  is  about  to  begin.  These  rows,  in  the  cartilaginous 
basis  of  long  bones,  are  vertical  to  its  ends ;  in  that  of  flat  bones  they  are 
vertical  to  the  margin.  The  cells  furthest  from  the  seat  of  ossification 
are  flattened  and  in  close  contact ;  nearest  that  seat  they  become  enlarged 
and  separated.  The  first  appearance  of  bone  is  that  of  minute  granules  in 
the  intercellular  tissue.  Canals  are  next  formed  in  the  bone,  by  absorption  ; 
these  ultimately  receive  blood-vessels,  and  become  the  "vascular  canals." 
The  immediate  nutrition  of  bone  is  provided  for  by  the  production  of 
minute  "  plasmatic  canals,"  "  lacunae,"  or  "  bone-cells  "  from  the  vascu- 
lar ones.  Ossification  begins  at  the  centre  of  round  bones,  and  proceeds 
towards  the  surface  ;  in  flat  bones  it  extends  between  two  membranes,  and 
from  a  central  point  towards  the  periphery  ;  in  short  bones,  towards  the 
circumference ;  and  in  long  bones,  from  a  central  point  or  diap/iysis, 
towards  another  centre — the  epiphysis,  situated  at  each  end.  Particular 
parts  or  processes  are  furnished  with  a  separate  centre  of  development, 
named  the  apophysis.  Length  occurs  at  the  extremity  of  the  diaphysis, 
and  bulk  by  deposition  on  the  surface,  the  medullary  cand  of  certain 
bones  being  due  to  internal  absorption. 

The  spinal  stalk  is  the  first  portions  of  the  skeleton  observed  in  the 
embryo,  it  being  represented  by  the  chorda  dorsalis,  which  is  composed 
of  a  mass  of  cells  in  the  interior  of  a  transparent  sheath.  The  proto- 
vertebrae  appear  on  each  side  of  the  cord,  and  ultimately  enclose  it  and 
constitute  the  spinal  canal ;  in  this  way  results  the  external  sheath  of  the 
cord,  and  the  superior  uniting  membrane.  The  vertebral  stalk  now  exists 
as  a  membraneous  axis,  but  not  for  long ;  as  it  becomes  segmented  in 
order  to  form  the  vertebrae,  and  these  segments  are  gradually  converted 
into  cartilage.  Each  persisteiit  vertebra  does  not  correspond  to  a  proto- 
vertebra,  the  latter  dividing  into  two  portions  to  constitute  two  vertebrae. 
The  body  of  the  veirtebra  is  developed  more   quickly  than  the  spinous 


CHANGES  IN  THE  OVUM. 


95 


portion  ;  at  the  end  of  the  second  month  all  the  vertebral  bodies  are  car- 
tilaginous, while  the  laminae  are  yet  in  a  membraneous  condition.  In  the 
third  month  ossification  commences,  and  during  this  process  the  dorsal 
cord  disappears,  except  between  the  vertebras,  where  it  is  developed  to 
form  the  intervertebral  fibro-cartilage. 

The /^<r^  and  <rrrt!«/V/?«  are  formed  by  a  membrane  that  envelops  the 
encephalon,  and  which  is  due  to  the  protovertebral  laminae.  This  cranial 
membrane  become  partly  cartilaginous  and  partly  fibrous,  the  cartilage 
existing  at  the  base  of  the  cranium,  and  appearing  to  be  a  prolongation 
of  the  bodies  of  the  vertebrae :  indeed,  there  is  a  resemblance  between  a 
vertebra  and  the  cranium,  in  so  far  as  the  latter  can  be  resolved  into  four 
portions,  each  corresponding  to  a  vertebra.  This  cartilage  is  slowly 
transformed  into  bone  ;  while  the  fibrous  part,  answering  to  the  roof  and 
sides  of  the  skull,  pass  directly  into  the  osseous  state.  The  bones  of  the 
face  are  formed  by  the  phary?igeal,  branchial,  or  visceral  arches  :  a  name 
given  to  four  laminae  which,  springing  from  the  anterior  extremity  of 
the  dorsal  cord,  curve  downward  to  meet  those  of  the  opposite  side  ; 
the  spaces  between  them  are  named  the  "pharyngeal  clefts."  The 
upper  jaw,  mouth,  and  nasal  cavities — composed  by  the  nasal,  maxillary, 
and  palate  bones — come  from  the  first  pharyngeal  arch ;  while  Meckel's 
■cartilage,  which  passes  from  the  handle  of  the  malleus  towards  the  lower 
jaw,  is  also  an  appendage  of  it.  This  cartilage  disappears  about  the 
sixth  or  seventh  month.  At  first  the  mouth  communicates  with  the  nasal 
cavities  ;  the  palate  is  developed  in  two  portions,  which  advance  towards 
each  other,  but  remain  for  some  time  apart  \  so  that  during  this  time  the 
young  animal  has  a  cleft  palate.*  The  second  pharyngeal  arch  forms 
the  stapes,  the  petrous  portion  of  the  temporal  bone,  the  styloid  arch  and 
the  hyoid  branch.  The  third  originates  the  hyoid  bone  with  its  cornua, 
while  the  fourth  only  constitutes  the  soft  parts  in  this  region  of  the 
throat. 

The  thorax,  consisting  of  the  ribs  and  sternum,  is  an  appendage  of  the 
protovertebral  laminae  which  incline  towards  the  lower  face  of  the  ver- 
tebral spine.  The  true  ribs  are  developed  most  rapidly,  and  before 
attaining  the  middle  line  they  unite  by  their  inner  extremity  to  form  a 
moiety  of  the  sternum.  A  fissure  at  this  part  separates  the  ribs  of  one 
side  from  those  of  the  other  ;  this  gradually  closing,  ends  by  disappearing 
altogether,  and  then  the  sternum  is  constituted.  The  ribs  are,  after  the 
petrous  portion  of  the  temporal  bone,  the  parts  of  the  skeleton  which 
ossify  most  promptly ;  ossification  begins  in  the  middle  bones.  The  ribs 
do  not  belong  exclusively  to  the  dorsal  vertebrae,  but  have  a  tendency  to 
be  developed  along  the  length  of  the  spine  ;  it  is  not  rare  to  see  a  small 
cartilaginous  nucleus  attached  to  the  lumbar  vertebrae,  and  which  is  soon 
lost  in  the  substance  of  the  abdominal  parietes  ;  in  birds  this  body 
assumes  large  dimensions  on  the  last  cervical  vertebrae. 

The  shape  of  the  thorax  differs  with  species,  being  round  in  some  and 
oval  in  others,  but  it  is  always  less  developed  in  the  foetus  than  in  the 
young  or  adult  animal. 

The  limbs  do  not  appear  until  after  the  formation  of  the  vertebral 
spine,  the  pharyngeal  arches,  and  the  thorax.  They  show  themselves  as 
four  small  prolongations  from  the  pelvis  and  chest,  slightly  thickened  at 

*  This  cleft  condition  of  the  palate  would  sometimes  appear  to  persist  after  foetal  life.  In  April,  1876, 
at  the  Middle  Park  Stud,  in  Kent,  I  saw  a  thoroughbred  foal  with  a  cleft  palate.  It  was  being  suckled, 
and  a  portion  of  the  milk,  instead  of  passing  down  the  oesophagus,  escaped  from  the  nostrils.  It  was  this 
unusual  course  of  the  milk  which  led  to  the  detection  of  the  imperfection. 


96  OBSTETRICAL  PHYSIOLOGY. 

their  origin  and  contracted  in  the  middle.  Their  free  extremity  is  flat^ 
and  is  either  simple  or  divided,  according  to  the  foot  of  the  species.  In 
these  prolongations  the  cartilaginous  segments  are  formed,  which,  when 
ossified,  at  a  later  period,  constitute  the  bones  of  the  limbs. 

The  muscles  are  divided  into  four  groups,  after  their  origin.  They  are 
the  vertebral  muscles^  which  arise  from  the  muscular  laminae  of  the  proto- 
vertebrae  ;  the  visceral  muscles  for  the  thoraic  and  abdominal  cavities,  the 
neck  and  jaws,  and  having  the  same  origin  ;  the  cutaneous  muscles,  which 
originate  from  the  cutaneous  laminae  of  the  middle  layer  of  the  blas- 
toderm ;  and  the  muscles  of  the  limbs,  whose  development  is  not  fully 
understood. 

It  was  believed  at  a  certain  period,  that  the  muscular  fibres  are  formed 
by  the  joining  together  at  their  ends  of  several  elongated  cells.  It  is 
now  known  that  each  fibre  is  constituted  by  a  single  cell  which  extends 
in  length,  and  whose  nuclei  are  multiplied  and  placed  at  the  surface  ; 
while  the  contents  are  transformed  into  a  substance  that  presents  all  the 
characteristics  of  contractile  tissue.  The  sarcolemma  is  formed  after  the 
fibre,  by  a  modification  of  the  connective  tissue  surrounding  it. 

The  locomotory  apparatus  of  the  majority  of  the  domesticated  species 
of  animals  is  so  developed  at  birth,  that  immediately  after  that  event 
the  young  creature  can  move  with  more  or  less  alacrity.  With  the 
larger  herbivorous  quadrupeds,  the  limbs  of  the  new-born  animal  are 
long  to  enable  it  to  reach  the  teat,  as  well  as  to  enable  it  to  escape  by 
flight  should  danger  be  apprehended. 

The  Circulatory  System. 

The  development  of  the  circulatory  system  is  not  apparent  until  some 
days  after  the  appearance  of  the  embr}^o  in  the  blastodermic  layer,  there 
being  no  trace  of  vessels  in  the  germinative  space.  It  is  not  long,  how- 
ever, before  the  central  organ  of  oirculation  and  some  vessels  appear  in 
the  middle  layer,  and  canals  also  spread  to  the  surface  of  the  umbilical 
vesicle.  While  the  contents  of  the  vitelline  vesicle  are  being  imbibed  by 
the  embryo,  the  heart  is  in  course  of  formation  ;  blood-vessels  are  increas- 
ing and  extending,  the  allantois  is  completed,  and,  finally,  the  placental 
circulation  is  established  and  continues  until  birth. 

The  pleuro-peritoneal  cavity  in  the  embryo  shows  a  diverticulum  in 
front — the  cardiac  cavity,  in  the  inferior  of  which  the  heart  is  developed. 
This  organ  is  at  first  a  small  mass  of  cells,  the  innermost .  of  which 
separate  in  order  to  leave  a  little  space,  and  to  create  blood  globules. 
As  soon  as  it  appears,  the  heart  contracts  and  relaxes  alternately,  the 
movements  being  very  slow,  though  they  gradually  become  accelerated. 
Towards  the  twelfth  day  the  organ  has  the  shape  of  a  cylindrical  con- 
tractile tube.  From  its  anterior  part  arise  two  branches,  the  aortic 
arches,  which  at  first  proceed  towards  the  head  of  the  embryo,  but 
afterwards  are  bent  backward  and  downward.  These  arches  join  to  form 
the  single  aorta,  which  in  its  turn  divides  into  two  branches — the  sub- 
vertebral  or  common  aortas, — which  run  parallel  along  the  lower  surface 
of  the  embryo,  giving  off  four  or  five  branches,  the  omphalo-meseraic 
arteries,  which  ramify  in  the  germinative  area  and  end  in  a  vein — the 
terminal  sinus.  From  this  ramification  and  sinus  arise  two  vessels,  the 
omphalo-meseraic  veins,  which  return  to  the  posterior  extremity  of  the 
heart.     The   circulation    in    the  umbilical  vesicle  is  very  ephemeral  in. 


I 


CHANGES  IN  THE  OVUM. 


97 


several  species,  while  it  is  as  persistent  in  others  ;  varying,  of  course, 
with  the  duration  of  the  vesicle  itself. 

The  heart,  from  being  merely  a  cylindrical  tube,  undergoes  considerable 
modifications  before  it  arrives  at  its  complete  development,  passing 
through  all  the  different  forms  which  characterize  the  organ  in  the 
various  vertebrate  animals.  The  first  change  consists  in  an  inflexion,  by 
which  the  inferior  part  becomes  the  superior  ;  then  it  dilates  at  three  dis- 
tinct points  :  one  anterior  and  superior,  at  the  origin  of  the  aorta,  named 
the  aortic  bulb ;  a  middle  one,  the  ventricular  cavity  ;  and  a  posterior,  the 
auricular  cavity  The  constriction  between  the  auricle  and  ventricle  is 
named  nailer's  passage  (detroit). 

These  two  cavities  are  single  only  for  a  brief  period ;  the  ventricular 


I 


Fig.  44. 
FcETAL  Circulation  in  a  Transition  State. 


a  bcJ,  Circle 


c  ..  n,  J  Envelope  resulting  from  the  Fusion  of  the  Vitelline  Membrane,  External  Layer 
of  the  Bastodermic  Vesicle,  and  the  Transformation  of  the  Allantois ;  c,  The  Diminishing 
Umbihcal  Vesicle:  ^,  Cephalic  Portion  of  the  Embryo;  ^.,  Caudal  Portion;  e,  Ventricle  0I 
the  Heart ,,/;  Auricle *f  the  Heart ;  /,  Aorta,  forming  the  Aortic  Arches  ;  //,  Trunk  Represent- 
ing the  Thoracic  Aorta  ;^,  Vessel  which  becomes  the  Anterior  Vena  Cava;  k.  Vena  Azygos  ; 
I,  Confluents  of  the  two  Veins  ^  and  k  ;  m,  Confluent  of  all  the  Veins  at  their  Entrance  into  the 


Auricle  of  the  Heart;  «,  Vessel  Resulting  from  the  Union  of  the^Allantoid'Ve'i'ns"/ A  "and  tlie 
Omphalo-Meseraic  Vein  g;   o    Posterior   Vena  Cava;    / /,   Allantoid  Veins;   /omphalc^ 

Meseraic  or  Umbilical  Vesicle  Vein  •  -  »—'-- ...i-^'^'.  .  ...»   y...  \»v".<»'"- 

t,  Omphalo-Meseraic  Artery. 


Posterior  or  Abdominal  Aorta ;  j  s,  Allantoid  Arteries  ; 


first  divides  into  two— a  division  marked  externally  by  a  furrow  which  is 

visible  on  the  surface  of  the  heart  of  a  foetal  lamb  at  the  nineteenth  day, 

and  the  twenty  fifth  in  the  foal.     This  furrow  corresponds  to  an  inter- 

[ventricular  septum  which  arises  insensibly  at  the  bottom  of  the  ventricles, 

jand  reaches  the  auricles,  where  it  concurs  to  form  the  auriculo-ve^itricular 

lorijices.    The  borders  of  the  openings  are  furnished  with  a  slightly  salient 

lip,  which   at   a   later   stage   develops,    and   constitutes  the  mitral  and 


98  OBSTETRICAL  PHYSIOLOGY. 

tricuspid  valves.  The  heart  now  contains  three  cavities,  two  ventricles 
and  an  auricle,  but  it  is  soon  to  have  a  fourth  ;  for  the  auricle  becomes 
partitioned  into  two  portions,  and  externally  this  division  is  marked  by 
another  depression,  corresponding  to  the  septum  formed  in  the  cavity. 
It  is  to  be  remarked,  however,  that  the  partition  remains  incomplete 
during  the  whole  period  of  uterine  life,  being  perforated  by  an  opening 
— Xh^  foramen  ovale  or  foramen  of  Botal.  The  aortic  bulb  now  contracts 
and  forms  two  vessels — the  aorta  and  pulmonary  artery. 

The  arteries  are  developed,  partly  at  the  expense  of  the  primary  circu- 
lation, and  partly  in  the  vascular  layer  of  the  embryo.  The  aortic 
arches,  situated  at  the  inner  face  of  the  first  two  pharyngeal  arches,  form 
five  new  vessels,  which  are  placed  within  the  other  arches  \  all  these, 
however,  do  not  exist  at  the  same  time,  some  becoming  atrophied  while 
the  others  are  forming.  For  instance,  the  first  two  completely  disappear ; 
the  third  form  the  carotids  ;  the  fourth,  the  axillary  artery  and  the  arch 
or  cross  of  the  aorta  ;  the  fifth  is  atrophied  on  the  right,  but  on  the  left 
forms  the  pulmonary  artery,  the  ductus  arteriosus^  and  the  aorta.  The 
latter  is  continued  along  the  spine  by  the  fusion  of  the  two  primitive 
aortae,  and  shows  at  its  posterior  termination  the  small  pelvic  vessels 
and  the  large  umbilical  arteries. 

The  peripheral  vessels  originate,  independently  of  the  central  vessels, 
in  the  interior  of  the  vascular  layer.  They  appear  as  solid  cellular 
branches,  which  soon  become  hollow  in  their  interior,  and  free  cells 
become  visible.  As  these  new  channels  are  developed,  the  omphalo- 
meseraic  vessels  gradually  diminish  and  disappear,  until  at  last  only  one 
or  two  pass  to  the  umbilical  vesicle. 

The  umbilical  veins  are  developed  immediately  after  the  formation  of 
the  omphalo-meseraic  veins,  and  join  these  ;  as  the  ramifications  of  the 
latter  diminish  in  size  the  former  increase  rapidly,  and  when  the  liver  is 
formed  around  them  they  throw  it  into  those  branches  which  are  the 
rudiments  of  the  hepatic  plexus.  Between  the  portal  and  hepatic  veins, 
the  umbilical  vein  communicates  with  the  vena  cava  by  the  ductus  vetiosus 
of  Aranzi,  which  does  not  exist  in  the  fcetus  of  solipeds  in  the  last 
month  of  gestation.  The  embryonic  veins  form  four  chief  trunks  :  two 
anterior,  the  anterior  cardinal  veins  ;  and  two  posterior,  the  posterior  car- 
dinal  veins.  The  veins  on  each  side  unite  in  pairs  to  form  the  ductus 
Cuvieri,  which  opens  transversely  into  the  omphalo-meseraic  trunk  near 
the  auricular  cavity.  The  anterior  cardinal  veins  issue  from  the  cranium, 
forming  the  jugular  veins,  and  communicate  by  a  transverse  anastomosis 
between  the  right  and  left  veins.  Below  this  the  left  vein  gradually 
atrophies,  as  does  the  ductus  Cuvieri  of  the  same  side ;  while  the  right 
vessel  enlarges,  and  is  ultimately  the  anterior  vena  carva. 

The  posterior  vena  cava  appears  in  the  liver  about  the  fifth  week;  it 
receives  the  veins  of  the  kidneys  and  the  Wolfiian  bodies,  and  behind  it 
anastomoses  with  the  cardinal  veins.  The  middle  portion  of  the  latter 
disappear  and  are  replaced  by  the  vertebral  veins,  the  right  of  which  forms 
the  vena  azygos.  There,  then,  only  remain  two  cardinal  veins  for  the 
two  extremities :  the  anterior,  which  enters  the  ductus  Cuvieri,  and  the 
posterior,  which  constitutes  the  hypogastric  and  crural  veins.  It  there- 
fore happens  that  the  venous  system  of  the  foetus,  which  was  at  first 
symmetrical,  becomes  asymmetrical  in  the  adult  animal. 

As  a  result  of  these  successive  developments,  the  placental  circulation 
is  instituted,  and  continues  the  same  until  the  end  of  gestation,  the  heart 


CHANGES  IN  THE  OVUM. 


99 


being  the  organ  which  circulates  the  blood  in  the  foetus.  This  fluid,  car- 
ried by  the  arterial  vessels,  reaches  the  umbilical  arteries,  and  from  them 
is  distributed  to  the  placenta.  There  it  is  respired,  depurated,  arterialized, 
through  indirect  contact  with  the  blood  of  the  parent,  and  is  returned  by 
the  umbilical  veins.  In  the  texture  of  the  liver  it  is  mixed  with  the 
venous  blood  of  the  intestines  and  the  hinder  part  of  the  body,  conveyed 
by  the  ductus  venosus,  and  is  finally  thrown  into  the  right  auricle,  then 
into  the  ventricle,  whence  it  is  expelled  by  a  contraction  of  that  cavity. 
Instead  of  entering  the  lungs,  which  do  not  act  during  fcetal  life  as  res- 
piratory organs,  the  blood  is  forced  into  the  ductus  arteriosus,  and  thence 
into  the  aorta.     So  that  the  organs  of  the  young  creature  are  never  sup- 


Fig.  45- 

F<ETAL  Circulation  :  Advanced  Period.  > 

A,  Placentulae;  Bi  Bi,  Umbilical  Veins,  with  their  Common  Trunk,  B  ;  D,  Vena  Portse,  and  its 
Anastomosis,  C  ;  E,  Ductus  Venosus  ;  F,  Posterior  Vena  Cava  ;  G,  Right  Ventricle  of  Heart ; 
H,  Pulmonary  Artery ;  J  J,  Aorta ;  I,  Ductus  Arteriosus  ;  K,  Umbilical  Arteries,  with  their 
Anastomosis  at  the  extremity  of  the  Umbilical  Cord. 

plied  with  pure  blood,  but  with  a  mixture  of  arterialized  and  venous 
blood  ;  this  mingling  taking  place  through  the  foramot  ovale,  in  the  aorta 
by  the  ductus  arteriosus,  and  in  the  liver  by  the  ductus  venosus.  The  head 
and  neck  receive  the  purest  blood,  a  circumstance  which  probably 
explains  the  predominance  in  size  of  the  upper  to  the  lower  parts  of  the 
body  of  the  foetus. 

At   birth   the   conditions  of   existence    being  suddenly  changed,  very 
marked  modifications  occur   in  the  circulation.     The  lungs  then  become 


loo  OBSTETRICAL  PHYSIOLOGY. 

the  organs  of  respiration,  and  rapidly  increase  in  capacity,  while  the 
thorax  enlarges  in  a  commensurate  degree ;  the  pulmonary  artery  also 
dilates  to  admit  the  increased  flow  of  blood,  and  the  ductus  arteriosus  is 
obliterated  to  prevent  the  mixture  of  arterial  and  venous  blood.  The 
ductus  venosus  also  aids  in  the  isolation  of  the  two  kinds  of  blood  by 
becoming  atrophied,  as  does  also  the  occlusion  of  the  foramen  ovale. 
This  opening,  however,  not  infrequently  remains  intact  in  young  animals  ; 
though,  as  a  rule,  this  does  not  greatly  affect  the  circulation,  for  when 
the  heart  contracts  the  auricles  are  isolated  by  the  narrowing  of  the 
orifice  and  the  elevation  of  a  valve. 

The  Respiratory  Apparatus. 

There  is  an  absence  of  unanimity  as  to  the  mode  of  development  of  the 
respiratory  apparatus,  and  particularly  the  lufigs.  Some  assert  that  the 
latter  are  derived  from  two  little  distended  cellular  masses  attached  to 
the  anterior  part  of  the  intestinal  tube,  and  which  afterwards  become 
perforated  with  numerous  ramifying  cavities,  that  communicate  with  the 
trachea  ;  while  others  describe  them  as  commencing  by  a  median  enlarge- 
ment, which  is  hollow,  and  opens  into  the  cesophagus.  The  walls  of  the 
orifice  of  communication  with  the  digestive  passage  become  considerably 
lengthened,  and  afterwards  form  the  trachea  and  larynx  ;  while  the 
vesicle  or  enlargement  representing  the  lungs  divides  into  two  pyriform 
sacs,  each  of  which  is  greatly  subdivided  to  constitute  the  pulmonary 
lobes,  with  their  vesicles  and  infundibula.  The  trachea  is  completed 
through  the  formation  of  the  cartilaginous  rings  in  the  tube  that  attaches 
the  lungs  to  the  oesophagus  ;  the  larynx  is  developed  in  the  same  man- 
ner, at  the  pharyngeal  opening  of  the  tube.  This  organ,  however,  is 
not  very  distinguishable  during  foetal  life,  and  only  assumes  its  definitive 
form  and  volume  at  puberty. 

Up  to  birth  the  placenta  retains  the  function  of  the  lungs,  which,  though 
ready  to  act,  only  come  into  play  when  the  creature  is  born.  Previous 
to  this  event  they  are  of  a  dark  red  color,  firm  and  compact,  heavier 
than  water,  and  apparently  destitute  of  alveoli ;  though  these  latter  exist, 
but  are  filled  with  embryonic  elements,  and  their  walls  are  in  contact. 
A  moderate  insufflation  is  sufficient  to  distend  the  air-vesicles,  when  the 
lungs  become  crepitant  and  enlarged,  have  a  rosy  color  and  spongy 
appearance,,  float  in  water,  and  the  air  cannot  be  completely  expelled 
from  them.  The  same  change  immediately  occurs  in  these  organs  when 
the  young  creature  is  born  alive ;  the  external  atmosphere,  acting  upon 
the  surface  of  its  body,  causes  it  to  inspire  deeply,  the  chest  dilates,  the 
air  rushes  into  the  lungs,  and  respiration  commences,  only  to  cease  with 
life.  This  alteration  in  the  color,  texture,  and  specific  gravity  of  the 
lungs  enables,  us  to  decide,  in  certain  cases,  whether  or  not  an  animal 
has  been  born  alive. 

The  thymus  gland  first  appears  towards  the  second  month,  as  a  growth 
from  the  respiratory  mucous  membrane,  near  the  larynx  ;  it  then  descends 
gradually  along  the  trachea  until  it  reaches  the  thorax,  where  it  is  situated 
between  the  layers  of  the  anterior  medianastinum.  It  increases  in  size 
until  birth,  after  which  it  remains  stationary  for  a  short  time  ;  then  it 
gradually  diminishes  and  disappears  at  a  period  which  varies  according 
to  species,  and  even  individuals.  Exceptionally,  it  has  been  found  in 
horses  three  years  of  age.  It  is  a  gland  in  structure,  though  it  has  no 
excretory  canal.     Its  uses  are  unknown,  though  it  is  surmised  that  it  plays 


CHANGES  IN  THE  OVUM.  loi 

a  part  in  the  nutrition  and  haematosis  of  the  fcEtus  and  young  animal.  It 
may  be  that,  like  the  spleen,  it  assists  in  converting  the  white  corpuscles 
of  the  blood  into  red  corpuscles. 

The  Digestive  Apparatus. 

The  development  of  the  digestive  apparatus  comprises  the  formation 
of  the  alimentary  canal  and  the  organs  attached  thereto.  The  alimentary 
canal  begins  to  appear  after  the  first  outlines  of  the  nervous  centres  and 
the  vascular  apparatus  have  been  manifested.  We  have  already  described 
the  manner  in  which  the  intestinal  cavity  was  formed  from  the  inner  lamina 
of  the  blastoderm.  This  cavity,  for  convenience  of  description,  may  be 
divided  into  three  portions  ;  the  anterior  iyitestine,  which  originates  the 
pharynx  and  oesophagus  ;  the  middle  intestine,  which  becomes  the  stomach 
and  intestines  proper;  and  the  posterior  intestine,  which  constitutes  the 
rectum.  The  chief,  or  middle  intestine,  is  at  first  a  cylindrical  uniform 
tube,  the  diameter  of  which  is  afterwards  modified  to  constitute  the  organs 
comprised  between  the  oesophagus  and  rectum. 

The  mouth  begins  by  a  depression  or  cul-de-sac,  which  is  limited  by  the 
maxillar}'-  tubercles  ;  it  increases  as  it  dips  towards  the  pharj'-nx,  from 
which  it  is  only  separated  at  last  by  a  thin  membrane  ;  this  is  eventually 
absorbed,  and  the  mouth  then  communicates  with  the  commencement  of 
the  digestive  canal.  Towards  the  third  month  the  mouth  is  confounded 
with  the  nasal  fossae,  but  after  this  the  palatine  bones  appear,  and  finally 
isolate  the  two  cavities. 

The  to7igue  is  at  first  only  a  small  protuberance  from  the  maxillary 
tubercles,  but  is  completed  by  the  addition  of  a  little  growth  from  the 
second  branchial  arch.  Its  ephithelium  and  glands  are  derived  from  the 
external  layer  of  the  blastoderm  ;  they  are  apparent  at  the  third  or  fourth 
month. 

The  pharynx  and  oesophagus  lengthen  and  widen  as  the  foetus  grows  ;  the 
latter  at  first  communicates  with  the  trachea,  but  it  gradually  closes,  and 
ends  by  separating  entirely  from  that  tube. 

The  stomach  is  formed  by  the  dilatation  of  the  anterior  part  of  the  mid- 
dle intestine.  This  dilatation  is  fusiform,  its  larger  axis  being  longitudi- 
nal ;  but  it  soon  curves  on  itself,  and  then  this  axis  becomes  transversal. 

In  ruminants  the  stomach  is  single  when  it  first  appears,  though  it  is 
not  long  before  furrows  are  observed  on  its  outer  surface  ;  while  inter- 
nally the  particular  septa  are  seen  as  in  adult  life.  In  the  foetus  the 
stomach  is  small,  but  its  volume  increases  rapidly  after  birth,  when  the 
animal  commences  to  take  solid  food.  During  the  sucking  period  in 
ruminants,  there  is  a  predominance  of  the  fourth  over  the  other  gastric 
compartments;  but  as  soon  as  the  young  animal  begins  to  consume 
fibrous  aliment,  the  rumen  increases  rapidly,  until  it  is  by  far  the  largest 
cavity. 

The  intestines  are  at  first  of  uniform  calibre,  though  in  a  short  time  it  is 
easy  to  distinguish  the  different  sections  of  which  they  are  ultimately  com- 
posed. In  hoofed  animals  the  caecum  appears  very  early  ;  it  is  situated 
near  the  omphalo-meseraic  duct,  which  is  detached  from  the  extremity  of 
an  intestinal  loop  that  is  drawn  towards  the  umbilical  ring  ;  while  the 
latter  is  becoming  obliterated,  this  loop  ascends  in  the  abdominal  cavity. 
The  intestines  are  quite  smooth  on  the  inner  surface  during  the  first,  two 
months,  and  towards  the  third  month  show  the  villi  and  glands  of  Lieb- 
erktihn  ;  the  Brunnerian  glands  and  the  follicles  are  only  seen  later. 


I02  OBSTETRICAL  PHYSIOLOGY. 

The  rectum  arises  from  the  posterior  intestine,  and  is  developed  like 
the  other  portions. 

With  regard  to  the  anus,  there  is  observed  towards  the  caudal  extrem- 
ity of  the  foetus  a  depression  analagous  to  the  buccal  cul-de  sac.  This 
becomes  deeper,  and  joins  the  rectum  and  genito-urinary  organs  ;  later, 
it  separates  from  the  last,  and  then  belongs  exclusively  to  the  alimentary 
canal. 

The  ANNEXES  OF  THE  ALIMENTARY  CANAL  are  the  salivary  glands,  teeth, 
liver,  pancreas,  and  spleen.  The  salivary  glands  are  developed  in  a  solid 
cellular  tubercle,  which  is  connected  with  the  epithelium  at  the  upper 
part  of  the  digestive  apparatus.  With  the  growth  of  this  tubercle,  it  is 
converted  into  a  series  of  cavities  having  the  form  of  glandular  culs-de-sac. 
The  submaxillary  gland  appears  first,  and  it  is  entire  in  a  foetus  of  only 
twelve  lines  in  length  ;  the  parotid  gland  is  the  last  formed. 

The  teeth  are  developed  in  the  interior  of  a  cavity  called  the  "dental 
follicle  "  or  "sac,"  by  means  of  the  elements  of  three  germs  correspond- 
ing to  the  anatomical  constituents  of  the  teeth — enamel,  ivory,  and 
cementum.  The  follicle  is  an  oval  cavity  whose  wall  comprises  two 
layers  :  an  external  fibrous  sac,  and  an  internal  gelatinous  lining,  at  the 
bottom  of  which  is  the  ivory p nip  or  germ.  This  is  a  prominence  detached 
from  the  bottom  of  the  sac,  and  has  exactly  the  shape  of  the  tooth.  It 
is  composed  of  a  mass  of  delicate  cellular  tissue  provided  with  vessels 
and  nerves,  and  on  the  surface  a  layer  of  elongated  cells.  At  the  sum- 
mit of  the  follicle,  facing  this  pulp,  is  the  enamel  pulp,  which  fits  accu- 
rately on  the  dental  pulp  like  a  cap.  This  is  made  up  of  a  small  quantity 
of  mucous  cellular  tissue,  covered  by  a  layer  of  cylindrical  cells  connected 
with  the  buccal  epithelium  by  the  gnberfiacnlnm  dentis.  The  cement  orgati 
manifestly  exists  in  the  foal,  being  found  at  the  base  of  the  ivory  germ, 
though  it  disappears  quickly  after  having  performed  its  function.  It  is 
unnecessary  in  this  place  to  enter  into  a  consideration  of  the  develop- 
ment of  the  teeth. 

The  liver  commences  to  be  formed  at  an  early  period  in  all  animals, 
appearing  at  the  surface  of  the  duodenum  in  the  shape  of  one  large  tu- 
bercle or  two  small  ones,  according  to  the  number  of  lobes  in  the  organ  of 
the  adult.  To  these  external  tubercles,  corresponding  internal  ones  arise 
from  the  intestinal  epithelium  ;  the  first  increase  and  enclose  the  omphalo- 
meseraic  vein,  while  the  second  ramify  in  their  interior  and  form  the 
biliary  ducts. 

The  liver  grows  rapidly,  and  when  about  one-third  of  the  period  of  ges- 
tation has  elapsed,  it  nearly  fills  the  abdominal  cavity.  At  a  later  date 
this  increase  is  less  marked,  although  when  gestation  is  nearly  terminated, 
the  gland  is -proportionately  more  voluminous  than  in  the  adult. 

The  pancreas,  like  the  salivary  glands,  is  first  seen  as  a  solid  cellular 
tubercle,  which  is  subsequently  hollowed  out  by  ramescent  cavities. 

The  spleen  is  developed  about  the  second  month,  on  the  great  curvature 
of  the  stomach  ;  it  would  appear  to  be  formed  at  the  same  time  as  the 
pancreas,  in  a  band  extending  from  the  stomach  to  the  duodenum  ;  but 
it  is  separated  from  the  pancreas  and  becomes  attached  to  the  stomach, 
where  its  elements  assume  the  character  of  splenic  tissue. 

The  Genito-urinary  Organs. 

The  genito-urinary  organs  are  related  to  each  other  in  their  develop- 
ment, and  have  some  parts  in  common.     Immediately  after  the  formation 


CHANGES  IN  THE  OVUM. 


103 


of  the  intestines,  these  organs  are  anticipated  by  the  Wolffian  bodies  or 
primordial  kidneys.  These  are  glandular  organs  extending  in  front,  or 
one  on  each  side,  of  the  vertebrae,  from  the  heart  to  the  pelvis.  They 
are  composed  of  small  transversely  disposed  tubuli  filled  with  a  white 
fluid,  and  opening  into  a  common  duct  running  parallel  to  the  spine, 
which  again  enters,  inferiorly,  that  portion  of  the  allantois  which  becomes 
the  bladder.  The  duct  is  formed  before  the  tubuli,  and  is  one  of  the 
earliest  developed  structures  in  the  embryo.  Placed  behind  the  perito- 
neum, the  Wolffian  bodies  are  attached  by  two  folds  of  serous  membrane  : 
one,  the  anterior,  named  the  diaphragmatic  ligament  of  the  Wolffian  bodies  ; 
and  the  other,  posterior,  the  lumbar  ligament  of  the  Wolffian  bodies.  These 
organs  secrete  at  first  a  fluid  resembling  wine,  though  their  function  is 
soon  greatly  modified,  as  they  are  not  long  in  becoming  atrophied  ;  then 
a  portion  serves  for  the  development  of  the  genital  organs,  while  another 
gives  rise  to  organs  whose  use  is  not  exactly  known,  such  as  the  Rosen- 
miiller  organ,  which  is  very  developed  in  the  equine  foetus,  and  the  canals 
of  Gaertner  visible  in  the  Cow 


Male  Foetus  of  the  Mare  at  Five-and  a  Half  Months:  the  Abdomen  opened  and 
Testicles  exposed. 

I,  Thighs  ;  2,  Penis,  neither  Scrotum  nor  Prepuce  are  yet  foj-med  ;  3,  Bladder,  with  the  two 
UmbiHcal  Arteries  ;  4,  Abdominal  Parietes ;  5,  Douglas'  Foramen,  with  the  two  Afferent 
Canals,  3,  i5i  ;  6,  Kidneys  ;  7,  Supra-renal  Capsules;  8,  Rectum  ;  9,  Mesorchis  or  Spermatic 
Cord  ;  a,  Gubemaculum  Hunterii  ;  «i,  Intenial  Inguinal  Ring  ;  b,  b.  Efferent  Ducts  ;  c,  c, 
Testicles  ;  d,  d,  Pampiniform  Plexus. 

With  regard  to  the  urinary  organs,  we  have  mentioned  how  the 
allantois  was  derived  from  the  terminal  portion  of  the  intestine  ;  it  only 
now  remains  to  add  that  the  urinary  bladder  is  derived  from  the  abdomi- 
nal portion  of  the  allantois,  which  is  merely  a  dilatation  of  that  sac. 
During  fcetal  life,  the  bladder  is  extended  by  the  urachus  to  the  umbilical 
ring ;  but  after  birth  this  canal  is  obliterated,  and  the  bladder  retires  to 
the  bottom  of  the  pelvic  cavity. 

The  kidneys  appear  a  long  time  after  the  Wolffian  bodies.  They  show 
themselves  in  the  form  of  two  culs-de-sac,  constituted  by  the  upper  wall  of 


I04 


OBSTETRICAL  PHYSIOLOGY. 


the  small  vesicle  of  the  allantois.  These  small  cavities  become  ramified, 
and  are  ultimately  replaced  by  solid  tubercles,  in  whose  interior  are 
developed  the  tubuli  uriniferi  and  the  Malpighian  tufts.  According  to 
some  observers,  the  kidneys  only  subsequently  communicate  with  the 
ureters,  which  are  developed  separately  in  the  middle  lamina  of  the  blas- 
toderm, and  terminate  in  the  pelvic  portion  of  the  allantois. 

The  genital  organs  of  the  male  -xr^d.  female  offer,  at  the  commencement 
of  their  development,  the  greatest  analogies.  For  a  certain  time  it  is 
impossible  to  distinguish  the  sexes  ;  so  that  some  authorities  propose  to 
term  this  the  "  indifferent "  state  of  the  genital  organs.  Afterwards  the 
sexes  become  defined,  and  at  this  stage  the  organs  may  be  studied  as 
internal  and  external.  The  indifferent  stage  begins  about  the  sixth  week, 
when  there  appears  on  the  lower  face,  and  near  the  inner  border  of  the 
Wolffian  body,  a  small  white  cord,  which,  in  keeping  this  position,  in- 
creases in  volume.  This  is  iht  genital  gland,  which  is  fixed  to  the  body 
by  folds  of  the  serous  membrane,  and  is  composed  of  a  collection  of 
young  cells  enclosed  in  an  envelope.  The  development  of  this  gland  is 
coincident  with  the  formation  of  Muller's  duet  or  the  genital  canal,  which 
lies  inside  and  in  front  of  the  Wolffian  duct.  Miiller's  duct  is  at  first  a 
solid  cellular  column,  but  is  afterwards  hollowed  out  into  a  cavity  ;  it 
terminates  in  a  cul-de-sac  at  its  upper  extremity,  and  opens  below  into  the 
bladder,  near  the  Wolffian  duct.  From  these  modifications  of  the  genital 
gland  and  the  ducts  of  Miiller,  it  results  that  the  testicle  arises  from  the 
gland,  which  shortens  and  widens  a  little,  while  its  tissue  is  transformed 


Genitourinary  Organs  of  a  Fcetal  Sheep. 

a,  a,  Rudimentary  Kidneys  ;  b,  Ureters  ;  c,  c,  Testes  ;  d,  d.  Wolffian  Bodies ;  e,  c,  Excretory 
Ducts  of  Wolffian  Bodies  or  Sperm  Ducts ;  ^,  Oviduct  with  its  openings/",,/ 

into  the  tubuli  seminiferi^  The  head  or  globus  major  of  the  epididymus 
is  formed  by  the  middle  portion  of  the  Wolffian  body  ;  the  tail  or  globus 
minor,  the  vas  deferens,  and  the  ejaculatory  canal,  are  derived  from  the 
Wolffian  duct.  Lastly,  the  vesiculce  seminales  and  the  commcjtcement  of  the 
urethra  are  formed  by  the  posterior  extremity  of  the  ducts  of  Miiller, 
which  joins  the  urogenital  sinus — the  very  short  canal  communicating 
between  the  bladder  and  the  cloaca.  The  developed  testicle  remains  in 
the  abdominal  cavity,  maintained  there  by  a  peritoneal  fold,  the  plica 
gubernatrix ;  or  descends  by  the  inguinal  canal  into  the  scrotum.  This 
descent  is  preceded  by  the  appearance  of  a  preparatory  structure — the 
gubernaculum  testis — consisting  of  a  central  axis  of  soft  gelatinous  sub- 
stance containing  many  nucleated  cells  and  surrounded  by  fibrous  tissue, 
which  soon  exhibits  the  striped  characteristics  of  voluntary  muscle. 
Some  of  these  fibres  spring  from  the  bottom  of  the  scrotum  and  traverse 


CHANGES  IN  THE  OVUM.  105 

the  abdominal  ring,  while  others  arise  from  Poupart's  ligament :  the 
whole,  enclosed  by  connective  tissue  and  connected  by  a  fold  of  perito- 
neum to  the. psoas  muscle,  extending  to  the  testis.  This  gubernaculum, 
in  shrinking  or  contracting,  draws  the  testis  below  the  kidney  to  the 
abdominal  ring,  where  it  rests  for  a  brief  space  ;  after  which  it  reaches 
the  scrotum,  where  it  is  found  after  birth  with  the  remains  of  the  scrotal 
part  of  the  gubernaculum.  The  iliac  and  the  pubic  portions  of  the  mus- 
cular tissue  now  become  the  "  cremaster,"  muscle,  while  the  sac  of  per- 
itoneum carried  down  with  the  testicle  is  converted,  by  obliteration  of  the 
neck,  into  the  tunica  vaginalis  testis. 

In  solipeds  the  testicles  do  not  usually  descend  into  the  scrotum  until 
six  months  after  birth  ;  when  one  or  both  do  not  appear,  as  sometimes 
happens  in  the  male  domesticated  animals,  and  remain  in  the  abdominal 
cavity  during  life,  the  gubernaculum,  or  what  corresponds  to  it,  is  reduced 
to  a  small  thin  cord,  without  a  trace  of  cavity,  and  showing  only  some 
few  pale  fibres  of  the  atrophied  cremaster  muscle.  In  the  foal  they  are 
voluminous,  and  somwhat  reddish  in  color ;  they  are  occasionally  found 
in  the  scrotum  at  birth  ;  but  they  soon  ascend  into  the  abdomen,  to 
redescend  during  the  first  year.  With  some  animals,  however,  as  has 
been  already  mentioned,  and  far  more  frequently  with  the  Horse  and 
Pig  than  any  others,  the  testicles  remain  in  the  abdomen  during  life,  or 
only  one  descends  to  its  natural  situation.  When  they  remain  in  the 
abdominal  cavity,  the  animal  is  said  to  be  "  anorchid  ''  or  *'  cryptorchid  \  " 
and  it  has  been  shown  that,  although  such  animals  have  the  sexual  pro- 
pensity well  marked,  yet  they  are  unproductive  j  their  semen  does  not 
contain  any  spermatozoa. 

When  one  testicle  has  migrated  to  the  scrotum,  leaving  one  iij  the 
abdomen,  the  Horse  is  "  monorchid,"  and  possesses  the  jDower  of  repro- 
duction unimpaired. 

In  ruminants  the  testicles  are  small,  and  are  in  the  scrotum  at  birth, 
where  they  remain.  Sometimes  there  is  a  strange  malposition  of  the 
testicles,  and  especially  in  the  Pig  ;  they  having  been  found  beneath  the 
chin,  in  the  flank,  and  elsewhere. 

In  the  female,  the  ovary  is  derived  from  the  genital  gland,  whose 
anatomical  elements  are  disposed  so  as  to  form  the  stroma,  Graafian 
follicles,  and  the  ova. 

In  foetal  solipeds  the  ovary  is  of  an  immense  size,  especially  about 
the  middle  of  gestation,  and  its  stroma  is  red  and  extremely  soft.  In 
other  animals,  and  particularly  ruminants,  this  disproportion  is  not  ob- 
served. 

The  Fallopian  tube  and  its  pavilion  are  formed  by  the  anterior  portion 
of  Miiller's  duct,  the  extremity  of  which  presents  a  small  linear  orifice. 
The  uterus  and  vagifia  arise  from  the  posterior  part  of  these  ducts,  which 
approach  each  other,  and  finish  by  amalgamating  posteriorly  to  form  a 
single  canal.  This  fusion  originates  the  vagina  and  body  of  the  uterus, 
the  two  diverging  portions  of  the  ducts  comprised  between  the  point  of 
union  and  the  Fallopian  tubes  forming  the  uterine  cornui.  The  uterus 
and  vagina  are  at  first  continuous  and  without  any  sign  of  demarcation, 
but  towards  the  sixth  month  the  neck  of  the  uterus  begins  to  become 
apparent. 

The  external  organs  of  the  female  in  their  indifferent  state,  demand 
notice.  The  intestine  terminates  in  the  cloaca,  a  cavity  into  which  not 
only  this  tube  but  also  the  bladder  enters,  through  the  urogenital  sinus. 


io6 


OBSTETRICAL  PHYSIOLOGY. 


This  arrangement  ceases  somewhat  suddenly,  by  the  development  of  a 
transverse  septum  that  divides  the  cavity  into  two  portions  :  the  anal 
opening,  and  the   urogenital    orifice.     At  the  lower  end  of  the  latter 


Fig.  48. 

Female  Organs  of  a  Fcetal  Deer. 

a,  Uterus  ;  b,  b,  Comua ;  c,  c,  Oviducts ;  d,  d,  Ovaries  ;  e,  e,  Wolffian  Bodies. 

appears  the  genital  tubercle,  the  rudiment  of  the  penis  or  clitoris,  and 
which  is  surrounded  by  cutaneous  ridges — the  genital  folds .  This  tubercle 
increases  in  size,  and  is  traversed  by  a  groove  or  fissure  passing  from 
behind  forward.     Up  to  this  time  the  sexes  cannot  be  distinguished. 


i 


Fig.  49' 
Female  Fcetus  of  the  Cow  (Natural  Size). 
I,  Heart ;    2,  Lungs;    3,  Diaphragm;    4,  Kidneys:  a,  Wolffian  Body;  3,  Germinal  Gland;  c. 
Wolffian  Duct ;  d,  Miillerian  Duct ;  di,  Uterus  and  Vagina  ;  dii,  Abdominal  Opening  of  the 
Oviduct ;  f.  Clitoris  ;  g^  Round  Ligament  of  the  Uterus. 

The  male  sex  is  marked  by  the  rapid  development  of  the  genital 
tubercle,  which  becomes  the  penis,  whose  extremity  is  enlarged  to  con- 
stitute the  "glans."  The  furrow  or  groove  is  closed  behind,  and  forms 
the  urethra ;  while  the  genital  folds,  meeting  each  other  below  the  penis, 
join  to  complete  the  scrotum.  Owing  to  these  changes,  the  digestive  are 
separated  from  the  urino-genital  organs,  and  the  urethral  canal  is  con- 
nected with  the  bladder  and  the  excretory  ducts  of  the  testicle. 


CHANGES  IN  THE  OVUM. 


[07 


The  organs  in  the  female  also  soon  indicate  the  sex.  The  urogenital 
sinus  forms  the  vulvular  cavity  or  vestibule  of  the  vagina^  so  marked  in  the 
lower  animals.  The  genital  tubercle  becomes  the  clitoris — the  homo- 
logue  of  the  penis.  The  cutaneous  folds  constitute  the  labia  of  the 
vulva  ;  while  the  genital  groove  is  closed  at  one  part  of  its  extent  to 
form  \\\Q.  perifieum.  The  mammce^  appendages  of  the  generative  organs, 
appear  in  the  early  months  of  uterine  life,  and  the  teats  are  perforated 
very  soon.  They  are  also  seen  very  distinctly  in  the  male  foetus  in  the 
early  months. 

In  certain  malformations  of  the  generative  organs,  more  or  less  of 
their  primitive  conditions  are  retained  ;  the  most  frequent  of  these  mal- 
formations is  hermaphrodism.  Examples  of  this  are  by  no  means  un- 
common among  the  lower  animals,  and  the  annexed  drawing  gives  a 
good  example  of  the  organs  of  a  hermaphrodite  goat,  with  the  male  parts 
predominating.  , 

s 


I 


Fig.  so. 

Genital  Organs  of  a  Hermaphrodite  Goat,  the  Male  Parts  predominating. 

a,  a,  Testas  ;  b,  h,  Combination  of  Epididymis  with  Abdominal  Ends  of  Miillerian  Ducts  ;  d,  d, 
Vasa  Deferentia  ;  e,  Body  of  Uterus  and  Vagina ;  f,  y",  Uterine  Cornua  :  ^,  g,  Fallopian 
Tubes. 

SECTION    IV. PERIODS    OF    DEVELOPMENT. 

Thus  far  we  have  traced  the  development  of  the  young  creature  in  the 
uterus  ;  but  as  our  description  may  appear  a  little  confused  from  our 
having  described  the  growth  of  individual  organs,  rather  than  the  foetus 
as  a  whole,  it  may  be  advisable  to  adopt  the  plan  of  dividing  this  bodily 
development  into  periods,  which  will  also  give  an  approximate  idea  of 
its  age.  From  conception  to  maturity,  utero-gestation  may  therefore  be 
divided  into  seven  periods  or  stages,  as  follows : — 

First  Period. — Towards  the  second  week  after  conception,  the  ovum 
or  germ  has  passed  from  the  ovary  into  the  uterus  ;  it  is  then  about  a 
line  in  diameter  (one-twelfth  of  an  inch). 


Io8  OBSTETRICAL  PHYSIOLOGY. 

Second  Period. — In  the  third  and  fourth  weeks  of  gestation  in  the  Mare, 
Ruminants,  and  Pig  ;  the  third  week  in  Carnivora  ;  there  appear  the 
first  traces  of  the  embryo,  and  the  head,  body,  and  limbs  can  be  distin- 
guished. Towards  the  twenty-eighth  day,  the  embryo  of  the  Mare  meas- 
ures about  six  lines,  and  that  of  the  Cow  four  lines  ;  that  of  the  Sheep 
at  twenty-five  days  is  four  and  a  half  lines ;  and  the  Bitch  at  eighteen 
days  two  lines. 

Third  Period. — This  is  from  the  fifth  to  the  eighth  week  with  th^  Mare 
and  Cow  ;  the  fifth  to  the  seventh  with  the  Sheep  and  Goat ;  and  the 
fourth  to  the  sixth  with  the  Pig.  The  embryo  of  the  Mare  has  acquired 
a  length  of  rather  more  than  2  inches  ;  that  of  the  Cow  i^  inches  ;  that 
of  the  Sheep  and  Goat  i^^  inches  ;  that  of  the  Pig  i^  inches;  and 
that  of  the  Bitch  11  to  12  lines. 

Fourth  Period. — This  is  from  the  ninth  to  the  thirteenth  week  with  the 
Mare  ;  the  ninth  to  the  twelfth  with  the  Cow  ;  the  seventh  to  the  eighth 
and  ninth  with  the  Sheep  and  Goat ;  the  sixth  to  the  eighth  with  the 
Pig ;  and  the  fifth  week  with  Carnivora.  The  length  of  the  fcetus  of  the 
Mare  is  6  inches;  that  of  the  Cow  5^^  inches  ;  that  of  the  small  Rumi- 
nants 3^1^  inches  ;  that  of  the  Pig  3  inches  ;  and  that  of  the  Dog  2j^ 
inches. 

Fifth  Period. — This  extends  from  the  fourteenth  to  the  twenty-second 
week  in  the  Mare  ;  the  thirteenth  to  the  twentieth  in  the  Cow;  the  tenth 
to  the  thirteenth  in  the  Sheep  and  Goat ;  the  eighth  to  the  tenth  in  the 
Pig;  and  the  sixth  week  in  Carnivora.  At  this  stage  the  foetus  of  the 
Mare  is  about  13  inches  long  ;  that  of  the  Cow  12  inches  ;  that  of  the 
Sheep  and  Goat  6  inches ;  that  of  the  Pig  5  inches  ;  and  that  of  the 
Bitch  3^  inches. 

Sixth  Period. — From  the  twenty-third  to  the  thirty-fourth  week  in  the 
Mare  ;  the  twenty-first  to  the  thirty-second  in  the  Cow ;  the  thirteenth 
to  the  eighteenth  in  the  Sheep  and  Goat ;  the  eleventh  to  the  fifteenth 
in  the  Pig  ;  the  seventh  to  the  eighth  in  Carnivora.  The  fcetus  of  the 
Mare  in  this  period  has  acquired  a  length  of  more  than  2  feet ;  that  of 
the  Cow  is  about  the  same  dimensions  ;  the  fcetus  of  the  Sheep  is  more 
than  a  foot ;  that  of  the  Pig  about  7  inches  ;  and  that  of  the  Bitch  5 
inches. 

Seventh  Period. — From  the  thirty-fifth  to  the  forty-eighth  week — up  to 
parturition,  in  the  Mare  ;  the  thirty-third  to  the  fortieth  in  the  Cow  ;  the 
nineteenth  to  the  twenty-first  in  the  Sheep  and  Goat ;  the  fifteenth  to 
the  seventeenth  in  the  Pig  ;  the  ninth  week  in  the  Bitch ;  and  the  eighth 
in  the  Cat. 

A  newly-born  foal  measures  about  3^  feet  long  ;  a  calf  2  feet ;  a  lamb 
i^  feet ;  a  pig  about  9  or  10  inches  ;  a  puppy  6  to  8  inches  ;  and  a 
kitten  about  5  inches. 

In  this  study  of  the  evolution  of  the  young  animal  in  utero,  one  cannot 
fail  to  be  struck  with  the  slowness  with  which  development  progresses 
for  a  certain  period,  and  its  rapidity  afterwards.  The  slowness  in  growth 
may  be  accounted  for  by  the  extreme  minuteness  of  the  ovum  at  the 
moment  of  impregnation,  and  its  containing  within  itself  alone  the  ele- 
ments upon  which  the  primary  steps  of  evolution  depend,  there  being  at 
first  no  direct  connection  between  the  embryo  and  the  uterine  vessels. 
The  parts  which  in  reality  grow  most  rapidly  in  the  early  period  of  ges- 
tation, are  the  enveloping  membranes  and  the  fluids  they  contain.     In 


CHANGES  IN  THE  OVUM.  109 

the  Sheep,  towards  the  end  of  the  first  quarter  of  gestation,  the  mem- 
branes alone  weigh  from  five  to  nine  times  more  than  the  fcetus ;  while 
the  allantoic  and  amniotic  fluids  are  from  eight  to  ten  times  as  heavy. 
These  fluids  increase  in  an  absolute  manner  from  the  commencement, 
until  within  perhaps  a  short  time  of  parturition.  Rapid  at  first,  towards 
the  middle  period  their  secretion  abates,  and  then  begins  the  more  active 
development  of  the  foetus,  with  a  relative  diminution  in  the  proportion 
of  the  fluids  ;  until  about  the  end  of  the  fourth  month  they  only  repre- 
sent something  like  a  third  of  the  weight  of  the  fcetus.  In  the  Sheep  a 
few  days  after  the  fifth  month,  or  about  birth  time,  they  are  a  sixth  of 
the  weight  of  the  young  animal. 

The  development  of  the  foetus  is  so  tardy  at  first,  that  the  foetal  lamb 
at  the  fortieth  day  has  scarcely  acquired  the  300th  part  of  the  weight  it 
has  at  birth  ;  at  two  months  it  has  only  a  60th,  but  now  it  grows  more 
rapidly  ;  so  that  at  the  expiration  of  the  fourth  month,  the  foetus  has 
gained  more  than  one-third  of  its  total  weight.* 

The  inequality  of  the  growth  of  the  different  organs  is  also  very  no- 
table ;  those  whose  functions  are  most  required,  such  as  the  nervous 
centres,  liver,  etc.,  attaining  considerable  proportions  very  quickly.  The 
brain,  for  instance,  soon  acquires  a  marked  predominance  over  the  other 
organs.  In  the  fcetus  of  the  lamb  at  the  fifty-seventh  day,  the  proportion 
of  the  entire  brain  to  that  of  the  body  in  weight  is  as  i  to  15  ;  at  the 
seventieth  day  it  is  as  i  to  55  ;  and  at  birth  as  i  to  65.  At  mid-term 
with  the  calf,  its  weight  is  to  that  of  the  body  as  i  to  53,  and  at  birth  as 
I  to  120. 

The  spinal  cord  does  not  follow  the  same  progression  in  growth.  In 
the  calf  at  mid-term  it  is  only  the  421st  part  of  the  weight  of  the  foetus, 
and  at  birth  the  470th  part.  In  the  lamb  at  birth,  it  is  equal  to  the  340th 
part  of  the  body. 

The  heart,  which  appears  so  early,  is  more  voluminous  in  the  embryo 
than  towards  the  termination  of  gestation  and  after  birth.  The  heart  of 
a  calf  at  mid-term  equals  125th  of  the  weight  of  the  body ;  that  of  a  lamb 
at  birth  the  120th  ;  in  the  adult  bull  it  is  only  the  264th  part. 

The  lungs  have,  relative  to  the  total  bulk  of  the  foetus,  a  variable  weight 
according  to  age.  In  those  of  the  Sheep  at  fifty- seven  days,  they  are 
equal  to  a  20th  part  of  the  weight ;  in  a  calf  at  mid-term,  the  33d  ;  in 
another  at  eight  months,  the  34th  ;  and  at  birth,  the  35th  and  55th  ;  in  a 
foal  a  little  more  than  eight  and  a  half  months,  they  were  the  33d  ;  in 
lambs  and  goats  at  birth,  they  averaged  from  the  24th  to  the  6ist  part  of 
the  w^hole  weight. 

The  development  of  the  thymus  gland  also  varies  considerably  accord- 
ing to  age  and  species.  In  a  calf  at  mid-term,  its  weight  was  the  137th 
part  of  the  body  ;  in  another  at  seven  months,  it  was  the  197th  ;  in  a 
foal  at  birth,  the  200th;  in  a  goat  at  the  same  period,  the  130th  ;  and  in 
a  lamb  eight  days  after  birth,  the  228th  part.  It  is  always  proportion- 
ally more  voluminous  in  ruminants  than  solipeds,  and  in  them  and  the 
Pig  it  extends  in  front  nearly  to  the  larynx.  In  the  Dog  it  does  not  get 
beyond  the  anterior  mediastinum,  and  is  small,  though  more  persistent. 
It  has  in  rare  cases  been  found  in  Horses  more  than  three  years  old,  but 
as  a  rule  in  the  adult  animal  it  is  only  represented  by  a  small  and  vari- 
able quantity  of  adipose  tissue. 

The  liver  is  extremely  voluminous  in  the  early  period  of  the  embryonic 
and  foetal  life,  but  decreases  proportionately  as  gestation  approaches  its 


no  OBSTETRICAL  PHYSIOLOGY. 

close.  In  the  foetus  of  a  lamb  at  the  fifty-seventh  day  it  has  been  found 
equal  to  i-6th  of  the  body  in  weight ;  in  calves  at  mid-term  and  birth 
to  i-29th  ;  with  the  foal  at  birth  1-2 ist,  and  i-24th  in  lambs  at  the  same 
period.  In  the  adult  horse  it  has  been  found  to  represent  i-75th  of  the 
total  weight,  and  i-83d  in  the  ox. 

The  intestines,  during  fcetal  life,  do  not  grow  in  length  so  as  to  attain 
the  proportionate  dimensions  they  offer  in  adult  life.  In  an  equine  foetus 
of  eight  or  nine  months,  the  small  intestines  measured  about  15  feet,  the 
caecum  6  7-10  inches,  and  the  large  intestines  3)^  feet,  or  a  total  of 
about  20  feet :  about  i-5th  of  their  length  in  after  life.  Shortly  after 
birth  they  acquire  i-3d  the  length  to  which  they  attain  when  fully  devel- 
oped. The  calf  at  mid-term  has  only  i-ioth  the  length  of  the  adult 
intestine  :  being  only  sixteen  times  the  length  of  the  body,  instead  of 
twenty  times.  The  lamb  and  kid  at  birth  have  i-3d  of  their  intestines 
complete  :  their  length  is  seventeen  to  eighteen  times  the  length  of  the 
body,  instead  of  twenty-seven  times  in  adult  life 

The  general  proportions  of  the  body,  and  especially  those  of  the  skel- 
eton, are  not  in  foetal  life  what  they  are  after  birth.  The  bones  are, 
relatively  to  the  other  parts,  more  voluminous  as  a  whole,  and  notably  at 
their  extremities,  than  in  the  adult.  The  limbs  in  particular,  and  this 
more  so  in  solipeds  and  ruminants,  have  attained  a  length  which  is  not 
at  all  proportionate  to  that  of  these  parts  when  their  growth  is  completed. 
And  several  bones  of  the  limbs,  such  as  the  radial,  tibial,  metacarpal, 
and  metatarsal  bones,  are  almost  fully  developed  in  their  dimensions  at 
birth.  The  following  interesting  table  exhibits  the  comparative  weight 
of  the  different  bones  in  the  foal  and  the  adult  horse. 

The  weight  is  given  in  grammes  (15*432  troy  grains). 


Species. 

1 

1 

£ 

■rt 

11 

1 

I 

3 

i 

i 

3 

i 

g 

i 

i 

i 

s 

2 

iS 

h 
11 

u 

M 

J 

m 

m 

^ 

P4 

CJ 

^ 

■A 

0 

1X4 

h 

H 

>i 

u 

grs. 

grs. 

grs. 

grs. 

grs. 

grs. 

grs. 

1 

grs.;  grs. 

grs. 

grs. 

grs. 

grs. 

grs. 

grs. 

grs. 

315 
370 

390 

35° 

no 

135 

383 
"26 

I9S 
190 
159 

t88 

243 
250 
224 

59 
40 

238 
240 

2l8 

139 
131 

227 
245 

232 
254 
223 

?6? 

(S6 

271 
275 
255 

17 
173 

Foal  at  Birth 

205 
170 

-•Ro 

6-> 

Foal  two  days  old 



246 

3/0 

3x0 

36 

45 

240 

170 

450 

390 

360 

7° 

280 

180 

SECTION    v. PHYSIOLOGICAL    PHENOMENA    IN    THE    FCETUS. 

With  regard  to  the  physiological  phenomena  which  occur  during  foetal 
life,  we  cannot  presume  to  speak  in  detail  in  this  place.  It  is,  however, 
interesting,  and  perhaps  necessary,  to  allude  briefly  to  several  of  the 
most  important,  in  order  to  complete  this  portion  of  our  subject. 


Nervous  Functions. 

The  development  of  the  nervous  functions  is  one  of  these  phenomena 
worthy   of  attention.     It  appears    certain    that   the    young   creature  is 


CHANGES  IN  THE  OVUM.  m 

formed  and  developed  without  the  direct  intervention  of  the  nervous 
influence  of  the  parent,  as  there  is  no  communication  between  the  nerves 
of  the  uterus  and  the  foetal  envelopes  ;  and  it  has  not  been  shown  that 
there  are  nerves  either  in  the  latter  or  yet  in  the  umbilical  cord.  The 
progressive  animation  of  the  new  creature  cannot,  therefore,  be  derived 
from  immediate  nervous  propagation  or  direct  extension  of  the  nervous 
activity  from  the  mother  to  its  offspring  ;  and  we  must  look  upon  this 
animation  as  originating  in  the  embryo,  and  becoming  developed  under 
the  influence  of  inappreciable  causes.  At  the  very  commencement  of 
embryonic  life,  the  nervous  system,  which,  in  extra-uterine  existence, 
holds  under  its  control  the  organic  functions,  appears  now  to  have  no 
possible  influence  on  the  phenomena  that  gradually  manifest  themselves. 
The  primary  changes  in  the  ovum  ocdur  before  the  earliest  traces  of  the 
nervous  system  are  apparent ;  .and  while  its  rudiments  are  forming,  those 
of  other  parts  are  also  being  developed.  Even  when  the  nervous  system 
has  attained  a  somewhat  considerable  growth,  it  does  not  appear  to  have 
assumed  those  controlling  powers  with  which  it  is  so  largely  endowed  at 
a  subsequent  period. 

In  the  homogeneous  plasma  of  the  ovum,  in  the  common  blastema, 
coincidently  or  successively,  a  multitude  of  different  parts  are  being 
formed  independently  of  each  other,  as  if  each  contained  within  itself  the 
why  and  wherefore  of  its  formation  and  ulterior  perfecting.  The  nerv- 
ous system  itself  seems  to  be  submitted  to  the  same  general  laws :  it 
does  not  appear  to  be  dependent  upon  any  other  part,  neither  does  any 
part  depend  upon  it  ;.even  when  it  is  fully  formed,  the  phenomena  per- 
taining to  growth  are  evidently  effected  without  its  stimulating  interven- 
tion. Besides,  it  is  well  known  that  the  monstrosities  which  are  some- 
times seen  destitute  of  brain  and  spinal  cord,  may  yet  reach  the  end  of 
their  fcetal  development.  True,  certain  facts  have  appeared  to  de- 
monstrate that  the  formation  of  parts  was  dependent  on  nervous  action. 
In  certain  monstrosities,  organs  have  not  become  developed  when  the 
nerves  which  should  have  been  distributed  to  them  were  absent;  in 
others,  several  organs  have  become  fused  together  when  their  nerves 
were  similarly  aggregated  \  while  an  organ  has  been  divided  into  frac- 
tions corresponding  to  the  accidental  development  of  its  nerve.  The 
muscles  of  the  posterior  part  of  the  body  of  the  foetus  of  the  Cow  and 
Pig  have  been  observed  to  be  absent  when  the  corresponding  portion  of 
the  spinal  cord  was,  with  its  nerves,  very  imperfectly  developed.  But 
these  facts  do  not  prove  that  the  absence  of  the  nerves  was  the  cause  of 
the  non-development  of  the  muscles  ;  for  in  such  cases  there  is  a  correla- 
tion between  the  non-formation  of  the  nerve  and  the  absence  of  the 
muscle  ;  the  same  cause  which  has  hindered  the  formation  of  the  one  in  a 
certain  part  of  the  body  has  also  prevented  the  growth  of  the  other  in 
that  part.  And  the  same,  to  a  certain  point,  with  the  relative  develop- 
ment of  vessels  and  the  increase  of  the  parts  to  which  they  are  distrib- 
uted. In  the  original  homogeneous  plasma,  there  were  developed  the 
diverse  elements  of  an  organ  at  the  same  time  as  its  vessels,  and  the 
force  which  created  the  connective,  nervous,  and  muscular  tissues,  crea- 
ted also  the  elements  of  the  vessels — arteries,  veins,  and  capillaries  : 
they  are  closely  related  to  each  other,  and  their  growth  goes  on  concur- 
rently. If  the  vessels  do  not  carry  a  sufficient  supply  of  formative  mate- 
rial, the  development  of  the  part  is  tardy  or  ceases  ;  and,  on  the  other 
hand,  if  the  latter  from  some  cause  becomes  feeble  and  cannot  assimilate 


112  OBSTETRICAL  PHYSIOLOGY. 

this  material,  tlie  vessels  gradually  cease  to  carry  it  -,  consequently  both 
become  atrophied  when  they  cease  to  grow. 

When  the  nervous  system  has  arrived  at  a  certain  degree  of  develop- 
ment, it  begins  to  assume  its  functions  ;  though  the  first  manifestations 
of  its  activity  are  very  obscure,  and  probably  limited  to  mere  tactile  im- 
pressions, evinced  by  movements  more  or  less  appreciable.  It  is  well 
known  that  in  the  pregnant  Mare  and  Cow,  after  their  ingestion  of  a 
large  quantity,  of  cold  water,  the  foetus,  towards  the  end  of  the  second  third 
of  gestation,  and  more  particularly  in  the  later  months,  executes  move- 
ments which  are  at  times  so  marked  that  they  can  be  felt  if  the  hand  is 
applied  to  the  abdominal  parietes,  or  even  seen  in  the  region  of  the 
flank.  It  is  very  probable  that  these  automatic  or  reflex  movements  may 
produce  torsion  of  the  umbilical  cord,  and  in  this  way  become  a  predis- 
posing cause  of  abortion.  Colin,  having  had  occasion  to  lay  open  the 
abdomen  of  a  living  pregnant  Mare  within  two  or  three  months  of  par- 
turition, saw  the  foetus,  immediately  after  the  incision  in  the  abdominal 
walls,  jumping  about  in  the  uterus  in  a  very  lively  manner  without  any 
external  stimulus  being  applied  ;  it  moved  the  whole  of  its  body,  or  with- 
drew its  legs  or  head  when  pinched  through  the  uterus  and  the  envel- 
opes. In  a  quarter  of  an  hour  after  removal  from  these  and  the  mother, 
it  no  longer  moved.  The  human  foetus  at  five  months  has  been  seen  to 
flex  and  extend  its  limbs  when  removed  from  the  uterus. 

Towards  the  termination  of  gestation,  there  can  be  no  doubt  that  the 
fcetal  movements  are  somewhat  energetic,  for  at  this  period  the  foetus 
changes  its  position  preparatory  to  passing  through  the  pelvis.  Thus 
the  young  soliped,  during  the  whole  of  its  intra-uterine  existence,  lay 
with  its  abdomen  turned  upwards  and  the  posterior  limbs  lodged  in  the 
largest  of  the  two  cornua  ;  but  it  now  turns  over  on  its  belly,  with  the 
legs  downwards,  and  the   umbilical  cord  passing  across  one  of  its  sides. 

The  movements  connected  with  deglutition  also  appear  to  be  performed 
at  an  early  stage  of  development,  for  some  of  the  hairs  which  are  so 
often  observed  in  notable  quantity  floating  in  the  amniotic  fluid,  have 
been  discovered  in  the  foetal  stomach. 

Absorption. 

The  phenomena  of  absorption  play  a  considerable  part  in  the  develop- 
ment of  the  young  animal.  As  soon  as  the  microscopic  ovule  reaches  the 
uterus,  its  vitelline  envelope  or  pellucid  zone  becomes  studded  with  deli- 
cate, hair-like  prolongations — villosities  without  vessels — which,  steeped 
in  the  fluid  thrown  out  on  the  uterine  surface,  transmit  this  to  the  laminae 
of  the  blastoderm.  At  first  this  absorbent  surface  is  very  small,  and  the 
growth  of  the  embryo  is  consequently  slow  ;  nevertheless,  this  trifling 
absorption  is  sufficient  to  increase. the  ovule  to  forty  or  fifty  times  its 
original  volume  before  the  blastodermic  laminae  and  the  germinative 
space  are  completed. 

Later,  when  the  umbilical  vesicle  is  formed  at  the  expense  of  the  vas- 
cular and  mucous  laminae,  its  vessels  absorb  the  soluble  matters  that 
are  added  to  the  mass  of  elements  necessary  for  the  growth  of  the  em- 
bryo. And,  finally,  when  the  chorion  is  at  last  organized,  and  furnished 
with  its  myriads  of  vascular  papillae  in  the  form  of  disseminated  or  ag- 
glomerated placentulae,  absorption  goes  on  with  exaggerated  activity  over 
the  whole  uterine  surface  and  texture,  in  order  to  supply  all  the  nutrition 
required  for  the  now  rapid  development  of  the  foetus. 


CHANGES  IN  THE  OVUM.  113 

The  nutritive  elements  are  absorbed  by  the  vessels  of  the  placental 
villosities,  transformed  into  blood,  and  conveyed  to  the  young  creature 
by  the  umbilical  veins.  The  extra-fcetal  absorption  is  supplemented  by 
that  which  is  taking  place  in  the  fluid  of  the  envelopes,  and  also  in  the 
organs  and  tissues  of  the  foetus  itself.  It  is  certain,  however,  that  the 
placental  absorption  is  by  far  the  most  important,  and  that  the  rapid 
development  of  the  fcetus  is  mainly,  if  not  altogether,  due  to  the  nutritive 
elements  obtained  there  ;  while  it  is  not  improbable  that  the  amniotic 
fluid  found  in  the  stomach  and  intestines  may  act  as  a  dilator  of  these, 
modify  the  action  of  the  bile  accumulated  in  the  latter,  and  perhaps  yield 
a  small  amount  of  nutriment :  though  it  must  be  remembered  that  it 
does  contain  much  of  the  nutritious  elements,  and  that  the  foetus,  which 
is  unprovided  with  a  mouth,  and  therefore  cannot  swallow,  is  neverthe- 
less as  well  developed  as  one  that  does  ingest  this  fluid. 

Nutritioji. 

It  has  been  shown  that  the  foetal  vascular  system  is  quite  distinct  from 
that  of  the  mother,  the  isolation  of  the  two  systems  being  .complete,  and 
only  brought  into  contact  at  the  placenta  or  placentulae.  There  the  mater- 
nal blood  is  conveyed  by  certain  arteries  into  particular  sinuses  or  recep- 
tacles of  the  uterus  containing  the  ultimate  radicles  of  these  vessels,  which 
emerge  into  veins ;  while  the  foetal  vessels,  extremely  attenuated,  dip 
down  into  these  receptacles,  and  are  bathed  in  the  blood  of  the  parent,  as 
the  "  gills  "  or  branchiae  of  aquatic  creatures  are  in  the  water  in  which 
they  live.  But  the  actual  blood  of  parent  and  offspring  never  meet :  they 
are  only  brought  into  indirect  contact ;  and  between  them  are  the  thin 
coats  of  vessels,  basement  membranes,  and  cells.  This  indirect  contact 
is  sufficient  to  permit  the  venous  foetal  blood  to  become  arterial,  by  en- 
abling it  to  part  with  its  carbonic  acid,  and  also  to  get  rid  of  excrementi- 
tious  matter  derived  from  the  different  processes  connected  with  the 
growth  of  the  foetus,  and  whose  retention  in  the  blood  of  the  young  crea- 
ture would  doubtless  be  a  source  of  injury  to  it.  This  arrangement  of 
the  two  systems  of  vessels  also,  as  has  just  been  said,  allows  certain  nu- 
tritious elements  of  the  maternal  blood — its  fluid  portion  only — to  be 
taken  up  into  the  system  of  the  foetus.  In  this  way,  as  has  been  pointed 
out,  these  vascular  rootlets  of  the  placenta  closely  correspond  to  the  villi 
of  the  mucous  membrane  of  the  intestines  ;  and  the  analogy  is  rendered 
more  complete  when  we  know  that  the  nutrient  material  is  selected  and 
prepared  by  two  sets  of  cells,  one  of  which — the  maternal — transmits  it  to 
the  other — the  fcetal — in  the  same  manner  as  the  epithelial  cells  of  the 
intestinal  villi  seem  to  take  up  and  prepare  the  nutrient  matter  that  is 
destined  to  be  again  assimilated  by  the  cells  which  float  in  the  circula- 
ting fluid.  No  other  communication  between  the  two  vascular  systems 
exists  ;  and  the  fact  that  the  blood  corpuscles  of  each  are  diflferent  in 
size,  conclusively  demonstrates  that  they  must  be  distinct.  Nevertheless, 
the  special  function  of  the  placenta,  and  the  intimate  relation  existing, 
through  it,  between  the  fluids  of  parent  and  offspring,  renders  it  evident 
that  the  maternal  blood  may  become  impregnated  with  substances,  or 
impressed  with  attributes,  which  will  affect  the  development  or  modify  the 
constitution  of  the  fcetus  ;  while  pernicious  matters  generated  in  the  latter, 
may  prove  more  or  less  noxious  to  the  mother. 

8 


114  OBSTETRICAL  PHYSIOLOGY. 

Ciradation. 

In  order  that  the  nutritive  matters  absorbed  by  the  placental  villi  may 
reach  the  foetus  and  be  circulated  in  its  body,  it  is  necessary  that  a  deter- 
mining and  regulating  power  should  be  brought  into  play  at  an  early  period 
in  the  existence  of  the  foetus.  This  power  appears  with  the  formation  of 
the  contractile  organ  which  has  been  named  the  heart.  From  the  mo- 
ment when  this  important  organ  appears  in  the  form  of  a  cylindrical  tube 
at  the  commencement  of  embryonic  life,  it  dilates  and  contracts  alter- 
nately, first  to  receive  the  venous  blood,  and  then  to  propel  it  into  the 
arteries. 

The  fluid  which  is  at  first  received  and  propelled  by  the  heart  is  trans- 
parent, colorless,  and  destitute  of  morphological  elements,  and  the  organ 
itself  exists  in  its  most  primitive  form.  As  has  been  stated,  the  situation 
of  the  heart  and  the  course  of  the  principal  trunks  of  the  vascular  area, 
are  early  visible,  and  are  marked  by  the  peculiar  disposition  of  the  aggre- 
gations of  cells  from  which  these  organs  are  to  be  developed.  It  was 
shown  that  whilst  the  outer  portions  of  these  aggregations  were  trans- 
formed into  the  walls  of  the  respective  cavities,  the  inner  portions  ap- 
peared to  deliquesce,  and  partly  to  remain  as  isolated  cells  floating  in  the 
resulting  fluid.  These  isolated  cells  are  supposed  to  be  the  first  blood 
corpuscles.  They  are  large,  colorless,  vesicular,  spherical  cells,  full  of 
yellowish  particles  of  a  substance  like  fatty  matter.  Many  of  these  parti- 
cles are  quadrangular  and  flattened,  and  have  been  called  stearine-plates, 
though  their  composition  is  not  ascertained  ;  each  cell  has  a  central  nu- 
cleus, which  is  not  at  first  very  distinct,  and  the  development  of  these 
embryo-cells  into  the  complete  form  of  corpuscles  is  effected  by  the  grad- 
ual clearing-up,  as  if  by  division  and  liquefaction,  of  the  contained  particles, 
the  acquirement  of  blood  color  and  of  the  elliptical  form,  the  flattening 
of  the  cell,  and  the  more  prominent  appearance  of  the  nucleus. 

In  tracing  the  development  of  the  red-corpuscles  of  the  blood,  it  is  found 
that  at  first  their  nuclei  have  no  envelope,  but  contain  nucleoli ;  that  they 
present  all  the  characters  of  pale  elementary  cells,  w^hilst  they  are  so  nu- 
merous as  to  give  the  blood  a  whitish  hue.  When  more  fully  developed 
they  acquire  a  cell  and  a  reddish  tint,  and  at  a  later  stage  are  circular, 
thick,  and  disc-shaped,  full-colored,  and  about  1-2 500th  part  of  an  inch 
in  diameter  ;  their  nuclei  are  central,  circular,  very  little  prominent  on 
the  surface  of  the  cell,  and  apparently  slightly  granular  or  tuberculated. 

When  the  liver  begins  to  be  formed,  the  multiplication  of  blood-cells  in 
the  entire  mass  of  the  blood  ceases,  and  in  a  short  time  all  trace  of  the 
development  of  the  red  from  the  original  colorless  formative  cells  is  lost, 
whilst,  on  the  other  hand,  there  takes  place  in  the  vessels  of  the  liver  a 
new  production  of  colorless  nucleated  cells,  which  are  formed  around 
free  nuclei,  and  which  undergo  a  gradual  change,  by  the  production  of 
coloring  matter  in  their  interior,  into  red  nucleated  cells.  This  new  for- 
mation of  blood  corpuscles  in  the  liver  continues  to  take  place  during  the 
whole  period  of  foetal  life  ;  but  whether  these  nucleated  cells  themselves 
undergo  transformation  into  the  non-nucleated  discs  which  constitute  a 
gradually  increasing  proportion  of  the  corpuscular  components  of  the 
blood  during  the  latter  period  of  embryonic  life,  or  whether  these  are 
formed  only  by  the  metamorphosis  of  lymph-corpuscles,  has  not  yet  been- 
determined. 

From  the  manner  in  which  the  circulation  is  carried  on   during  foetal 


CHANGES  IN  THE  O  VUM.  i  j  5 

life,  and  which  has  been  adverted  to,  it  is  seen  that  the  chief  propelling 
power  is  centred  in  the  right  side  of  the  heart ;  the  force  of  the  left  heart 
being  mainly  spent  in  effecting  a  due  supply  of  blood  to  the  head  and 
upper  extremities.  And  the  structure  of  the  heart  proves  this  to  be  the 
case,  for  the  walls  of  the  right  ventricle  have  been  found  as  thick  as  those 
of  the  left ;  while  the  walls  of  die  right  auricle  are  even  thicker  and  more 
muscular  than  those  of  the  left  auricle  :  a  condition  which  persists  for  a 
short  time  after  birth. 

The  isolation  that  exists  in  the  two  circulatory  systems,  might  lead  to 
the  inference  that  there  was  no  relation  between  the  contractions  of  the 
heart  in  the  foetus  and  those  of  the  maternal  organ,  and  experience  proves 
this  to  be  the  case.  Naegele  has  noted  that  there  is  no  relation  between 
the  beats  of  the  heart  of  the  human  foetus  and  those  of  its  mother's  heart. 
By  auscultation  he  was  able  to  distinguish  the  two  sounds  of  the  foetal 
heart,  and  found  it  beat  on  an  average  135  times  per  minute  :  never  more 
than  180,  nor  less  than  90;  and  he  remarked  that  the  beats  were  sensi- 
bly the  same  from  four  and  a  half  months,  when  they  are  first  perceptible, 
until  birth.  And  Hollmann,  in  resorting  to  the  same  mode  of  investigation 
in  Cows,  ascertained  that,  in  one  which  was  advanced  eight  and  a  half 
months  in  pregnancy,  and  whose  pulse  was  64  per  minute,  the  foetal  beat 
was  124  ;  in  another  Cow,  but  which  was  ill,  the  pulse  was  from  70  to 
112,  while  that  of  the  foetus  was  113  to  128. 

Colin  opened  a  living  Mare  which  had  been  pregnant  for  nine  or  ten 
months,  and  a  Cow  whose  gestation  dated  about  three  months.  When 
the  uterus  of  the  Mare  was  opened,  and  the  contained  envelopes  incised 
to  extract  the  foetus,  the  latter  moved  actively  and  respired  deeply,  though 
at  rare  intervals.  The  umbilical  arteries  and  vein  yielded  some  blood, 
from  the  small  punctures  made  through  their  walls  ;  the  first  throbbed 
with  a  certain  amount  of  force,  and  the  pulsations  were  rapid.  When  the 
cord  was  divided  and  tied,  the  foetus  appeared  to  be  dead  :  there  were  no 
more  spontaneous  movements,  and  the  respiration  had  ceased.  The  tho- 
rax and  the  abdomen  were  now  thrown  open,  and  it  was  observed  that 
the  heart  contracted  spontaneously  arid  strongly,  and  the  pulsations  of 
the  aorta  and  umbilical  arteries  could  be  very  distinctly  felt.  At  first  the 
contractions  of  the  auricles  regularly  alternated  with  those  of  the  ventri- 
cles, as  in  a  normal  condition  ;  but  soon,  as  occurs  in  expiring  animals, 
the  auricles  contracted  several  times  for  one  contraction  of  the  ventricles, 
as  if  it  required  several  systoles  of  these  to  fill  the  ventricular  cavities. 
At  each  contraction  the  auricles  diminished  much  in  volume,  became 
nearly  empty,  and  looked  very  pale,  but  assumed  their  reddish-violet 
color  again  during  their  diastole.  At  last  the  rhythmical  movements  be- 
came altogether  perverted  ;  the  auricles  and  ventricles  contracted  simul- 
taneously and  quickly,  but  more  and  more  feebly,  and  finally  ceased  alto- 
gether half  an  hour  after  the  thorax  had  been  opened.  The  Cow  in 
which  the  foetal  circulation  was  studied,  had  its  flank  wddely  incised,  and 
one  of  the  cornua  of  the  uterus  withdrawn  through  the  opening.  Some 
of  the  placentulae  were  removed  with  difficulty  from  their  cotyledons,  and 
both  bled  a  good  deal.  When  the  umbilical  cord  was  exposed,  the  beat- 
ing of  its  very  tense  arteries  could  be  distinctly  felt ;  and  when  com- 
pressed, these  enlarged  between  the  foetus  and  the  point  where  the  pres- 
sure was  applied.  On  removing  the  foetus  from  the  uterus,  it  did  not 
make  any  perceptible  movement,  but  then  it  was  only  three  or  four 
months  old.     The  thorax  having  been   opened,  the   action  of  the  heart 


Ii6  OBSTETRICAL   PHYSIOLOGY. 

was  observed  to  resemble  that  of  the  other  foetus  ;  there  were  31  pulsa- 
tions in  the  first  minute,  18  in  the  third,  11  in  the  fourth,  and  21  in  the 
fifth.  The  beats  ceased  in  about  twenty-five  minutes.  In  these  two  ex- 
periments, as  well  as  in  others  made  on  smaller  animals,  M.  Colin  found 
it  impossible  to  perceive  any  difference  in  color  between  the  blood  of  the 
umbilical  arteries  and  that  of  the  veins,  both  fluids  showing  a  tint  inter- 
mediate to  that  of  the  arterial  and  venous  blood  of  the  adult. 

Secret  io7i. 

With  regard  to  secretiofi  in  the  fcetus,  it  is  worthy  of  remark  that  several 
glandular  structures  at  an  early  period  and  during  foetal  life  exhibit  a  re- 
markable degree  of  activity;  and  more  especially  is  this  the  case  with 
those  of  the  stomach  and  intestines,  the  liver,  the  mucous  membrane  of 
the  air-passages,  and  the  kidneys.  The  glands  of  the  mouth  and  oesopha- 
gus only  furnish  the  mucus  that  covers  the  membrane  lining  these  parts, 
but  it  is  not  long  before  the  stomach  is  filled  with  a  white  or  colorless 
viscid  fluid,  in  which  is  a  large  proportion  of  epithelial  cells  and  nuclei. 
Colin  has  found  as  much  as  229  grammes  of  this  fluid  in  the  stomach  of 
a  foal  at  birth,  from  150  to  180  in  lambs  at  the  same  period,  200  to  300 
in  calves  towards  the  middle  of  gestation,  and  500  to  600  in  those  at 
birth.  It  is  neutral  or  slightly  alkaline,  and  contains,  more  especially  in 
the  foetuses  of  solipeds  and  ruminants,  a  very  large  proportion  of  sugar, 
with  mucine  and  salts.  This  fluid  can  scarcely,  however,  be  looked  upon 
as  a  gastric  secretion,  but  rather  as  a  mixture  of  this  with  the  amniotic 
liquid  swallowed  by  the  fcetus  ;  and  it  appears  certain  that  though  the 
mucous  glands  are  active,  yet  that  those  which  elaborate  the  pepsine  are 
inactive.  The  stomach  of  a  foetal  calf  twenty  weeks  old,  digested  for 
eight  days  in  milk  at  a  temperature  of  20  degrees  (Cent.),  transformed 
that  fluid  into  a  gelatinous  mass,  but  did  not  coagulate  it. 

The  secretory  function  of  the  pancreas  is  so  obscure,  that  it  has  not 
yet  been  determined. 

The  biliary  secretion  soon  appears,  and  is  remarkably  abundant.  In 
the  foetus  of  the  Cow  at  birth,  a  small  quantity  of  clear  bile  having  a 
slight  greenish  tint  is  found  in  the  gall-bladder ;  and  at  the  fourth  month 
of  gestation,  the  large  intestines  of  this  creature  and  the  foetus  of  solipeds 
are  filled  with  meconium,  which  is  recognizable  through  the  walls  of  the 
tube  by  its  green  hue.  The  foetal  bile  becomes  thicker  and  deeper-col- 
ored as  birth  approaches  ;  it  is  insipid  and  alkaline.  M.  Lassaigne  ana- 
lysed that  of  the  foetus  of  a  Cow  six  months  old,  and  found  two  coloring 
matters,  mucus,  the  carbonate  and  chloride  of  sodium  and  phosphate  of 
lime,  but  no  picromel. 

Mixed  with  the  fluids  thrown  out  by  the  intestines  and  the  other  mat- 
ters entering  them,  it  forms  the  meconium,  which  is  composed,  according 
to  Simon,  of  cholesterine  16,00  ;  extractive  matter  and  biliary  resin  10,40  ; 
caseous  matter  34,00  ;  picromel  6,00  ;  green  coloring  matter,  4,00  ;  and 
epithelium,  mucus,  albumen  26,00.  This  meconium  is  scanty  in  the  first 
periods  of  foetal  life,  and  has  been  found  to  be  white  in  foetuses  destitute 
of  a  liver,  as  well  as  in  others  whose  intestine  was  obliterated  below  the  en- 
trance of  the  biliary  duct.  It  is  very  consistent  and  plentiful  in  the  in- 
testines at  birth.  In  those  of  a  foal  whose  stomach  contained  229 
grammes  weight  of  the  white  viscid  fluid  above  mentioned,  there  was 
found  216  grammes  of  greyish  meconium  in  the  small  intestines,  and  559 
of  green  in  the  large  intestines.     This  product  is  frequently  expelled  in 


CHANGES  IN  THE  OVUM. 


117 


certain  quantities  towards  the  end  of  gestation,  and  is  found  in  the  liquor 
amnii,  which  owes  its  yellow  color  to  its  presence  ;  it  is  swallowed  with 
this  fluid,  and  is  then  observed  in  small  masses  in  the  stomach. 

The  liver  appears  to  be  engaged,  during  foetal  life,  in  the  depuration 
of  the  blood,  as  appears  from  this  accumulation  of  meconium,  which  is 
chiefly  altered  bile  ;  but  at  the  same  time,  as  has  been  stated,  it  is  serv- 
ing as  a  blood-making  organ,  and  this  is  probably  its  principal  function 
before  birth. 

The  secretion  of  urine  is  somewhat  active  during  intra-uterine  life,  and 
appears  to  be  effected  by  the  Wolffian  bodies  before  the  kidneys  begin  to 
act.  It  is  not,  however,  until  the  end  of  gestation  that  a  notable  quantity 
of  urine  is  found  in  the  bladder,  and  urea  in  the  allantoic  fluid  of  the 
Cow.  It  is  certain,  however,  that  this  fluid  is  not  altogether  the  urine 
of  the  foetus,  as  its  proportion  is  relatively  larger  at  an  early  epoch  of 
foetal  life,  and  the  communication  between  the  bladder  and  allantois  is 
more  limited  towards  parturition. 

With  regard  to  the  function  of  the  thyroid  and  thymus  "  glands,"  as 
they  have  been  termed,  and  the  spleen  and  supra-renal  capsules,  during 
foetal  life,  there  is  but  little  positively  known.  It  appears,  however,  to  be 
admitted  that  the  office  performed  by  these  ductless  or  vascular  glands, 
is  to  restore  to  the  circulating  current  any  substances  which  they  may 
withdraw  from  it,  and  that  their  action  is  subsidiary  to  the  process  of 
sanguification  \  being  exercised,  perhaps,  chiefly  upon  that  portion  of  the 
nutrient  materials  which  did  not  pass  through  the  absorbent  system  when 
first  introduced,  but  was  taken  up  directly  by  the  blood-vessels. 

SECTION    VI. WEIGHT    AND    DIMENSIONS    OF    THE    FCETUS    AT    BIRTH. 

The  various  phenomena  connected  with  development  having  been 
completed,  so  far  as  uterine  existence  is  concerned,  it  may  be  useful  to 
note  what  has  been  ascertained  with  regard  to  the  weight  and  dimensions 
of  the  foetus  at  birth;  the  latter  being  of  much  importance  from  an 
obstetrical  point  of  view,  though  it  is  a  subject  which  has  not  received  all 
the  attention  it  merits  from  veterinary  obstetrists. 

With  regard  to  weight,  we  find,  as  might  be  expected,  that  this  varies 
considerably,  according  to  the  size,  breed,  and  condition  of  the  parents, 
and  other  circumstances  which  more  or  less  influence  growth. 

For  the  Horse  species,  Boussingault  estimated  that  foals  from  pa- 
rents weighing  from  400  to  500  kilogrammes,  weighed  at  birth  51  kilo- 
grammes.* According  to  a  table  drawn  up  by  Saint-Cyr,  it  appears  that 
a  foal  at  birth  may  vary  in  weight  from  30  to  60  kilogrammes,  according 
to  breed  and  individual  peculiarities  ;  though  between  38  to  42  kilo- 
grammes may  be  accepted  as  the  average  weight. 

With  regard  to  the  Bovine  species,  Tisserant  has  stated  that  calves 
weigh  at  birth  from  one-thirteenth  to  one-sixteenth  of  the  weight  of  the 
Cow  ;  whereas  Riedesel  gives  it  as  one-tenth.  Magne  mentions  that 
calves  vary  between  20,  25,  45,  and  50  kilogrammes.  Saint-Cyr  alludes 
to  the  observations  made  at  the  Agricultural  School  of  Saulsie,  France, 
where  Cows  of  the  Ayrshire  breed  were  chiefly  kept.  The  animals  were 
maintained  in  good  condition  all  the  year  round,  and  though  they  were 
only  middle-sized,  their  weight  varied  between  400  and  650  kilogrammes. 
The  Cows  were  regularly  weighed,  as  were  the  calves  immediately  after 

*  The  kilogramme  is  equal  to  2*205  pounds  avoirdupois. 


ii8  OBSTETRICAL  PHYSIOLOGY. 

birth,  and  the  register  for  1868  gave  the  following  results.  The  weight 
varied  from  31  to  35  kilogrammes — the  average  being  32^  kilogrammes. 
The  males  were  a  little  heavier  than  the  females.  In  twenty-eight 
instances,  the  average  weight  of  the  calf  compared  with  that  of  the  cow 
was  as  2  to  31. 

The  average  weight  of  one  hundred  lambs  weighed  at  the  Alfort  pens, 
is  given  by  Magne  as  about  4  kilogrammes  for  both  sexes.  The  males 
were  heaviest. 

With  regard  to  dimensio7is^  Saint-Cyr  justly  regrets  the  paucity  of  obser- 
vations which  have  been  made  on  this  important  point.  It  is  of  course 
well  known  that,  in  a  general  wa}^,  the  foetus  is  larger  than  the  pelvic 
opening  through  which  it  has  to  pass  at  birth,  but  we  have  to  ascertain 
how  much  larger  it  is  than  that  canal,  and  what  is  the  amount  of  reduc- 
tion in  volume  to  which  it  has  to  submit  in  passing  the  outlet  of  the 
pelvis.  Rainard  merely  states  that  some  measurements  he  had  made, 
gave  the  diameter  of  the  thorax  of  calves,  from  withers  to  sternum  (verti- 
cal) as  from  1034^  to  11  inches;  and  the  diameter  from  side  to  side 
(transversal)  as  63^  to  7  inches.  Saint-Cyr,  anxious  to  arrive  at  some 
definite  conclusion  in  the  matter,  in  order  the  better  to  understand  the 
mechanism  of  natural  parturition,  as  well  as  to  gain  a  knowledge  of 
how  to  surmount  the  difficulties  of  protracted  labor,  undertook  some 
researches  in  this  direction.  His  object  was  to  ascertain  the  depth  and 
width  of  the  chest,  and  width  of  croup  of  the  foetus',  these  being  the 
dimensions  which  it  is  most  important  to  compare  with  the  different 
diameters  of  the  pelvis  of  the  mother,  so  as  to  understand  how  the 
former  may  accommodate  themselves  to  the  latter.  He  gives  the 
name  of  sierno-dorsal  line  to  the  verticle  measurement  taken  from 
the  summit  of  the  highest  dorsal  spines  to  the  sternum,  and  biscapulo- 
humeral  line  to  the  distance  measured  from  one  scapulo-humeral  artic- 
ulation to  the  other  ;  while  the  bicoxo-femoral  line  is  the  measure- 
ment of  the  croup  from  one  coxo-femoral  articulation  to  the  other. 
From  the  measurements  in  the  Horse  species,  we  find  that  a  Mare 
measuring  a  trifle  over  fifteen  hands  in  height,  and  whose  pelvis 
was  nearly  nineteen  inches  in  width,  brought  forth  a  foal  weighing 
slightly  less  than  thirty  pounds,  and  whose  sterno-dorsal  measurement 
was  nearly  twelve  inches,  biscapulo-humeral  line  7^  inches,  and  bicoxo- 
femoral  line  nearly  8  inches.  The  other  measurements  of  Mares  and 
foals  yielded  similar  results,  and  give  an  idea  of  the  expulsive  efforts  the 
uterus  must  make  to  expel  the  foetus.  In  the  case  first  cited,  it  may  be 
admitted  that  the  pelvis  of  the  Mare  had,  approximately,  the  following 
dimensions  :  inlet  of  the  pelvis — sacro-pubic  diameter,  9  inches  ;  inlet  of 
the  pelvis — bi-iliac  diameter,  8^  inches.  In  comparing  these  dimensions 
with  those  of  the'  foal  to  which  it  gave  birth,  it  is  obvious  that  the  bi- 
scapulo-humeral and  bicoxo-femoral  diameters  of  the  latter  could  be  easily 
accommodated  by  the  bi-iliac  diameter  of  the  mother,  as  they  are  less  by 
1 34^  and  ^  inch  ;  but  it  is  not  the  same  with  regard  to  the  sacro-pubic 
diameter,  which  is  less  by  nearly  three  inches  than  the  sterno-dorsal 
line  of  the  foetus.  It  is  therefore  evident  that  in  order  to  pass  through 
the  pelvis,  this  line  must  be  diminished  at  least  by  three  inches. 

.  With  regard  to  the  Bovine  species,  nine  Cows  were  tabulated.  The 
first,  the  smallest,  was  11 3^  hands  high,  and  the  width  of  the  croup  18^ 
inches  ;  the  weight  of  the  foetus  was  about  sixty-two  pounds,  the  sterno- 
dorsal    diameter    10^    inches,  the    biscapulo-humeral    6iV    inches,    and 


GESTATION.      '  119 

the  bicoxo-femoral  7t'o  inches.  Another  Cow  was  i2>^  hands  high, 
the  width  of  croup  iSy^  inches  ;  the  weight  of  the  foetus  was  about 
seventy-three  pounds,  the  sterno-dorsal  diameter  103^  inches,  the  bi- 
scapulo-humeral  6  inches,  and  the  bicoxo-femoral  8Vo  inches.  With  a 
Cow  \2Y^  hands  high,  and  croup  18  inches  in  width,  which  had  experi- 
enced a  protracted  accouchment  in  consequence  of  the  size  of  the  calf, 
and  which  had  aborted  the  previous  year,  the  weight  of  the  foetus  was 
sixty-six  pounds,  the  sterno-dorsal  diameter  15  inches,  the  biscapulo- 
humeral  7^  inches,  and  the  bicoxo-femoral  8^^  inches. 


CHAPTER  V 
Gestation. 


Gestation,  or  pregna?icy,  comprises  the  period  during  which  the  female 
animal  carries  its  young  while  this  is  undergoing  development.  Its  con- 
sideration is  of  much  moment,  and  we  will,  with  regard  to  it,  study  it  in 
this  chapter  from  a  normal  physiological  point  of  view  :  noticing  the 
anatomical  and  functional  alterations  attending.it,  the  mode  of  recogniz- 
ing it,  its  duration  in  various  species  of  animals,  and  the  exceptional 
departures  from  the  usual  law,  with  respect  to  the  number  of  young  pro- 
duced. 

SECTION    I. MODIFICATIONS    IN   THE    UTERUS    DURING    PREGNANCY. 

With  the  development  of  the  foetus,  the  uterus  undergoes  important 
anatomical  and  physiological  modifications,  while  the  system  of  the 
mother  also  participates  more  or  less  generally  in  the  phenomena  which 
mark  the  period  of  gestation.  The  modifications  and  phenomena  are 
worthy  of  attentive  notice,  not  only  from  the  importance  they  hold  with 
regard  to  the  reproduction  of  animals,  but  also  from  the  practical  issues 
involved  in  the  study. 

The  anatomical  changes  in  the  uterus  are  those  relating  to  its  volume, 
structure,  form,  situatmi,  and  direction. 

Volume. 

W^th  regard  to  volume^  we  have  seen  that  during  and  after  copulation 
the  uterus  is  congested,  and  that,  when  conception  has  taken  place,  the 
thin  pulpy  secretion  corresponding  to  the  decidua  of  the  human  female 
covers  its'  internal  surface.  The  vessels,  distended  with  blood,  gradually 
enlarge  to  a  great  size  :  from  the  smallest  to  the  largest  forming  most 
intricate  and  beautiful  plexuses  on  and  in  the  texture  of  the  organ.  The 
coats  of  the  arteries  are  thickened  to  compensate  for  their  distention, 
and  the  additional  labor  they  have  to  perform  ;  wdiile  the  veins  are  still 
more  enlarged  in  calibre.  The  lymphatics  are  likewise  augmented  in 
number  and  dimensions ;  and  the  nerves,  which  were  comparatively 
small  in  the  unimpregnated  state,  enlarge  and  anastomose  so  freely  as  to 
compose  a  network  similar  to  that  of  the  vessels — the  increase  taking 
place  in  the  nerve  termina,  not  in  the  nerve  substance. 


I20  OBSTETRICAL  PHYSIOLOGY. 

Structure. 

These  changes  add  to  the  thickness  and  density  of  the  uterus  ;  but 
there  are  others  still  more  remarkable.  While  the  organ  is  increasing  in 
volume,  becoming  rounder,  acquiring  a  greater  capacity,  and  its  cervix 
widening,  its  proper  structure  is  exaggerated  to  an  extraordinary  degree. 
This  exaggeration,  however,  does  not  occur  equally  throughout ;  it  is 
most  marked  in  the  cornua  of  multiparous  creatures  at  the  points  where 
the  young  are  fixed  ;  in  ruminant  animals  at  the  situation  of  the  cotyle- 
dons ;  and  in  solipeds  at  the  part  of  the  body  of  the  uterus  corresponding 
to  the  foetal  placenta.  So  that,  at  least  in  the  early  months  of  pregnancy, 
it  is  thinnest  towards  the  cervix.  The  increased  thickness  of  the  organ, 
however,  never  equals  that  observed  in  the  human  female,  compared  with 
which  the  walls  of  the  uterus  of  the  domesticated  animals  are  thin. 

The  firmness  or  density  of  the  organ  is  always  most  conspicuous  in  the 
cornua,  and  in  the  operation  of  "  spaying,"  or  castration  of  the  female, 
this  serves  as  a  useful  guide  in  enabling  the  operator  to  distinguish  be- 
tween the  cornua  and  the  intestines,  which  they  so  closely  resemble  in 
appearance. 

But  during  pregnancy  this  density  seems  to  diminish,  as  the  organ 
becomes  more  vascular,  and  the  cervix  assumes  a  much  softer  condition 
than  usual.  For  instance,  in  the  fcetal  cornu  of  a  Cow  advanced  three 
months  in  pregnancy,  the  thickness  of  the  wall  was  only  2-5  millimetres, 
while  in  the  other  horn  it  was  four  millimetres.  In  another  Cow  at  five 
months,  it  was  two  millimetres  in  the  foetal  horn  and  five  millimetres  in 
the  vacant  one.  The  mucosa  is  thicker,  redder,  more  pulpy  and  vascu- 
lar, than  before  impregnation  ;  the  longitudinal  rugse  it  then  exhibited 
gradually  disappear  ;  the  epithelium  covering  it  usually  loses  its  .colum.nar 
form  ;  the  utricular  glands  enlarge — they  are  longer  and  their  orifices 
wider,  and  their  secretion,  as  well  as  that  of  the  other  glands,  is  increased  ; 
the  interglandular  tissue  is  largely  and  rapidly  augmented  by  multiplica- 
tion of  the  cells  of  the  surface  epithelium,  and  proliferation  of  the  cor- 
puscles of  the  sub-epithelial  connective  tissue,  so  that  the  glands  are 
more  widely  separated  ;  while  the  uterine  cotyledons  grow  quickly,  and 
there  can  be  no  doubt  that  new  ones  appear,  Rainard  speaks  of  exam- 
ining the  uterus  of  several  calves  and  lambs,  and  finding  only  thirty  or 
forty  cotyledons  ;  while  after  parturition  he  has  ^counted  more  than  a 
hundred ;  and  more  recent  observers  have  testified  to  this  fact.  In  the 
uterus  of  a  six  months'  pregnant  Cow,  Franck  found  that  the  horn  con- 
taining the  fcetus  had  forty-seven  cotyledons  and  weighed  3,54zollpfund  ; 
while  the  other  horn  had  only  forty-two  placentae,  and  weighed  no  more 
than  0,22  zollpfund. 

In  addition  to  these  supplementary  appendages  of  the  mucous  mem- 
branes, a  new  glandular  apparatus,  of  which  no  trace  was  to  be  found 
previous  to  gestation,  now  makes  its  appearance  in  the  form  of  a  large 
number  of  small  openings  in  the  mucosa,  each  leading  into  a  depression 
which  was  for  a  long  time  regarded  as  the  dilated  mouth  of  the  tubular 
or  utricular  glands,  but  which  is  really  a  "  crypt  "  formed  in  the  hyper- 
trophied  tissue  of  the  uterus — a  kind  of  open  follicle  placed  in  the  inter- 
glandular part  of  the  mucous  membrane.  These  crypts  are  new  struct- 
ures, formed  during  pregnancy,  and  are  for  the  lodgment  of  the  villi  that 
project  from  the  chorion  of  the  foetus — being,  in  fact,  the  maternal  coty- 
ledons or  maternal  portion  of  the  placenta.     They  are   small  straight 


GESTATION.  I2i 

depressions,  lying  more  or  less  closely  together  throughout  the  whole  of 
the  uterine  mucous  membrane  of  the  Mare,  their  cavity  being  lined  by  a 
layer  of  tessellated  epithelium,  and  a  very  fine  capillary  network  surround- 
ing each.  In  the  Cow,  these  crypts  are  assembled  on  the  surface  of  the 
projections  designated  cotyledons,  of  which  they  constitute  nearly  the 
entire  mass  during  pregnancy.  In  the  Bitch,  they  are  only  developed 
where  the  ovule  is  fixed,  forming  then  a  glandular  layer  occupying  the 
contour  of  the  uterine  cornu. 

The  utricular  glands  do  not  open  directly  into  the  crypts^  nor  is  their 
secretion  poured  into  them,  but  on  a  definite  surface  of  the  mucous  mem- 
brane between  the  crypts,  the  size  and  areas  of  which  correspond,  of 
course,  to  the  size  and  arrangement  of  the  foetal  tufts. 

Between  the  foetal  and  maternal  placentae,  there  is  always  a  layer  of 


Vertical  Section  through  a  Portion  of  the  Uterine  Cotyledon  of 
AN  Early  Stage  of  Pregnancy. 


Cow  in 


a,  Serous  Membrane;  3,  Section  of  Longitudinal  Muscular  Layer;  c.  External,  andfi,  Internal 
Layers  of  the  Circular  Muscle  ;  d,  Submucosa,  with  vessels  ;  e,  Adenoid  Tissue  of  the  Cotyle- 
don ;  f.  New  Tissue  of  the  Placenta  Uterina  ;  g,  Section  of  the  Mucous  Layer  of  the  Cotyle- 
don, with  the  Interspaces  into  which  the  Foetal  Cotyledons  are  inserted  ;  h  k,  Utricular  Glands 
passing  under  the  Side  of  the  Cotyledon;  i  i,  Large  Cotyledonal  Vessels;  k,  Uterina  Mucosa; 
//,  Epithelial  Layer  of  the  Cotyledon. 

epithelial  cells  of  varying  thickness,  which  represents  the  membrana 
decidua  or  serotlna  of  woman.  If  not  during  parturition,  at  least  after- 
wards, all  placental  mammals  are  "  deciduate,"  more  or  less.  With  the 
Cow  and  Sheep,  for  example,  large  quantities  of  cells,  possessing  the 
character  of  epithelial  cells  of  the  pits  and  crypts  of  the  maternal  cotyle- 
dons, have  been  found,  mingled  with  the  villi  of  shed  foetal  cotyledons, 
in  the  fluid  extruded  during  and  after  parturition :  showing  that  a 
portion  of  the  maternal  structure  is  carried  away  at  this  time.  The 
crypts  possess  structural  characters  of  secreting  organs  ;  and,  indeed, 
we  cannot  but  look -upon  the  maternal  placenta  and  the  remarkably  modi- 
fied mucous  lining  of  the  uterus  as  a  great  secreting  organ. 

In  addition  to  the  mucous  membrane,  the  outer  or  serous  membrane  is 


122  OBSTETRICAL  PHYSIOLOGY. 

also  hypertrophied,  the  broad  ligaments  are  increased  in  every  direction, 
but  especially  in  length,  and  muscular  fibres  are  abundantly  developed 
between  their  layers,  in  order  to  give  them  sufficient  strength  to  sustain 
the  weight  of  the  uterus.  In  the  Cow,  the  fibres  even  form  very  distinct 
intercrossing  fasciculi. 

The  greatest  increase  of  all  noted  in  the  texture  of  the  uterus,  occurs 
in  the  middle  or  muscular  tunic.  There  appears  to  be  a  vast  multiplica- 
tion of  the  fusiform  nucleated  fibres  going  on  during  pregnancy,  as  well 
as  an  immense  increase  in  the  volume  of  those  already  existing.  This 
tunic  gradually  becomes  redder  as  well  as  thicker,  and  the  muscular 
fasciculi  more  distinct,  and  visibly  more  numerous.  The  inner  layer, 
composed  of  circular  fibres,  is  most  conspicuous  in  the  cornua  of  carni- 
vorus  animals,  and  there  they  contract  in  the  interspaces  between  the 
young,  so  as  to  form  well-marked  constrictions.  The  connective  tissue 
which  unites  the  muscular  fibres  also  increases  during  pregnancy,  and 
becomes  markedly  fibrous. 

Sensibility. 

With  the  increase  in  volume,  w-eight,  and  capacity,  the  uterus  likewise 
acquires  a  higher  decree  of  sensibility^  doubtless  from  the  development 
of  its  nerves.  So  that  between  the  cervix,  the  body,  and  the  cornua, 
there  is  established  a  sympathetic  relation  that  is  sometimes  not  advan- 
tageous ;  for  irritation  of  the  cervix,  howsoever  produced,  may  bring  on 
violent  contractions  of  the  whole  organ,  and  lead  to  the  premature  ex- 
pulsion of  the  foetus.  This  expulsion,  as  is  well  known,  sometimes  fol- 
lows copulation  ;  though,  as  a  rule,  animals  usually  do  no  seek  to  copulate 
during  pregnancy  if  left  to  their  own  natural  instincts.  It  may  also  be  a 
consequence  of  manipulation  by  the  hand  of  the  explorer. 

This  contractility  of  the  uterus  is  sometimes  evidenced  before  parturi- 
tion, when  animals  have  been  killed  and  quickly  opened.  Colin  has  wit- 
nessed well-marked  movements  in  the  ut^Tus  of  a  Cat  which  contained 
five  young — three  in  one  horn  and  two  in  the  other  ;  these  contractions 
were  most  energetic  at  the  constricted  spaces  between  the  foetuses.  The 
same  talented  veterinary  physiologist  has  seen  similar  phenomena  in 
Sheep  at  different  periods  of  gestation  ;  the  cornua  contracted  and  dilated 
alternately,  approached  or  withdrew  from  each  other  or  the  body  of  the 
uterus  ;  the  movements  persisting  sometimes  for  forty  or  fifty  minutes 
after  the  animal's  death.  In  a  pregnant  Cow  opened  when  alive,  the 
same  contractions  were  noted  ;  they  became  more  active  and  stronger 
under  the  influence  of  a  slight  irritation  ;  the  cornua  changed  their  form 
in  contracting ;  they  shortened  sensibly,  and  became  twisted  on  them- 
selves at  their  anterior  extremity.  In  a  Mare  identical  contractions  were 
seen. 

Haller  had  long  ago  remarked  that,  even  in  the  unimpregnated  animal, 
these  uterine  contractions  were  present — though  they  were  most  energetic 
in  the  pregnant  Bitches,  Cats,  and  Rabbits  he  opened,  the  movement  being 
spontaneous  and  peristaltic,  like  that  of  the  intestines,  and  that  it  con- 
tinued in  the  organ,  even  when  it  was  removed  from  the  body.  Those 
veterinarians  who  have  had  occasion  to  insert  their  hand  into  the  uterus  of 
one  of  the  larger  animals,  to  adjust  the  foetus  or  for  any  other  object, 
must  have  been  astonished,  and  frequently  embarrassed,  at  the  firmness 
with  which  the  arm  was  grasped  at  the  cervix  during  the  expulsive  efforts 
the  creature  made. 


{ 


GESTATION. 


123 


These  uterine  contractions  are  very  powerful,  and  in  all  probability 
their  rhythm  is  analogous  to  that  of  the  intestines  j  extending  from  the 
extremity  of  the  cornua  towards  the  cervix  in  a  peristalic  manner,  par- 
ticularly in  those  animals  which,  like  the  Bitch  and  Pig,  have  very  long 
cornua,  and  the  young  arranged  one  after  another  in  them. 

This  increase  in  sensibility,  which  the  uterus  acquires  during  gestation, 
must  be  considered  as  the  organic  cause  of  its  contractions  ;  the  sensi- 
bility and  contractility  gradually  diminishing  after  parturition,  during 
which  it  reaches  its  apogee.  Its  contractility,  which  signifies  also  its 
retractility,  enables  it  to  .contract  on  itself  after  delivery,  and  to  nearly 
obliterate  its  cavity.  This  rapid  diminution  in  the  capacity  of  the  organ 
closes  the  orifice  of  the  vessels  which  open  on  its  internal  surface  during 
the  act,  and  thus  prevents  fatal  haemorrhage. 

Its  main  function,  however,  appears  to  be  concerned  in  the  expulsion 
of  the  foetus,  and  then,  as  at  other  times,  it  is  entirely  independent  of  the 
will.  Besides,  its  intensity  is  not  always  related  to  the  strength  of  the 
animal  ;  pain  deadens  and  paralyzes  the  contractile  force,  as  is  seen  in 
primiparous  creatures.  When  the  contractions  have  been  vigorous,  the 
uterus  rapidly  diminishes  ;  but  if  they  have  been  slow  and  weak,  the 
organ  slowly  contracts  on  itself.  When  -it  does  not  contract  quickly  after 
delivery  it  is  said  to  be  inert,  and  the  cause  is  to  be  found  in  the  expend- 
iture of  its  contractile  power,  either  through  excessive  distention,  a 
delivery  too  prompt  or  too  slow,  or  general  w^eakness  of  the  maternal 
system..  By  long  exercise,  like  voluntary  muscles,  those  of  the  uterus 
become  weakened ;  so  that  when  the  act  of  parturition  has  been  pro- 
tracted, the  contractions  of  the  organ  become  slow  and  feeble,  or  cease 
altogether.  Opiates  and  narcotics  generally  produce  the  same  effect, 
and  are  therefore  successfully  administered  when  the  contractions  are 
too  energetic  or  painful  during  delivery,  or  before  abortion.  The  con- 
tractions are  stimulated  by  irritation  of  the  cervix  or  body  of  the  uterus  : 
such  as  ,is  produced  by  retention  of  the  whole  or  a  portion  of  the  placenta, 
titillation  of  the  cervix  by  the  finger,  frictions  on  the  belly,  the  applica- 
tion of  cold  to  this  part,  or  the  administration  of  ergot  of  rye. 

Form. 

The  uterus,  after  conception,  begins  to  change  inform  as  well  as  in 
volume  and  structure ;  this  alteration,  like  the  others,  proceeding  pari 
passu  with  the  develepment  of  the  fcetus.  The  body  becomes  round, 
and  in  the  carnivora,  as  already  described,  the  cornua  elongate  and  show 
the  alternate  dilatations  and  constrictions  due  to  the  presence  of  the 
young  in  their  cavities.  In  the  Mare,  Cow,  and  Sheep,  if  there  is  but 
one  foetus,  a  single  horn  is  enlarged — usually  the  right — to  contain  the 
posterior  limbs,  and  the  other  is  relatively  smaller  and  contracted,  and 
looks  a  mere  appendage.  When  a  carnivorous  animal  contains  only  one 
foetus,  it  is  developed  in  the  horn,  and  not  in  the  body  of  the  uterus,  and 
it  is  not  until  parturition  commences  that  it  descends  into  the  latter  ; 
should  the  creature  die  before  delivery,  the  offspring  will  be  found  there. 
In  this  species  each  horn  generally  contains  one  or  more  young  ;  should 
there  be  only  two,  one  occupies  each  cavity  ;  but  when  there  is  only  one 
foetus,  it  is  then  in  one  of  the  cornua. 

The  changes  taking  place  in  the  cervix  of  the  uterus  during  pregnancy 
have  not  been  accurately  ascertained  in  the  domesticated  animals  ;  as  in 
the  smaller  species  there  is  usually  no  occasion  or  necessity  to  make  an 


124 


OBSTETRICAL  PHYSIOLOGY, 


examination  ;  and  in  tlie  larger  the  risk  of  injury  to  the  examiner,  and 
of  abortion  in  the  animal,  militates  against  such  an  investigation.  It  is 
only  known  as  a  fact,  that  it  widens  at  the  termination  of  gestation,  and 
loses  it  cervical  character,  as  well  as  its  longitudinal  mucous  folds.  It 
may  also  be  noted  that,  from  being  firm  and  dense  at  ordinary  times,  its 
texture  becomes  gradually  soft  and  elastic  ;  while  it  diminishes  in  length, 
its  projection  into  the  vaginal  cavity  is  lessened,  and  indeed  at  a  late 


Fig.  52. 

The  Gravid  Uterus  of  a  Multiparous  and  Uniparous  Animal. 

A,  Multiparous  Uterus;  «,  ai,  Ovaries  ;  3,  bi.  Fimbriae  of  Fallopian  Tubes,  c,  c'i  ;  d,  </i,  Cornua 
of  Uterus — that  on  the  left  contains  four  Embryos,  on  the  right  two,  one  of  which  is  exposed  ;  e. 
Body  of  Uterus  ;  f,  Vagina  ;  g,  g;  Mesometry  or  Ligament  of  Uterus  ;  B,  Uniparous  Uterus  : 
c,  a,  Fallopian  Tubes ;  e,  Body  of  Uterus,  containing  early  Uterine  Ovum  ;  /,  Vagina  ;  C, 
Early  Uterine  Ovum. 

period  almost  effaced,  it  appearing  merely  as  a  kind  of  ring  separating 
the  uterus  from  the  vagina,  and  which  is  sometimes  a  little  open.  Not 
infrequently  the  cavity  of  the  cervix  is  filled  with  a  thick,  adherent, 
glutinous  matter,  sometimes  so  abundant  that  it  also  occupies  the  vagina, 
and  forms  an  unpleasant  obstacle  to  exploration,  though  it  does  not  in- 


GESTATION.  125 

terfere  with  parturition.  We  have  already  alluded  to  the  sensitiveness  of 
the  cervix.  The  cornua,  also,  in  becoming  wider  lose  their  inferior  and 
posterior  curves. 

Situation. 

The  uterus  cannot  change  its  form  and  volume  without  altering  its 
situation.  Before,  and  until  a  certain  time  after  conception,  the  body  of 
the  uterus  is  contained  in  the  pelvis,  but  as  it  and  the  fcetus  increase  the 
position  changes,  and  this  causes  an  alteration  in  the  situation  of  other 
organs.  In  the  Mare  it  gradually  displaces  the  pelvic  flexure  of  the  colon 
lodged  in  that  cavity,  and  passes  forward  below  that  intestine,  towards 
and  beyond  the  umbilicus,  to  rest  on  the  floor  of  the  abdomen,  in  proximity 
to  the  diaphragm,  stomach,  and  liver,  towards  the  termination  of  preg- 
nancy. In  its  development  it  is  situated  chiefly  in  the  middle  line  of  the 
body,  slightly  inclining  to  the  left,  because  of  the  large  mass  of  the  colon 
occupying  the  right  flank. 

In  Ruminants,  the  uterus  pushes  the  rumen  and  csecum  out  of  the 
pelvis,  presses  the  mass  of  intestines  to  one  side,  and  extends  between  the 
right  sac  of  the  rumen  and  the  abdominal  walls.  The  presence  of  the 
rumen  in  the  left  flank  causes  it  to  deviate  somewhat  to  the  right. 

In  multiparous  animals,  in  which  the  young  are  placed  end  to  end  in  the 
cornua,  the  latter  rest  on  each  side  of  the  floor  of  the  abdomen  and  curve 
upwards  ;  in  the  Pig  they  incline  somewhat  to  the  right  side,  though  in 
both  each  cornu  lies  above  its  corresponding  mammary  line. 

While  these  changes  are  taking  place,  the  broad  or  lateral  ligaments  are 
faciliating  them  by  becoming  unfolded  and  lengthened,  and  the  uterus  in 
its  increasing  bulk  extends  backwards  as  well  as  forwards.  The  cervix, 
firm  and  resisting,  approaches  the  vulva,  and  to  such  a  degree  sometimes 
that,  in  certain  breeds  of  cattle — particularly  those  which  have  the  pelvis 
wide  and  inclined  posteriorly,  and  bear  large  calves — the  posterior  por- 
tion of  the  vagina  appears  between  the  labia  of  the  vulva  a  month  or 
more  before  parturition,  and  especially  when  they  lie  down. 

With  other  Cows,  however,  whose  abdomen  is  very  pendent,  the  op- 
posite occurs  ;  for  the  uterus,  in  passing  forwards  and  downwards,  carries 
the  posterior  portion  of  the  vagina  behind  it,  and  this  cavity  becomes 
lengthened  and  constricted  posteriorly,  while  the  cervix  is  shortened,  and 
the  vulva  appears  to  be  deeply  buried  between  the  tuberosities  of  the 
ischium. 

Direction. 

With  regard  to  the  direction  of  the  uterus,  it  is  to  be  noted  that  its  hori- 
zontal position  in  the  domesticated  animals  obviates  those  lateral  dis- 
placements which  are  so  frequent  in  woman,  its  weight  and  that  of  its 
contents  maintaining  it  in  an  antero-posterior  direction,  and  in  a  line  with 
the  body  of  the  animal.  This  direction  rarely  varies  to  any  appreciable 
degree,  and  it  is  only  in  a  case  of  hernia  at  the  flank,  which  is  very  un- 
common, that  it  inclines  to  one  side.  The  only  marked  inclination  it 
assumes  is  forward  and  downward  in  Cows  whose  abdomen  is  very  wide 
and  pendulous.  Otherwise,  the  uterus  keeps  its  normal  direction. 
Rainard  draws  attention  to  a  form  of  abdominal  hernia  which  gives  the 
uterus  a  particular  direction  ;  it  is  that  which  takes  place  in  the  Mare  or 
Cow,  in  the  vicinity  of  the  crural  arch,  when  the  uterus,  or  one  of  its 
horns  containing  the. foetus,  descends  behind  the  corresponding  mammary 


126  OBSTETRICAL  PHYSIOLOGY. 

gland,  or  into  the  subcutaneous  connective  tissue  of  the  inguinal  region, 
forming  a  large  tumor  in  which  the  limbs  of  the  young  animal  can  be  felt. 
Another  change  in  the  direction  of  the  uterus,  which  it  is  most 
important  to  consider  in  the  larger  animals,  is  the  more  or  less  complete 
rotation  or  twisting  on  its  axis  of  this  organ  :  its  upper  face  becoming  the 
lower,  or  again  become  superior  after  describing  an  entire  circle  ;  for 
this  torsion  occasions  serious  changes  in  the  form  of  the  cervix  and  the 
direction  of  its  cavity.  The  position  of  the  cervix  is  the  inverse  of  that 
of  the  uterus,  being  always  found  on  the  side  opposite  to  that  of  the 
i^ew  direction  of  the  organ  itsfelf  ;  it  is  directed  upwards  if  the  uterus  is 
downwards,  and  if  the  latter  twists  to  the  right  or  left  the  cervfx  goes  to 
the  left  or  right.  Cases  are  mentioned  in  which  torsion  of  the  cervix 
itself  has  been  found  ;  and  though  it  has  been  argued  that  the  lateral 
ligaments  would  not  permit  this  malposition,  yet  there  can  be  no  doubt 
as  to  the  fact.  Lecoq  of  Bayeux,  cited  by  Rainard,  found  in  a  Cow  that 
had  died  through  non-delivery,  the  upper  face  of  the  uterus  turned 
downwards  to  the  floor  of  the  abdomen,  the  rotation  having  taken  place 
from  right  to  left ;  the  utero-vaginal  portion  was  twisted  on  itself,  and 
the  suspensory  ligaments  were  themselves  twisted  around  this  part. 
Numerous  cases  are  recorded  which  incontestibly  prove  that  during 
pregnancy,  the  uterus  perform  a  half  or  even  a  complete  revolution  on 
itself,  producing  torsion  of  the  cervix  and  the  posterior  part  of  the 
vagina,  and  consequent  strangulation  of  the  organ  near  the  neck  by  the 
suspensory  ligaments ;  so  that  spontaneous  delivery  of  the  young  animal 
by  the  natural  pass^ige  is  impossible. 

Influence  on  afid  Alterations  in  Position  of  Neighboring  Organs. 

The  alterations  occurring  in  the  uterus  necessarily  bring  about  others 
in  the  neighboring  organs  with  which  it  has  mechanical  relations.  The 
changed  position  of  the  organ  in  the  abdominal  cavity  has  been  alluded 
to.  In  the  Mare  and  Cow  the  horn  in  which  the  limbs  of  the  foetus  is 
lodged  becomes  extended  and  displaces  the  intestines,  pushes  the 
stomach  more  to  the  left,  rests  on  the  liver,  and  is  an  obstacle  to  the 
free  movements  of  the  diaphragm.  The  suspensory  ligaments  of  the 
uterus  retain  that  organ  and  the  cornua  in  situ  ;  but  when  they,  in  the 
early  stage  of  gestation,  begin  to  extend  forward,  the  vagina  is 
lengthened,  until  at  a  later  period,  when  the  size  of  the  foetus  forces  the 
uterus  backwards  into  the  pelvic  cavity,  that  canal  is  also  pushed  back 
and  forms  a  circular  enlargement  in  the  vulva.  Its  lining  membrane, 
owing  to  the  compression  and  the  increased  circulation  of  the  blood 
through  it,  assumes  a  violet  or  dark -brown  tint,  and  appears  to  become 
thickened,  while  it  secretes  a  larger  quantity  of  viscid  mucus. 

The  pressure  the  gravid  uterus  exercises  on  the  blood-vessels  of  the 
hind  limbs  and  the  vulva  and  rectum,  retards  the  venous  and  lymphatic 
circulation  ;  so  that  towards  the  end  of  gestation,  and  especially  in  the 
Mare,  there  is  considerable  oedema  of  these  parts.  This  oedema  is  all 
the  more  marked,  in  the  Cow  as  well  as  in  the  Mare,  when  the  com- 
pression is  greatest  at  the  posterior  parts  of  the  abdomen,  towards  the 
commencement  of  the  saphena  and  mammary  veins. 

The  oedema  is  always  greatest  in  those  cases,  somewhat  rare,  it  is  true, 
in  which  there  is  a  giving-way  of  the  abdominal  parietes  near  the  crural 
arch  above  one  of  the  mammae,  when  the  uterus  forms  a  hernia  beneath 
the  skin  ;  then  there  is  seen  an  enormous  swelling,  at  the  upper  part  of 
the  limb. 


GESTATION.  127 

The  udder  increases  notably  in  volume,  and  it  and  the  teats  are  tense. 
In  the  carnivora,  the  prominences  of  the  mammae,  especially  the  ventral 
ones,  are  increased  by  two  rows  of  elevations  on  each  side  of  the  linea 
alba,  which  correspond  to  the  portions  of  the  cornua  in  which  the  young 
are  being  developed,  and  where  they  form  projections  on  the  wall  of 
their  sac. 

The  increase  in  volume  and  the  various  changes  which  the  gravid 
uterus  undergoes,  bring  about  alterations  in  and  frequently  derangement 
of  certain  functions  in  the  animal.  Fortunately,  however,  these  altera- 
tions are  slow  and  gradual ;  so  that  the  different  organs  concerned 
generally  adapt  themselves  to  their  changed  condition  without  much 
inconvenience.  The  animal  becomes  lazy  and  slower  in  movement,  and 
is  more  desirous  of  quiet  and  tranquillity  as  gestation  advances.  These 
indications  are  observed  at  an  early  period.  At  the  same  time  the 
abdomen  enlarges  and  changes  its  shape :  it  becomes  rounded  and 
projects  below,  and  on  each  side  bevond  the  crural  region,  while  the 
flanks  become  hollow,  the  croup  and  thighs  wasted-looking,  and  the 
sacrum  and  external  tuberosities  of  the  ilium  more  salieni. 

In  the  domesticated  animals  there  are  not  observed  those  disturbances 
in  the  digestive  organs  so  marked  at  the  commencement  of  pregnancy 
in  woman.  On  the  contrary,  immediately  after  conception,  possibly 
because  oestrum  has  disappeared,  the  appetite  is  increased,  digestion  is 
easier,  and  all  the  formative  phenomena  seem  to  acquire  increased 
activity  ;  more  use  appears  to  be  made  of  the  food  in  the  economy,  and 
there  is  a  notable  tendency  to  fatten.  This  tendency  has  been  taken 
advantage  of  by  breeders  and  feeders  of  animals  which  are  destined 
more  for  food  than  reproduction  ;  and  those  intended  for  slaughter  are 
usually  rendered  pregnant,  and  fed  until  about  the  middle  period  of  ges- 
tation, when  they  have  reached  their  most  favorable  condition  :  as  towards 
the  last  period  this  tendency  vanishes,  and  wasting  is  more  apparent,  due 
to  the  increased  demands  of  the  foetus  and  the  enlargement  of  the 
mammary  glands. 

In  some  cases,  however,  and  particularly  with  the  Cow,  the  appetite 
becomes  somewhat  depraved,  the  animals  eating  soil,  gnawing  the  walls 
or  woodwork  of  their  stable,  drinking  foul  water,  etc. 

With  the  increased  bulk  of  the  uterus,  as  has  been  observed,  the 
abdominal  and  thoracic  organs  experience  more  or  less  the  effects  of  the 
compression  it  exercises  on  them.  The  diaphragm  is  pushed  forward, 
and  diminishes  the  capacity  of  the  thorax,  and  the  expansibility  of  the 
lungs  ;  the  ribs,  encumbered  by  the  weight  of  the  foetus,  are  raised  with 
difficulty  by  the  muscles  of  inspiration,  so  that  respiration  is  frequent  and 
shallow,  and  the  creature  is  readily  "blown"  and  fatigued.  Digestion 
is  a  little  impaired  and  tardy,  and  slight  constipation  is  not  rare.  The 
strain  induced  by  the  uterus  on  the  vagina,  and  indirectly  on  the  neck  of 
the  bladder,  causes  attempts  at  micturition  to  be  more  frequent ;  while 
the  compression  on  the  liver,  vena  portae  and  vena  cava,  explains  the 
mechanical  obstruction  to  the  circulation  and  consequent  oedema,  par- 
ticularly in  the  Mare. 

In  addition  to  all  this,  the  blood  is  more  or  less  modified.  Its  abso- 
lute quantity  is  not  diminished  ;  on  the  contrary,  it  may  be  increased  to 
a  certain  extent ;  but  its  corpuscles  diminish  in  number  in  a  very  percep- 
tible manner,  giving  rise  to  a  serous  plethora  more  allied  to  anaemia  than 
any  thing  else. 


128  OBSTETRICAL  PHYSIOLOGY. 

SECTION    II. POSITION    OF    THE    FCETUS    IN    THE    UTERUS. 

The  position  of  tlie  fcetus  in  the  uterine  cavity  is  pretty  well  constant 
in  the  same  species  ;  and  this  position  it  retains  more  or  less  during  intra- 
uterine existence,  and  until  parturition  occurs,  when  it  is  changed. 

Brugnone,  cited  by  Rainard  and  Saint-Cyr,  writes  :  "  If  the  uterus  of  a 
Mare  is  opened  longitudinally  at  the  ninth  or  tenth  month  of  gestation, 
we  find  the  foetus  with  its  head  directed  backwards,  and  bent  in  such  a 
way  that  its  lower  jaw  touches  the  throat  and  its  mouth  the  breast.  It 
forms  an  arc  of  a  circle  ;  the  neck  being  in  contact  with  the  sacrum,  and 
the  spine  being  bent  round  is  turned  towards  the  right  or  left  side  of  the 
lower  part  of  the  abdomen.  The  limbs  are  flexed  :  the  fore  ones  in  such 
a  manner  that  the  knees  reach  the  middle  of  the  head  and  the  feet  the 
umbilicus  ;  while  the  hind  limbs  are  doubled  under  the  abdomen.  The 
croup  and  haunches  are  at  the  bot  o  i  of  the  uterus,  in  the  vicinity  of 
the  stomach." 

Colin  states  that  towards  the  termination  of  pregnancy,  the  fcetus  of 
the  Mare  lies  wifh  the  belly  upwards,  the  hinder  limbs  in  the  longest  of 
the  uterine  cornua,  and  the  anterior  limbs  and  head  directed  towards,  the 
cervix  uteri. 

In  the  Cow,  according  to  Saint-Cyr,  the  uterus  is  curved  downwards, 
the  superior  convexity  of  the  body  being  prolonged  forward  by  the  cornu 
in  which  the  foetus  is  partially  developed.  When  the  uterus  is  opened, 
the  foetus  is  discovered  with  the  head  bent  back,  the  body  much  inclined 
and  looking  as  if  almost  lying  on  one  side  or  other,  and  pressing  on  the 
empty  cornu,  which  is  considerably  less  developed  than  that  of  the  oppo- 
site side,  and  which  also  is  lower.  Otherwise,  like  the  foal,  the  calf  is 
curved  eii  arc,  the  head  more  or  less  near  the  sternum,  and  the  limbs 
flexed  and  close  together  (Fig.  36). 

According  to  Colin,  the  belly  of  the  foetus  is  downwards  in  ruminants, 
and  towards  the  concavity  of  the  cornua,  the  head  being  directed  back- 
wards. 

In  multiparous  animals,  the  foetuses  are  distributed  in  the  two  cornua, 
one  after  the  other,  the  head  being  usually  turned  towards  the  cervix  uteri, 
sometimes  to  the  opposite  side,  and  the  abdomen  lying  towards  the  con- 
cave portion  of  the  cornua,  where  the  broad  ligaments  are  attached  and 
the  vessels  enter.  In  the  Sow,  however,  it  has  been  noted  that  the  young 
lie  in  a  contrary  direction  ;  the  head,  instead  of  being  presented  to  the 
cervix  uteri,  is  turned  towards  the  ovarian  extremity  of  the  cornua,  though 
the  abdomen  and  limbs  always  correspond  to  the  concave  border  of  the 
horns,  as  it  is  there  the  placenta  is  situated. 

In  forty-three  Cows  and  Sheep,  Colin  found  in  twenty-five  the  foetus  in 
the  right  cornu,  and  in  the  left  cornu  in  eighteen.  At  first  sight  it  might 
be  supposed  that  the  preference  for  the  right  cornu  was  due  to  the  im- 
pediment offered  to  development  in  the  left  by  the  large  digestive  organs 
of  these  animals  ;  but  this  difference  cannot  have  any  influence  on  the 
function  of  the  ovaries,  the  dehiscence  of  the  Graafian  vesicles  in  the 
right  being  apparently  more  frequent  than  in  the  left.  In  multiparous 
animals,  the  foetuses  are  rarely  equal  in  number  in  both  cornua,  though 
neither  of  the  latter  has  a  constant  advantage  over  the  other  in  this  re- 
spect. 

The  position  of  the  foetus  towards  the  termination  of  gestation  may 
vary  occasionally,  and  even  frequently,  owing  to  the  active  reflex  move- 


GESTATION.  129 

ments  which  it  performs  ;  and  to  these  energetic  movements,  it  cannot 
be  doubted,  are  due  the  difficult  presentations  which  the  foetus  offers  so 
frequently  (at  least  in  some  species)  at  birth. 

SECTION    III.— ^SIGNS    OF    PREGNANCY. 
t 

Having  traced  thus  far  the  process  of  uterd-gestation,  we  have  now  to 
study  the  signs  by  which  this  process  reveals  itself.  This  study  is  very 
important,  in  several  respects,  to  the  comparative  pathologist,  or  rather 
to  the  veterinary  surgeon,  whose  science  extends  beyond  pathology,  and 
v/ho  is  frequently  called  upon  to  give  an  opinion  as  to  whether  an  animal 
is  or  is  not  pregnant. 

The  signs  which  announce  pregnancy  are  numerous  and  varied,  though 
they  are  not  all  reliable,  and  several  are  very  deceptive,  and  not  peculiar 
to  gestation.  Indeed,  it  has  frequently  happened  that  animals  whose 
condition  was  not  at  all  certain  have  brought  forth  young,  and  others 
have  done  the  same  without  giving  rise  to  any  suspicion  that  they  were 
pregnant ;  though  it  must  be  remembered  that  at  first  there  is  nothing 
present  to  guide  one  in  forming  an  opinion  as  to  the  animal  having  con- 
ceived. 

Nevertheless,  in  order  that  a  correct  opinion  may  be  arrived  at,  the 
most  equivocal  signs  must  be  taken  into  consideration,  as  well  as  those 
which  are,  so  to  speak,  unequivocal :  indeed  they  ought  to  receive,  for 
this  very  reason,  more  than  ordinary  attention  ;  as  it  is  a  matter  of  much 
moment,  and  particularly  in  cases  of  jurisprudence,  that  the  veterinarian 
should  be  able  to  speak  positively  as  to  the  presence  or  absence  of  preg- 
nancy. 

The  diagnosis  of  pregnancy  is  not  always  easy,  and  it  is  all  the  more 
difficult  as  the  stage  is  early. 

In  order  to  study  the  signs  of  pregnancy  conveniently,  it  is  usual  to 
divide  them  into  three  categories  as  follows  :  i.  The  rational, physiological, 
ox  subjective  signs  ;  2.  T\\q  material  or  objective  signs  ;  3.  The  sensible  signs 
which  are  derived  from  observation  and  ma?iipulation  to  ascertain  the 
presence  of  the  foetus.  In  this  study,  of  course  the  larger  animals  will 
be  more  particularly  referred  to,  because  of  their  relatively  higher  value 
and  importance,  their  longer  period  of  gestation,  and  also  because  the 
veterinary  surgeon  is  most  frequently  consulted  as  to  their  condition. 

Rational  Signs. 

There  are  several  rational  signs  due  to  the  modifications  brought  about 
in  the  economy  of  the  pregnant  animal,  and  manifested  by  alterations 
in  temperament,  character,  and  aptitudes. 

The  cessation  of  heat  or  rutting  is,  perhaps,  the  earliest  subjective, 
though  it  is  certainly  not  the  most  certain  sign,  of  gestation,  and  may 
even  lead  to  mistakes.  It  is  usually  manifested  soon  after  conception 
has  taken  place  (six  or  eight  days),  by  a  diminution  in  the  venereal  ex- 
citement which  marks  the  period  of  oestrum  ;  the  animal  is  comparatively 
tranquil  and  does  not  exhibit  any  desire  for  the  male,  neither  does  she 
show  the  usual  concomitant  symptoms  of  "  heat."  If  the  male  ap- 
proaches, the  sexual  desires  are  not  excited,  and  in  refusing  him  the 
female  may  even  resort  to  aggressive  movements.  So  that  it  has  usually 
been  held  as  a  sign  of  conception,  if  the  female  refuses  the  male  soon 
after  copulation,  and  particularly  if  a  month  or  two  has  elapsed,  and  the 
Mare  is  in  good  condition   and  well  fed.     But  in   some  cases  the  symp- 

9 


[30 


OBSTE  TRIG  A  L  PHYSIOL  OG  V. 


toms  of  "  heat  "  persist  for  some  time  after  this  act,  and  the  erethism  of 
the  generative  organs  is  not  allayed,  although  in  reality  impregnation  has 
taken  place;  and  in  very  exceptional  instances  the  "heat "  will  return 
after  having  disappeared  for  a  certain  time.  Some  Mares  pregnant  for 
two  or  three  months,  and  especially  those  which  have  been  put  to  the 
stallion  early  in  the  year,  ^'111  exhibit  indications  of  oestrum  when  the 
weather  becomes  warmer  and  the  pastures  afford  more  nutriment.  When 
in  this  state  the  female  may  again  receive  the  male,  and  it  may  even  hap- 
pen that  a  second  fecundation  takes  place  at  this  time  ;  thus  occasioning 
those  somewhat  unusual  conceptions  which  give  rise  to  superfoetation — 
though  if  pregnancy  is  somewhat  advanced,  it  is  dangerous  and  may 
occasion  abortion.  A  story  is  told  of  a  Mare  in  the  Saint-Leger  stud, 
France,  which,  after  being  pregnant  for  some  months,  yet  showed  symp- 
toms of  "  heat."  Louis  XIV.,  who  was  more  inclined  to  favor  the  de- 
sires of  the  animal  than  to  listen  to  the  opinion  of  Garsault,  the  famous 
equestrian  of  that  period,  ordered  her  to  be  put  to  the  stallion.  This 
was  done,  copulation  took  place,  and  the  Mare  aborted. 

Stallions  exclusively  employed  for  covering,  frequently  refuse  to 
approach  pregnant  Mares  in  which  the  "  heat  "  persists  or  reappears  ; 
though  this  is  not  always  the  case,  particularly  with  young  stallions. 

In  the  Cow,  as  in  the  Mare,  oestrum  may  continue  or  reappear  after 
fecundation  ;  though  as  a  rule,  I  believe,  the  male  refuses  to  copulate 
again  when  the  female  is  in  this  condjj;ion.  "  Very  often,"  says  Grognier, 
"  the  Mare  and  Sheep,  as  well  as  the  Cow,  manifest  signs  of  '  heat ;'  but 
the  Bull,  better  than  the  Stallion  or  Ram,  knows  the  indications  of  gesta- 
tion, and  abstains  from  having  intercourse  while  they  are  in  this  state." 
M.  Magne  remarks  that  the  Bull  accustomed  to  consort  with  pregnant 
Cows,  smells  at  them  as  it  does  at  others  going  with  it,  but  without  being 
excited  by  their  emanations.  Exceptionally,  however,  it  must  be  noted 
that  Cows  have  been  known  to  manifest  oestrum  regularly,  and  to  receive 
the  Bull,  even  a  month  before  parturition.  But  these  instances  are  very 
rare.  For  cattle,  therefore,  it  is  an  almost  certain  sign  of  pregnancy 
when  the  Bull  refuses  a  Cow,  though  the  latter  may  be  in  heat. 

With  Sheep  oestrum  may  continue  after  fecundation,  and  the  Ram  may 
copulate. 

In  general  terms,  then,  it  may  be  said  that  the  cessation  of  oestrum 
before  its  regular  period,  and  soon  after  copulation,  indicates  that  con- 
ception has  taken  place  :  that  its  persistence  or  reappearance  in  the  Mare 
and  Sheep  some  time  after  the  first  copulation,  does  not  absolutely  imply 
that  impregnation  has  not  occurred,  even  though  the  male  again  consorts  ; 
but  if  it  frequently  appears  it  is  a  presumption  that  the  female  is  not  only 
not  pregnant,  but  that  fecundation  is  not  readily  induced. 

It  has  been  generally  observed  that  a  change  takes  place  in  the  char- 
acter of  the  animal  which  has  conceived,  and  this  sometimes  almost  im- 
mediately after  conception  ;  the  change  being  something  analogous  to 
that  produced  after  castration.  Mares  which  were  previously  vicious, 
troublesome,  or  unsteady  when  in  "  heat,"  are  nearly  always  gentle  and 
tractable  when  in  foal  ;  the  genital  excitement  which  caused  their  capri- 
ciousness  or  viciousness  being  allayed,  they  are  no  longer  under  its  in- 
fluence. This  change,  when  occurring  after  copulation,  is  a  valuable  sign 
of  successful  impregnation  ;  and  though  it  may  sometimes  fail,  yet  when 
present,  it  can  scarcely  lead  to  a  mistake.  If,  on  the  contrary,  the  animal 
has  not  been  fecundated  after  one  or  more  coverings,  its  vices  become 
exaggerated  when  again  put  to  the  Horse. 


GESTATION.  131 

In  the  Cow  a  similar  phenomenon  may  be  remarked,  though  it  is  not 
so  frequent  or  prominent  as  in  the  Mare. 

The  other  animals  are  seldom  so  irritable  in  their  disposition  as  to  lead 
any  one  to  notice  a  similar  change  in  them. 

A  tendency  to  fatten  is  such  a  notorious  consequence  of  impregnation, 
that  with  the  Cow  and  Sheep  graziers  usually  resort  to  it  in  order  to  get 
these  animals  in  good  condition  for  market,  when  they  are  intended  for 
slaughter.  But  this  aptitude  is  most  marked  in  the  early  months  of  ges- 
tation ;  for  in  the  Cow  towards  the  last  three  months,  and  in  the  Sheep 
and  Pig  at  the  last  month,  when  the  mammae  begin  to  enlarge,  there  is  a 
tendency  to  lose  condition.  According  to  the  butchers,  there  is  less  in- 
ternal fat,  and  the  animals  altogether  are  not  so  heavy  as  they  appear 
externally,  when  gestation  has  advanced.  It  often  happens,  particularly 
with  Cows,  that  the  appetite  is  depraved,  the  animals  eating  earth,  drink- 
ing filtljy  water,  licking  wails,  and  gnawing  innutritions  substances. 

Coincidentally  with  the  progress  of  gestation  those  animals  employed 
•  in  labor  for  speed  or  draught,  lose  their  vigor  somewhat,  particularly  to- 
wards the  end  of  gestation  ;  they  become  "soft,"  and  their  paces  slower 
and  heavier,  requiring  more  urging  to  make  them  perform  a  certain 
amount  of  work.  They,  if  Mares,  trot,  gallop,  and  jump  with  more  fatigue, 
and  yield  themselves  far  less  readily  to  inordinate  exercise  than  before : 
either  because  their  temperament  alters,  their  instinct  urges  them  to  pre- 
serve their  progeny,  or  the  foetus  itself  physically  embarrasses  them  in 
their  movements. 

But  this  is  not  always  a  sure  sign  ;  for  sometimes,  though  rarely.  Mares 
will  perform  their  work  with  the  same  energy  and  speed  as  before  concep- 
tion, even  up  to  a  very  brief  period  before  parturition  commences.  Taken 
with  other  signs,  nevertheless,  this  may  afford  assistance  in  diagnosing 
gestation. 

At  pasture.  Cattle  and  Sheep  are  more  tranquil,  and  rest  much  ;  as  do 
also  Pigs  and  Bitches  during  this  period. 

Material  Signs. 

The  material,  physical^  or  objective  signs  are  those  depending  upon  the 
change  in  volume  of  the  abdomen  and  the  mammcB,  the  appearance  of  the 
milk  in  the  latter,  alterations  in  the  composition  of  ihejirine,  and  increase 
in  weight  of  the  animal. 

The  abdomen  enlarges  in  every  direction,  and  at  the  same  time  changes 
its  shape.  It  descends  or  "  drops,"  becoming  larger  inferiorly  :  the  flanks 
become  hollow,  and  the  spine  appears  more  concave  in  the  dorso-sacral 
region ;  while  the  lateral  portions  of  the  croup  sink  so  much  as  to  make 
the  sacrum  and  haunches  towards  the  root  of  the  tail  look  more  salient. 
These  phenomena  are  progressively  developed  as  gestation  approaches 
its  term,  when  they  are  very  evident.  In  the  Mare  they  are  irregular  in 
their  appearance,  commencing  three  or  four  months  after  conception,  and 
do  not  possess  the  same  value  in  every  instance ;  for  there  are  some 
animals  in  which  the  abdomen  is  scarcely  at  all  unusually  developed,  and 
particularly  the  Mare,  which  is  primiparous,  until  near  parturition  ;  and 
others,  generally  those  at  pasture,  or  which  have  had  a  number  of  foals, 
that  always  have  the  belly  considerably  developed  and  pendulous,  and  in 
which  it  is  difficult  to  perceive  any  increase,  even  when  they  are  in  foal. 

Besides,  some  diseased  conditions — as  ovarian  dropsy,  uterine  polypus, 


132  OBSTETRICAL  PHYSIOLOGY. 

hydrometra,  ascites,  etc. — may  give  rise  to  amplification  of  the  abdomen  ; 
and  it  must  not  be  forgotten  that  Mares  fed  on  poor  fibrous  forage  not 
unfrequently  have  the  belly  enlarged.  So  that  of  itself  this  is  not  at  all 
a  sure  criterion  of  pregnancy. 

Taken  in  connection  with  the  other  signs,  however,  the  increase  in  the 
abdomen — most  marked  towards  its  inferior  third,  and  becoming  evident' 
towards  the  fifth  or  six  month  of  pregnancy — has  a  certain  value.  It  is 
most  noticeable,  perhaps,  in  looking  at  the  animal  from  behind  ;  though 
repeated  examinations  at  various  intervals  may  be  necessary  to  ensure 
certainty,  and  in  important  cases  recourse  may  even  be  had  to  measure- 
ment of  the  abdomen. 

The  enlargement  of  the  fnammce  is  a  sign  which  varies  considerably  in 
different  species,  according  to  the  condition  of  the  females.  In  primipar- 
ous  animals,  as  the  Mare  and  Cow,  they  begin  to  increase  soon  after 
conception — ^towards  the  second  or  third  month.  The  udder  is  more 
prominent  and  firm  to  the  touch,  loses  its  wrinkles,  and  the  teats  are 
more  visible.  This  appearance  is  generally  only  ephemeral  and  par- 
tially disappears,  to  reappear  again  more  markedly  after  some  weeks ; 
then  to  subside  and  show  itself  several  times  during  the  process  of  ges- 
tation. 

Besides  this  mammary  enlargement  in  the  primiparae,  and  which  may 
be  accepted  as  a  certain  indication,  these  glands  furnish,  towards  the 
last  third  of  the  period  of  gestation,  a  yellow,  viscid,  transparent  liquid — 
the  colostrum — similar  to  white  of  e^g,  and  which  can  be  easily  extracted 
from  the  teats  by  milking.  In  the  last  weeks  of  pregnancy  this  liquid 
sometimes  become  white  and  opaque,  as  we.i  as  less  viscid,  and  is  then 
milk.  When  the  animals  have  bred  several  times,  the  increase  in  the 
size  of  the  udder  is  only  remarked  in  the  last  days  of  gestation.  In  milch 
Cows,  and  particularly  in  those  which  are  not  good  "  milkers,"  another 
sign  is  to  be  found  in  the  diminution  of  the  lacteal  secretion,  and  the 
shrinking  of  the  gland  some  time  after  conception — usually  about  the 
twentieth  day. 

In  the  pregnant  Mare  which  still  has  a  foal  running  with  her,  the  se- 
cretion of  milk  also  ceases  some  time  before  parturition,  and  the  animal 
appears  to  be  aware  of  this,  for  it  weans  the  foal  generally  between  the 
sixth  and  eighth  month. 

In  the  smaller  animals,  the  enlargement  of  the  mammae  and  the  appear- 
ance of  the  milk  are  usually  remarked  earlier,  and  more  regularly,  than 
in  the  larger  creatures. 

Though,  in  a  natural  state,  the  mammary  glands  are  only  intended  to 
furnish  aliment  to  the  young  creature  until  it  is  sufficiently  strong  and 
active  to  find  its  own  food,  when  they  suspend  their  function  ;  yet  domes- 
tication has  greatly  modified  their  secretory  power  in  some  species — as 
with  the  Cow,  Goat,  and  sometimes  the  Ass  and  Sheep — and  the  secretion 
of  milk  becomes  an  almost  permanent  office.  Not  only  this,  but  at  times 
the  secretion,  as  observed  in  the  unimpregnated  Bitch,  is  very  anomalous 
and  unnatural.  In  the  non-pregnant  female  of  various  species — not 
excepting  the  human  species — the  secretion  may  appear  naturally  or  be 
induced  by  mulsion  or  frequently  repeated  suction  of  the  teats,  even  in 
very  young  creatures,  a  short  time  afterbirth  ;  and  what  is  more  astonish- 
ing, male  animals  have,  in  rare  instances,  assumed  a  function  which 
is  alv/ays  looked  upon  as  specially  characteristic  of  the  female  sex  at  the 
maternal  period.     So  early  as  the  days  of  Aristotle — who  mentions  a  he- 


GESTA  TION. 


133 


goat  which  yielded  milk,  this  strange  phenomenon  has  been  at  times 
observed  ;  and  M.  Lecoq  testifies  to  an  ox,  in  process  of  fattening,  having 
the  four  rudimentary  mammae  increased  in  volume  and  yielding  milk 
which  furnished  cream,  and  became  casein  when  an  acid  was  added  to  it. 

Certain  alterations  in  the  composition  of  the  tcrine  have  been  reported  by 
M.  Keiner  of  Gunsback,  which,  with  other  circumstances,  might,  if  found 
to  be  trustworthy,  be  valuable  as  an  aid  to  the  diagonsis  of  pregnancy. 
He  has  discovered  that  the  salts  of  lime  in  the  urine  diminish  in  pro- 
portion as  the  foetus  requires  these  for  the  formation  of  its  bones  ;  and 
his  discovery  has  been  tested  by  a  chemist  whose  analysis  of  this  fluid, 
obtained  from  a  pregnant  mare,  shows  that  the  lime  lessens  very  much  as 
the  time  for  parturition  draws  nigh.  At  the  fifth  or  sixth .  month  it  is 
diminished  fifty-five  per  cent.,  and  to  seventy  per  cent,  from  the  sixth  to 
the  ninth  month. 

It  has  been  proposed  to  weigh  animals  which  are  suspected  to  be  preg- 
nant, at  certain  intervals  ;  an  increase  in  weight  being  an  evident  accompa- 
niment of  growth  in  the  foetus.  In  this  direction,  Rueff  has  recorded 
that  Mares,  towards  the  fourth  or  fifth  month  of  pregnancy,  have  shown 
an  average  increase  in  weight  of  more  than  eleven  pounds  in  eight  days, 
and  he  particularly  recommends  this  aid  to  diagnosis,  which  appears  to 
be  most  useful  at  mid-term. 

It  may  be  noted  as  an  additional  aid  to  diagnosis,  that  with  the  pro- 
gress of  gestation  the  mucous  membrane  lining  the  vulva  and  vagina 
becomes  swollen,  and  assumes  a  red  or  bluish-red  hue,  instead  of  !ts  • 
usual  pink  color  ;  and  towards  the  termination  of  pregnancy,  the  secre- 
tion of  vaginal  mucus,  particularly  in  the  Cow,  is  largely  increased. 


All  these  numerous  signs  are  by  no  means  to  be  implicitly  relied  upon, 
^however,  as  they  are  not  infallible  in  proving  the  existence  of  pregnancy 
fin  every  case  ;  some  of  them  are  only  noticeable  at  a  late  period,  while 
[Others  may  be  absent.  It  is  necessary  in  taking  them  into  consideration, 
jto  distinguish  those  animals  which  are  kept  at  pasture  and  destined  for 
[breeding,  from  those  which  are  kept  in  the  stable  and  used  for  various 
[purposes.  With  the  first,  the  cessation  of  oestrum  and  the  refusal  of  the 
smale  are  almost  certain  indications  of  conception  ;  while,  with  the  latter, 
[the  same  phenomena  may  be  the  result  of  fatigue  or  bad  food  and  man- 
fagement. 

With  regard  to  fattening,  change  of  temper,  etc.,  it  is  evident  that  they 
^may  depend  upon  other  causes  than  gestation  ;  and  the  obesity  can  only 
i'be  very  conspicuous  in  primiparous  animals,  or  those  which  are  not 
rearing  young  ;  for  Mares  or  other  creatures  put  to  the  male  a  few  days 
Rafter  parturition,  are  not  likely  to  accumulate  fat  and  rear  their  progeny 
iat  the  same  time.  When,  however,  all  the  above  signs  are  manifest  in 
an  animal,  they  establish  a  very  strong  presumption,  though  not  an 
absolute  certainty,  as  to  its  condition.  It  is  not  until  a  latter  period, 
when  the  abdomen  begins  to  increase  more  rapidly  in  volume,  the  an- 
[imals  become  sluggish,  and  the  mammas  enlarge  and  secrete  the  oleagin- 
ous fluid  just  described,  that  the  existence  of  pregnancy  might  safely  be 
[affirmed. 

The  chances  of  error  in  diagnosing  pregnancy  in  the  first  half  of  the 
: period  are  numerous,  and  even  up  to  a  later  stage — until  parturition,  in 
fact — these  indicative   signs  may  be  absent.     I  know  of  an   instance  in 


134  OBSTETRICAL  PHYSIOLOGY. 

which  an  unfortunate  Mare  was  ridden  to  hounds  until  the  day  before  it 
gave  birth  to  a  dead  foal,  and  died  itself. 

Sensible  Signs. 

To  obviate  as  much  as  possible  the  risks  of  error  in  diagnosing  preg- 
nancy, various  expedients  have  been  devised  and  resorted  to,  in  order  to 
ascertain  with  certainty  the  presence  of  the  foetus  in  the  uterus.  Some  of 
these  are  as  barbarous  as  they  are  stupid.  One  especially  merits  the 
strongest  condemnation  ;  this  is  pouring  water  into  the  ears  of  the  Mare 
or  Cow,  under  the  supposition,  that  if  the  animal  is  not  pregnant  that  it 
will  shake  its  whole  body  to  get  rid  of  the  fluid,  but  if  pregnant  that  it  will 
only  shake  the  head  and  ears.  Another  cruel  and  dangerous  test  is  caus- 
ing these  animals,  but  especially  the  Mare,  to  run  very  quickly  for  a  cer- 
tain time,  and  to  give  them  cold  water  to  drink  or  oats  to  eat  immediately 
afterwards,  in  order  to  excite  inordinate  movements  in  the  foetus.  It  will 
readily  be  understood  that  these,  and  other  vicious  practices,  are  very 
likely  to  produce  abortion,  and  that  they  should  therefore  be  discounte- 
nanced and  discontinued.  The  only  useful  and  practicable  means  that  can 
be  resorted  to,  are  those  which  appeal  to  the  senses  of  touch,  sight,  and 
hearing.  But  it  must  be  remarked  that  these  have  fewer  opportunities  for 
their  exercise,  and  are  more  limited  in  their  application,  in  animals  than 
in  woman. 

To  feeling  or  touching,  watching  the  movements  of  the  foetus  as  they 
are  manifested  externally,  and  auscultation,  we  must  mainly  rely,  and 
these  afford,  with  the  other  signs,  the  only  conclusive  evidence  we  can 
obtain. 

The  indications  obtainable  by  manual  exploration  are  through  the  ab- 
dominal., rectal,  and  vagi7ial  touch.  The  feel  of  the  abdomen  does  not 
yield  equally  certain  results  in  all  the  domesticated  animals.  In  those 
which  are  small,  as  the  Bitch  and  Cat,  a  little  careful  manipulation  will 
render  the  presence  of  the  creatures  ///■  iitero  very  evident  towards  the 
middle  period  of  gestation  ;  but  in  the  larger  .animals — the  Mare  and  Ass 
on  the  one  hand,  and  the  Cow  on  the  other — there  exist  considerable  dif- 
ferences, as  pointed  out  by  Trasbot.  * 

With  the  Cow,  after  the  fifth  or  sixth  month,  the  presence  of  the  foetus 
can  be  readily  ascertained  by  this  means  ;  but  in  solipeds,  it  is  not  until 
the  seventh  or  eighth  month  that  the  same  information  can  be  derived  ;  and, 
besides,  it  is  not  always  easy  to  apply  this  mode  of  investigation  to  these 
animals,  from  their  fidgetiness.  It  is  better  to  examine  the  animal  when  it 
is  standing,  as  the  signs  are  not  so  jDerceptible  when  it  is  recumbent.  The 
examiner  stands  on  the  right  side  of  the  Cow,  the  left  of  the  Mare,  with 
his  back  towards  the  animal's  head,  and  applies  the  palm  of  his  right  or 
left  hand  against  the  abdomen,  immediately  below  the  flank,  and  about 
eight  or  ten  inches  in  front  of  the  stifle,  and  just  above  the  udder,  press- 
ing moderately,  the  other  hand  resting  on  the  back.  At  this  part  of  the 
abdomen  a  hard  voluminous  mass  can  be  felt  in  the  uterus,  while  the 
movements  of  the  foetus  are  perceptible,  as  it  stirs  at  irregular  intervals, 
and  causes  the  jerks  and  shock  of  its  displacements  to  be  communicated 
to  the  walls  of  the  abdomen.  These  movements  are  strongest  in  the 
morning,  and  are  more  distinct  if  the  mother  is  eating  or  drinking,  espe- 
cially if  the  water  is  cold,  or  immediately  after  feeding.  Some  old  authori- 
ties recommend  that,  to  render  the  movements  of  the  foetus  more  percept- 
ible, the  Mare  should  be  trotted,  then  put  in  the  stable  and  given  some 


GESTA  TION.  135 

food,  and*  then,  by  placing  the  hand  on  the  before-mentioned  region,  the 
foal  will  be  felt  if  it  is  there.  The  dilatation  of  the  stomach  by  food  com- 
presses the  other  abdominal  organs,  and  especially  the  uterus,  and  the  in- 
convenient displacement  excites  the  young  creature  to  movement.  The 
ingestion  of  fluids  does  the  same,  and  particularly  if  they  are  cold  ;  for  then 
they  powerfully  affect  the  foetus  by  the  uncomfortable  sensation  they 
give  rise  to.  Cold  water  thrown  against  the  belly,  or  the  application  of 
the  cold  wet  hand,  will  produce  a  similar  effect.  In  the  Cow,  smart  com- 
pression of  the  abdomen  with  the  closed  fist,  at  the  part  just  indicated,  so 
as  to  push  the  uterus  upwards  and  allow  it  to  return  with  a  little  force,  is 
also  a  good  method  of  ascertaining  the  presence  of  the  foetus,  and  will 
prove  successful  when  simple  application  of  the  flat  of  the  hand  \s\\\  fail. 
It  is  most  likely  to  succeed  when  there  is  not  much  food  in  the  stomach 
and  intestines  ;  as  the  uterus  is  then  much  easier  displaced.  When  this 
compression  has  been  made  with  some  energy,  the  -uterus  strikes  the  ab- 
dominal wall  immediately  afterwards,  and  then  there  can  be  perceived  a 
firm  voluminous  mass  ;  this  is  the  uterus  containing  the  foetus. 

At  a  more  advanced  period,  in  the  last  two  months,  the  movements  of 
the  foetus  can  be  easily  remarked  as  it  jumps  about  briskly,  striking  the 
interior  of  the  abdomen  at  brief  intervals.  This,  and  the  other  signs 
appreciable  at  this  time,  leaves  no  doubt  as  to  the  existence  of  pregnancy. 
The  fcetal  movements  are  never  more  marked  and  precipitous  than  imme- 
diately before  abortion,  at  a  late  period  of  gestation ;  they  are  then  ener- 
getic, and  to  all  appearance  convulsive. 

With  the  smaller  animals  the  same  methods  of  exploration  may  be 
resorted  to,  and  with  the  same,  or  even  more  marked  results.  The  per- 
ceptible movements  of  the  foetus  of  course  settles  the  question  as  to  preg- 
nancy and  the  vitality  of  the  young  creature  ;  but  their  absence  is  not 
conclusive  as  to  the  contrary,  for  it  has  not  unfrequently  happened  that 
the  foetus  remained  insensible  to  this  kind  of  excitation,  and  yet  was  alive 
at  birth.  The  tests  should  be  applied  more  than  once  in  these  doubtful 
cases. 

It  may  be  noted  that  the  "  feel  "  of  the  abdomen  distended  by  the  uterus, 
is  very  different  when  the  distention  is  caused  by  fluid,  flatus,  etc.  The 
uterine  tumor  is  firm,  hard,  elastic,  and  defined,  preserving  its  form  in  all 
positions  of  the  body ;  whereas  in  ascites  the  defined  tumor  is  wanting, 
there  is  no  repercussion  on  compression  at  the  flank  of  the  Cow,  the  fluid 
obeys  the  laws  of  gravitation,  and  the  abdomen  has  not  the  same  firm, 
elastic  feel.  Percussion  will  aid  in  distinguishing  between  pregnancy  and 
tympanitis.  In  certain  diseased  conditions  of  the  uterus,  however,  a 
diagnosis  is  very  difficult,  and  the  next  means  of  exploration  will  have,  in 
some  of  these  embarrassing  cases,  to  be  adopted. 

Rectal  exploration^  as  well  as  that  by  the  vagina,  can  only  be  successfully 
carried  out  in  the  larger  animals,  because  of  the  small  dimensions  of  these 
passages  in  such  creatures  as  the  Bitch  and  Cat.  The  risks  attending  this 
mode  of  examination  have  been  at  times  much  exaggerated,  and  there  is 
really  but  little  danger  to  the  animal  so  long  as  reasonable  precautions  are 
taken  not  to  produce  injury  ;  the  foetus  has  even  been  pushed  gently  about 
in  the  uterus  without  any  accident  to  it  or  the  parent.  After  the  third 
month  it  will  afford  an  indication  of  pregnancy. 

To  examine  an  ■3ccavi\2X  per  rectum  it  should  be  standing,  and,  if  dangerous 
or  irritable,  the  twitch  may  be  applied  to  the  nose,  or  for  safety  to  the 
operator  the  hind  limbs  must  be  secured  ;  with  the  Cow  the  nose  seized  by 


13^  OBSTETRICAL  PHYSIOLOGY. 

one  hand  of  an  assistant  and  a  horn  by  his  other  hand,  will  be  sufficient. 
The  bowel  should  be  emptied  of  the  fseces  it  may  contain,  so  as  to  allow  the 
oiled  hand  and  arm  of  the  explorer  to  be  introduced  and  freely  moved  about. 
When  the  abdomen  is  large  and  pendulous,  it  is  useful  to  place  the  animal 
higher  before  than  behind,  and  to  have  the  lower  part  of  the  belly  raised  by 
assistants  on  each  side,  by  means  of  a  sheet  or  sack,  or  even  their  hands  joined 
beneath,  so  as  to  throw  the  uterus  backwards  and  upwards  ;  though  in  the 
majority  of  cases  these  measures  are  not  necessary.  The  hand  being 
passed  into  the  rectym  to  beyond  the  brim  of  the  pubis,  it  is  opened  and 
the  palm  placed  on  the  lower  surface  of  the  intestine  and  gently  pressed 
downward,  towards  the  floor  of  the  abdomen ;  when  there  will  be  felt,  if 
the  animal  is  pregnant,  a  hard  irregular  mass,  more  or  less  voluminous 
according  to  the  stage  of  gestation,  and  capable  of  being  displaced  to  a 
certain  extent — even  partially  brought  into  the  pelvis,  if  parturition  is 
near.  In  this  case,  the  head  or  other  parts  of  the  foetus  can  be  distin- 
guished through  its  envelopes  and  the  uterine  and  rectal  walls.  But  if 
pregnancy  is  not  so  advanced, — say  only  at  the  sixth  month,  the  foetus 
cannot  be  so  readily  felt,  and  it  may  happen  that  at  this  period  it  is 
situated  low  down  in  the  abdomen,  or  well  forward  in  one  of  the  horns 
of  the  uterus,  and  lying  to  one  side  of  the  mesial  line  (nearly  always  to 
the  right  in  the  Cow)  ;  so  that  an  inexperienced  or  careless  examiner 
might  miss  it  altogether  at  the  first  exploration.  This  error  can  be 
avoided  by  carefully  moving  the  introduced  hand  to  the  right  and  left  as 
far  as  the  intestine  will  permit,  with  the  animal's  body  inclined  backwards 
and  the  belly  raised  by  assistants,  as  just  described.  The  foetus  should 
be  excited  to  move,  if  possible,  so  as  to  guarantee  its  presence. 

The  difficulties  are  greater  if  it  is  desired  to  know  whether  the  foetus  is 
alive  or  dead.  Sometimes  we  may  at  once  perceive  the  movements  of 
the  young  creature  in  the  uterus  ;  but  at  other  times  it  is  motionless,  and 
cannot  be  made  to  exert  itself  except  by  moving  and  pushing  it  several 
times.  This,  however,  is  not  commendable,  unless  performed  with  the 
greatest  gentleness  and  care  ;  and  if  there  is  nothing  urgent,  it  would  be 
preferable  to  make  an  examination  at  another  time,  rather  than  incur 
the  dangerous  results  that  might  follow  this  manipulation. 

The  prominences  of  the  foetus  might  be  mistaken  for  the  hard  masses 
of  fasces  lodged  in  the  intestines  ;  but  a  distinction  can  generally  be  made 
by  the  rapidity  with  which  these  prominences  appear  and  disappear 
through  the  sudden  movements  of  the  young  creature,  compared  with 
the  slow,  regular,  peristaltic  motion  of  the  intestine  and  its  fecal  con- 
tents. 

Vaginal  exploration,  as  mentioned,  can  only  be  practised  on  the  larger 
animals.  It  is  not  attended  with  any  more  danger  than  the  rectal 
examination  ;  but  though  it  is  of  great  value  in  woman,  especially  when 
hallottement*  is  resorted  to,  yet  it  is  not  nearly  so  useful  in  animals  ;  for 
in  consequence  of  their  horizontal  position,  this  repercussion  is  not  possi- 
ble. Neither  is  it  so  valuable  as  the  exploration/d-r  rectufn.  It  is  practised 
with  the  animal  in  the  same  position  as  for  the  last-named  examination, 

*  The  ballottement  or  repercussion  to  ascertain  the  presence  of  a  fcEtus  in  woman,  is  produced  by  the 
operator  placing  his  patient  in  the  upright  position,  or  if  in  bed,  raising  her  shoulders.  The  forefinger  is 
then  introduced  into  the  vagina  and  placed  on  the  cervix  uteri,  while  the  other  hand  is  employed  to  keep 
the  uterine  tumor  steady;  then  suddenly  but  slightly  jerking  upwards  the  point  of  the  introduced  finger,  a 
sensation  is  experienced  of  something  having  receded  from  it,  and  which  he  will  perceive  to  fall  again  on 
the  point  of  his  finger  in  a  moment  or  two.  The  jerk  of  the  finger  upon  the  head  of  the  foetus  causes  it  to 
float  upwards  a  little  in  the  liquor  amnii,  and  its  weight  makes  it  descend  again.  We  have  seen  that  a  kind 
of  external,  or  flank  ballottement,  can  be  practised  in  the  Cow. 


J 


GESTATION.  ,3^ 

and  the  hand,  well  lubricated  with  soft  soap  or,  better  still,  with  olive  oil, 
is  inserted  into  the  vagina  as  far  as  the  cervix  uteri.  In  the  first  months 
of  gestation  the  uterus  descends  into  the  abdomen;  consequently,  the 
vagina  is  longer  and  more  inclined  downwards  in  front :  while  the  foetus 
is  beyond  reach  of  the  hand.  Towards  the  fifth  or  sixth  month,  the 
uterus,  in  expanding  in  every  direction,  approaches  the  vulva,  and  the 
canal  of  the  vagina  being  shortened,  it  can  be  perceived  in  the  pelvic 
cavity.  The  same  manipulatory  manoeuvres  as  were  practised  in  the 
rectum,  may  be  employed  in  the  vagina  at  this  time,  but  the  results  are 
far  from  being  so  satisfactory  ;  the  vaginal  examination  should,  therefore, 
never  be  preferred  to  that  by  the  rectum. 

Ballottement  may  be  resorted  to  in  the  smaller  animals,  by  placing 
them  in  a  vertical  position  ;  but  the  other  signs  of  pregnancy  are  usually 
so  manifest  in  them,  that  generally  there  is  little  difficulty  in  diagnosing 
their  condition. 

Auscultation  has  not  been  much  employed  in  the  diagnosis  of  preg- 
nancy in  the  lower  animals,  though  its  value  in  woman  is  undeniable  ;  as 
since  its  introduction  by  M.  Mayor,  of  Geneva,  in  18 18,  its  utility  has 
been  frequently  and  successfully  put  to  the  test,  not  only  to  ascertain 
whether  there  was  a  foetus,  but  also  whether  it  was  alive.  In  woman, 
either  the  uncovered  ear  or  the  stethoscope  is  applied  to  the  abdomen  ; 
the  latter  is  generally  preferred,  as  by  it  the  sound  is  limited,  as  well  as 
defined. 

The  piilsatio7i  of  the  fcEtal  heart  ox  double  batteinent,  consists  of  a  rapid 
succession  of  short,  regular,  double  pulsations,  differing  from  those  of  the 
adult  heart  in  rhythm  and  frequency  ;  the  sound  being  like  the  muffled 
ticking  of  a  watch,  or  the  pulsations  of  the  heart  of  a  new-born  child.  In 
addition  to  the  sounds  of  the  foetal  heart,  there  is  also  the  uterine  souffle 
or  placental  bruit,  CAused  by  the  blood  passing  through  the  greatly  en- 
larged vessels  of  the  uterus,  particularly  at  the  part  to  which  the  placenta 
is  attached  ;  it  is  an  intermittent  whirling  sound,  heard  at  an  early  period 
of  pregnancy,  and  usually  regarded  ^s  one  of  its  most  unequivocal  signs. 
There  is,  in  addition,  the  pulsation  of  the  umbilical  cord  ox  fmie  souffle, 
heard  in  certain  favorable  positions  of  the  foetus;  it  is  synchronous  with 
the  fcetal  pulsations. 

In  the  larger  animals,  ascultation  of  the  abdomen  for  the  purpose  of 
discovering  the  existence  of  these  sounds  is  generally  unsuccessful, 
because  of  the  intestinal  walls,  the  rumblings  and  noises  of  the  intestines, 
and  those  of  the  rumen  in  the  Cow,  which  entirely  mask  the  bruits  of  the 
foetus ;  so  that  it  is  seldom,  if  ever,  resorted  to.  Lafosse  and  others, 
however,  have  resorted  to  it,  and  apparently  with  satisfactory  results. 
Lafosse  states  that,  on  several  occasions,  he  heard  the  pulsations  of  the 
foetal  heart  very  distinctly  in  Cows  which  were  six  months  pregnant; 
though  he  also  asserts  that  they  cannot  ahvays  be  perceived  on  ausculta- 
tion. Hollmann  likewise  mentions  that  he  has  often  heard  these  foetal 
beats,  which  varied  from  113  to  128  per  minute,  those  of  the  Cow  being 
64  to  70,  and  were  not  markedly  influenced  by  the  state  of  the  mother's 
health ;  he  acknowledges  that  they  cannot  be  heard  in  every  instance, 
even  towards  the  end  of  pregnancy.  Saake,  using  the  stethoscope  in  the 
right  iliac  region,  in  front  and  a  little  above  the  crural  arch,  recorded  the 
number  of  beats  of  the  foetal  heart  from  the  twenty-fifth  week  up  to  two 
hours  before  birth,  though  he  was  certain,  from  their  distinctness,  that 
they  might  have  been  heard  earlier.  .  In  number  they  varied  from  126  to 
128  per  minute,  the  mother's  pulse  being  68  to  84. 


138  OBSTETRICAL  PHYSIOLOGY. 

Rainard,  Trasbot,  and  others,  have  not  succeeded  in  detecting  these 
sounds  ;  and  I  have  on  several  occasions  practised  auscultation  on  preg- 
nant Mares,  but  have  failed  to  distinguish  the  foetal  pulsations. 

But  there  is  no  reason  why,  as  suggested  by  M.  Trasbot,  the  uterus 
should  not  be  auscultated  from  the  cervix,  by  a  long  special  stethoscope 
— or  rather  "  metroscope  " — introduced  by  the  vagina,  and  its  wide  end 
resting  on  the  cervix.  The  intestinal  noise  would  be  evaded  in  this  way, 
and  the  fluids  surrounding  the  foetus  being  good  conductors  of  sound,  the 
beats  of  his  heart  should  be  distinctly  heard,  if  it  is  alive.  Nauche,  so 
long  ago  as  1826,  and  Verardini,  in  187 1,  have  spoken  strongly  in  favor 
of  this  iiitra-vdgina  auscultation  in  the  human  species. 

From  what  has  been  said  of  the  signs  of  pregnancy,  it  will  be  perceived 
that,  in  the  early  period  of  this  condition,  there  is  but  little  more  than 
supposition  to  guide  us,  the  presumptions  becoming  stronger  as  the 
physical  and  other  indications  are  more  marked.  It  is  only,  however, 
towards  the  middle  period,  when  all  the  rational  and  physical  signs  are 
present,  and  when  the  condition  of  the  uterus  has  been  ascertained  by 
the  exploratory  manoeuvres  above  described,  that  we  can  affirm,  without 
the  danger  of  error,  the  existence  of  pregnancy.  And  when  a  doubt 
chances  to  prevail  at  this  stage,  it  is  well  to  remember  that  this  condition 
may  exist  without  being  accompanied  by  very  evident  signs,  and  that  a 
hasty  conclusion  must  not  be  drawn.  When,  for  instance,  some  rational 
signs  present  give  rise  to  the  presumption  that  an  animal  is  pregnant,  but 
no  physical  indication  reveals  this  state,  the  examinations  must  be  re- 
peated before  a  final  decision  is  arrived  at.  The  value  of  experience" 
and  observation,  when  added  to  theoretical  knowledge,  is  well  displayed 
in  this  branch  of  veterinary  science.  Not  unfrequently  the  diagnosis  of 
pregnancy  is  surrounded  by  great  difficulties,  and  a  guarded  opinion 
must  be  given. 

SECTION    IV. DURATION    OF   PREGNANCY. 

The  duration  of  pregnancy  varies*  considerably  in  different  species  of 
the  domesticated  animals  \  and  even  in  the  same  species,  there  are  indi- 
vidual variations  which,  though  not  very  great,  are  yet  important.  From 
the  doe  Rabbit,  which  carries  its  young  only  twenty-eight  to  thirty  days, 
to  the  female  Elephant,  whose  period  of  pregnancy  is,  according  to 
report,  two  years,  there  are  a  number  of  intermediate  terms  ;  and  it  is 
scarcely  possible  to  establish  a  satisfactory  relationship  between  the 
duration  of  gestation  and  the  other  conditions  of  organization — such  as 
size  or  longevity.  In  closely  allied  species,  and  which  may  couple  and 
produce  hybrids — as  the  Horse  and  Ass,  Sheep  and  Goat — the  period  is 
pretty  nearly  the  same. 

With  regard  to  breeds,  Wilhelms  has  remarked  that  the  Hungarian 
Cow  av,erages  ten  days  more  than  the  Dutch  Cow.  With  a  male  foetus, 
the  duration  of  gestation  is  greater  than  in  the  case  of  a  female.  It  has 
even  been  remarked  that  the  male  parent  may  have  an  influence  in  this 
direction.  For  instance,  a  Mare  which  has  been  put  to  a  thorough-bred 
Horse  will  be  longer  pregnant  than  when  impregnated  by  a  common- 
bred  stallion  ;  and  the  Mare  which  has  been  fecundated  by  a  stallion 
Ass  goes  longer  than  when  put  to  a  Horse.  The  duration  of  pregnancy 
also  depends  upon  the  age  of  the  female,  and  her  strength  and  condition  ; 
a  weakly  or  worn  animal  does  not  go  so  long  as  one  which  is  strong  and 
well  fed. 


GESTA  TION. 


139 


The  differences  in  individuals  of  the  same  breed  or  species  may  be 
partly  accounted  for  by  the  fact,  that  impregnation  is  possible  at  any 
time  during  oestrum — a  variable  period  ;  and  if  coitus  has  taken  place 
several  times  during  this  condition,  it  is  impossible  to  predict  when  con- 
ception took  place.  And  even  when  contact  has  only  occurred  once 
between  the  male  and  female,  fecundation  does  not  necessarily  coincide 
with  this  intercourse  ;  as  the  ovule  may  meet  the  spermatozoa  in  differ- 
ent regions  of  the  uterine  system,  and  may  therefore  only  be  fertilized 
some  days  after  copulation.  The  time  required  for  the  ovule  to  pass 
through  the  Fallopian  tube  also  varies  in  different  animals.  In  the 
Rabbit  and  Guinea-pig,  for  instance,  it  takes  three  days  ;  in  Ruminants 
from  four  to  five  days,  and  in  the  Bitch  from  eight  to  ten  days. 

And,  as  has  been  remarked,  various  circumstances  may  retard  or 
accelerate  the  development  of  the  foetus  ;  not  only  this,  but  with  some 
animals  it  may  apparently  remain  for  a  number  of  days  in  the  uterus 
after  it  is  ready  for  birth,  without  inconvenience  to  the  mother  or  itself, 
just  as  it  may  be  born  several  days  before  the  ordinary  period  without 
compromising  its  safety. 

For  these  reasons,  the  period  of  gestation  can  only  be  approximately 
fixed,  though  there  are  of  course  limits  beyond  which  Nature,  ever 
provident  and  watchful   for  the  preservation   of  species,  cannot  go  with 


ceasing  to  be  natural. 


Mare. 


The  usual  period  of  gestation  with  the  Mare  is  eleven  mo?iths,  though  it 
may  vary  between  ten  and  twelve. 

From  the  observations  of  Winter,  Brugnone,  Tessier,  and  Grille,  in 
284  Mares,  it  results  that  the  shortest  period  of  gestation  in  this  animal 
was  307  days,  and  the  longest  394  days — or  a  mean  duration  of  346  days. 

Gayot,  in  25  instances  noted  at  the  Haras  of  Pin,  France,  found  the 
average  to  be  343^  days  ;  the  shortest  being  324  days,  and  the  longest 
367  days. 

A  writer  in  the  Jourjial  d' Econofnie  rurale  beige  for  1829,  cited  by 
Rainard,  gives  as  the  minimum  322  days,  maximum  419  days,  the  aver- 
age being  347  days. 

Colin  gives  the  average  as  345  days,  though  birth  may  occur  at  the 
330th  to  365th,  and  sometimes  to  the  380th  day. 

Dieterichs  gives  the  shortest  period  as  307  to  317  days,  and  the  longest 
as  409  to  419  days — the  average  being  336  to  342  days.  Baumeister 
and  Rueff  give  a  minimum  of  330  days,  or  eleven  months,  the  maximum 
as  420  days,  or  fourteen  months* — the  average  as  340  days,  or  11^ 
months. 

With  regard  to  the  influence  of  breed  on   the  duration  of  pregnancy, 

*  H^mon  {Recueil  de  Med.  Veterinaire,  1867)  alludes  to  the  case  of  a  Mare  seven  years  old,  which 
went  beyond  her  ordinary  period  of  pregnancy,  only  manifesting  at  the  usual  time  the  customary  signs  of 
foaling  ;' though  these  soon  ceased,  but  recurred  again  in  fifteen  days,  only  to  disappear  in  a  short  time. 
After  this  interval  the  animal  appeared  to  be  quite  well,  feeding  and  working  as  before.  At  the  seventeenth 
month  of  pregnancy  she  was  in  the  same  condition  ;  but  on  the  fifteenth  day  of  the  eighteenth  month, 
she  was  siezed  with  serious  symptoms  which  continued  during  four  days,  when  death  ensued.  Hamon 
examined  the  body  in  the  presence  of  many  people,  who  were  much  interested  in  the  case,  and  discovered 
a  foal  which  weighed  75  kilogrammes,  and  was  as  fat  and  fresh-looking  as  if  it  had  been  extracted  at  the 
normal  period.  The  tongue  protruded  from  the  mouth,  the  eyes  were  almost  gone,  the  muscles  were  well 
developed  but  somewhat  bloodless,  and  the  position  of  the  foetus  was  natural.  The  umbilical  cord  had  the 
same  aspect  as  in  ordinary  cases,  but  there  was  no  Wood  in  its  vessels,  and  it  was  ruptured  at  five  or  six 
centimetres  from  the  abdominal  walls.  The  foetal  envelopes  were  hypertrophied,  their  total  thickness  being 
four  to  five  centimetres;  otherwise  they  were  healthy.  The  cervix  uteri  was  of  a  great  thickness  and 
very  rigid  ;  when  dilated  it  would  only  allow  the  passage  of  the  list.    The  liquor  aninii  was  reddish-colored. 


I40  OBSTETRICAL  PHYSIOLOGY. 

we  have  the  researches  of  Baumeister  and  Rueff ;  from  these  it  appears 
that,  with  pure-bred  Persian  Mares,  the  gestation  period  was  341  days — 
343  for  male  foals,  and  -^t,^  for  females  ;  in  thorough-bred  Arab  Mares, 
the  average  was  338  days — 339  for  males  337  for  females  ;  in  high-bred 
Russian  Mares,  some  of  which  belonged  to  the  Orloff  race,  the  average 
duration  was  3415^  days — 341  for  males  and  342  for  females.  With 
English  Mares,  they  found  that  in  half-breeds  the  average  was3395^  days 
— 340  for  males,  and  339  for  females. 

Saint-Cyr,  referring  more  particularly  to  Gayot's  observations,  arrives 
at  the  following  conclusions  : 

1.  That  in  the  Mare,  the  normal  duration  of  pregnancy  may  be  fixed 
between  340  to  350  days — this  being  the  interval  in  which  the  majority 
of  foals  are  born. 

2.  Some  foals  may  be  born  alive  from  the  300th  to  the  310th  day,  but 
this  is  rare. 

3.  Births  are  frequent  between  325  and  340  days  • 

4.  They  are  not  rare  from  350  to  365  days,  but  they  are  indeed  so 
after  the  latter  period. 

5.  We  may  consider  300  to  400  days  as  the  extreme  limits  within  which 
normal  gestation  occurs  in  the  Mare  ;  below  or  beyond  these  it  ceases  to 
be  natural  and  really  physiological. 

6.  According  jto  the  researches  of  M.  Gayot,  pregnancy  is  often  a 
little  longer  for  a  colt  than  a  filly  ;  and  though  this  conclusion  is  certain- 
ly not  founded  on  a  sufficiently  large  number  of  observations,  it  never- 
theless acquires  a  certain  degree  of  probability  from  being  in  conformity 
with  what  is  observed  in  the  bovine  species. 

It  is  also  generally  admitted  that  pregnancy  is  longer  in  the  Ass  than 
the  equine  species. 

The  average  duration  of  pregnancy  with  thirty-three  thorough-bred 
Mares  which  foaled  at  the  celebrated  Middle  Park  Stud,  Eltham,  in 
1876,  I  find  on  examination  to  be  335^  days — the  shortest  periods  being 
316  days  (one  intance),  and  318  days  (one  instance)  ;  and  the  longest 
354  days  (one  instance),  and  348  days  (one  instance).  Between  the 
320th  and  330th  days  there  were  only  5  instances ;  between  the  330th 
and  340th  days  there  were  1 1  instances  ;  and  between  the  340th  and 
348th  days  there  were  15  instances.  Owing  to  some  of  the  Mares  having 
been  put  to  the  Horse  more  than  once,  and  in  some  cases  at  intervals  of 
several  days,  the  averages  may  not  be  absolutely  correct,  as  the  last 
coitus  has  been  the  one  which  is  reckoned  from.  But  with  one  Mare 
(Entremet)  put  only  once  to  the  stallion  (Rosicrucian),  the  period  was 
324  days  ;  with  another  (Hilda)  put  to  the  same  stallion,  the  period  was 
332  days  ;  and  with  another  (Imogene)  and  this  stallion,  it  was  342  days. 

With  regard  to  sex,  there  were  sixteen  colts  and  seventeen  fillies :  the 
average  gestation  period  of  the  former  was  3363^  days,  and  the  latter 
334  days.  The  shortest  period  (316  and  318  days)  was  with  fillies,  and 
the  longest  period  was  also  with  fillies  (354  and  348  days).  The  ages  of 
the  Mares  ranged  from  five  to  nineteen  years  ;  there  being  three  at  five, 
two  at  six,  three  at  seven,  two  at  nine,  two  at  ten,  six  at  twelve,  four  at 
fourteen,  four  at  fifteen,  two  at  sixteen,  one  at  seventeen,  one  at 
eighteen,  and  three  at  nineteen.  In  the  first  group,  pregnancy  averaged 
340  days;  in  the  second  350^  days;  in  the  third  328^^  days;  in  the 
fourth  34054  days  ;  in  the  fifth  336  days  ;  in  the  sixth  337  -^  days  ;  in 
the  seventh  336)^  ;  in  the  eighth  t^t^t,  days  ;  in  the  ninth  340^  days ;  in 


GESTATION.  X41 

the  tenth  324  days  ;  in  the  eleventh  330  ;  in  the  twelfth  325".  These 
figures  would  go  to  prove  that  the  period  of  gestation  decreases  with  age  ; 
and  indeed  we  find  that  the  shortest  pregnancies  occurred  in  Mares 
nineteen  years  old  (316  and  318  days),  and  the  longest  in  six  and  nine 
years  old  Mares  (354  and  348  days). 

The  animals  were  of  course  kept  in  the  most  favorable  conditions  for 
I:)reeding  ;  and  this,  with  their  splendid  qualities  and  precocity,  doubt- 
less shortened  the  period  of  gestation,  which  is  below  the  ordinary 
average. 

It  is  commonly  believed  that  the  Cow  is  pregnant  for  the  same  length 
of  time  as  woman,  and  this  is  to  a  certain  extent  correct,  so  far  as  the 
average  period  is  concerned  ;  but  there  are  variations  which  must  be 
taken  into  account,  and  which  will  be  apparent  if  we  look  at  the  published 
results  of  various  observers.  Of  1062  observations  made  at  the  Agricul- 
tural School  of  Saulsaie,  and  by  Blaine,  Tessier,  Grille,  and  Fiirstenberg, 
we  find  that  15  were  pregnant  for  less  than  241  days,  52  from  241  to  270 
days,  119  from  271  to  280  days,  544  from  271  to  300,  230  from  281  to 
290  days,  70  from  290  to  300  days,  and  32  beyond  301  days.  So  that  it 
would  appear  that,  with  the  Cow,  parturition  is  very  rare  before  the  241st 
day  ;  not  so  rare  after  the  300th  day ;  somewhat  common  from  the  240th 
to  the  270th  day;  and  quite  common  between  the  280th  and  the  290th 
day  ;  the  average  duration  of  pregnancy  being  about  283  days.  Colin 
gives  an  average  of  from  280  to  285  days,  though  birth  may  occur  at  the 
250th  to  the  300th  day,  and  even  later. 

Dieterichs  gives  the  shortest  period  as  from  210  to  226  days  ;  the 
longest  between  326  and  353  days — average,  286  days  ;  while  Baumeister 
and  Rueff  give  the  shortest  they  observed  as  240  days,  and  the  longest 
330  days — average,  285  days.  The  average  of  the  Bernese  Simmenthaler 
breed  at  Hohenheim  was  280^  days  :  male  calves  283,  and  cow  calves 
278  days. 

Earl  Spencer  has  furnished  notes  of  764  observations,  which  would  go 
to  prove  that  no  calf  can  be  born  alive  before  the  220th,  nor  after  the 
313th  day,  and  that  it  is  impossible  to  rear  those  born  before  the  24M 
day.  Those  births  which  occurred  before  the  260th  day  he  considered 
as  decidedly  premature,  while  those  which  took  place  after  300  days  were 
classed  as  irregular.  In  314  instances,  310  calved  after  the  285th  day, 
three  went  on  to  the  306th  day,  and  one  to  the  313th.  The  average 
given  is  284  to  285  days.  Among  the  calves  born  between  the  290th 
and  300th  day,  there  was  a  decided  preponderance  of  males  ;  all  those 
produced  after  the  300th  day  were  females.. 

In  the  Amerian  Joiirfial  of  the  Medical  Sciences  for  1845,  the  result  of 
observations  on  62  Cows  gives  the  longest  period  as  336  days,  and  the 
shortest  as  213  days:  the  average  for  the  male  calves  being  288  days, 
and  females  282  days. 

Cattle-breeders,  we  believe,  generally  entertain  the  notion,  notwith- 
standing Earl  Spencer's  observations,  that  gestation  is  longer  for  a  male 
than  a  female  calf. 

^  Sheep  and  Goat. 

The  Sheep  and  Goat  go  with  young  shout  Jive  months.  M.  Magna 
carefully  noted  the  pregnancy  of  429  Sheep  at  the  Alfort  Veterinary 
School  during  a  period  of  eight  years,  with  the  following  result : — 


142 


OBSTETRICAL  PHYSIOLOGY 


2  instances  of  143  days 


15 

22 

30 

55 
68 
80 


144 

145 
146 
147 
148 
149 


57  instances  of  150  days 


49 

151  " 

23 

152  " 

13 

7 

153  " 

154  " 

7 
3 

155  " 

156  " 

From  this  list  we  observe  that  the  difference  between  the  longest  and 
shortest  period  was  only  three  days,  by  far  the  largest  number  of  births 
occurring  between  the  147th  and  i5is't  days.  The  average  duration  of 
pregnancy  was  about  149  days.  Gestation  was  longer  with  the  female 
than  the  male  lambs,  and  this  Magne  attempts  to  explain  by  the  greater 
development  and  weight  of  the  former,  which  rendered  parturition  more 
difficult  and  slow. 

Colin  says  the  average  period  in  the  Sheep  is  151  to  152  days,  though 
parturition  may  take  place  from  the  145th  to  the  i6oth  day. 

Dieterichs  gives  the  shortest  period  as  146  days,  the  longest  157 — 
average,  151  days;  and  Baumeister  and  Rueff  state  the  shortest  period 
in  the  Sheep  and  Goat  as  135  days,  the  longest  160 — average,  144  days  ; 
the  male  lambs  requiring,  as  usual,  the  longest  period.  With  regard  to 
breed,  these  authorities  found  that  the  period  of  gestation  in  Merinos 
averaged  150*3  days;  while  with  Southdowns  it  was  only  i44"2  days,  or 
six  days  less. 

In  the  Merinos,  for  the  male  lamb  the  average  period  was  i5i'i  days, 
female  lamb  i5o'6  days,  and  twins  i49'9  days  ;  and  in  the  Southdowns, 
for  the  male  lamb  1447  ^^^.ys,  female  lamb  144*1,  and  twins  144  days. 

Magne  asserts  that  the  Goat  goes  a  little  longer  than  the  Sheep — the 
average  being  five  months  and  some  days. 

Pig. 

The  Pig  is  usually  pregnant/^/zr  fnonths,  or  according  to  some  author- 
ities three  months,  three  weeks,  and  three  days.  Baumeister  and  Rueff  give 
the  longest  period  as  130  days,  the  shortest  no — average,  120;  while 
Dieterichs  gives  109  days  as  the  shortest  and  133  as  the  longest — average, 
115  to  116  days  ;  and  Magne  says  that  it  is  rarely  less  than  109  or  more 
than  120  days.  Rainard  noted  the  period  of  gestation  in  65  Pigs,  and 
reports  it  to  be  as  follows  : — 

2  instances  104  days. 
10         "  no  to  115  days. 

23  "  116  to  120  days. 

27         "         121  to  125  days. 
2         "         126  days. 
I  "         127  days. 

The  average  was,  therefore,  119  days,  the  interval  between  the  longest 
and  shortest  periods  being  23  days. 

Bitch. 

The  Bitch  goes  with  young  about  two  months,  or  from  58  to  65  days  ; 
the  average  being  (>t^  days  or  nine  weeks.  Baumeister  and  Rueff  state 
the  shortest  period  to  be  55  days,  and  the  longest  70 — the  average  being 
60  days. 


The  Cat  is  pregnant  from  50  to  60,  62,  or  even  64  days,  the  average 
being  55  clays  or  eight  weeks. 

SECTION    V. GEMELLIPAROUS,    PLURIPAROUS     OR    MULTIPAROUS 

GESTATION. 

Among  the  domestic  animals  there  are  species  which  are  naturally  uni- 
parous — produce  only  one  at  a  birth ;  and  others  which,  in  a  normal  or 
physiological  manner,  bring  forth  two,  three,  or  more  at  a  time,  and  are 
therefore  designated  g3meUiparous  or  tnidtiparoiis,  gestation  being  known 
as  double,  triple,  quadruple,  etc.  As  examples  of  uniparoiis  animals,  we 
may  give  the  Mare,  Ass,  Cow,  and  Sheep  ;  while  we  may  cite  the  Pig, 
Bitch,  and  Cat  as  imiltiparous  creatures.  As  multiparity  is  normal  with  the 
latter,  we  shall  not  refer  to  them,  but  will  allude  to  those  creatures  which, 
naturally  uniparous,  sometimes  bring  forth  more  than  one  descendant  at 
a  time. 

It  is  seldom  that  twins  are  produced  by  the  larger  domesticated  animals, 
and  particularly  by  the  Mare  and  Ass,  though  instances  are  recorded  of 
these  ;  while  in  the  Cow,  Sheep,  and  Goat  the  occurrence  of  twins,  triplets, 
or  even  more  young  creatures  at  a  birth,  are  not  so  rare. 

The  causes  of  multiparity  are  not  well  ascertained.  It  may  be  due  to 
simultaneous  ripening  of  two  or  more  Graafian  vesicles,  which,  rupturing 
at  the  same  time,  allow  the  escape  of  the  ovules  they  contain,  and  which 
may  become  impregnated  at  a  single  coitus.  Or  a  Graafian  vesicle  may 
contain  two  or  more  ovules,  as  Bischoff  has  witnessed  in  woman  ;  and 
these  arriving  together  in  the  uterus,  may  be  fecundated  at  one  time.  Or 
it  may  even  happen  that  the  vitelline  membrane  contains  two  yolks,  as 
sometimes  occurs  in  the  fowl's  Qgg  ;  and  as  the  vitelline  mass  is  the 
essential  part  of  the  ^gg,  it  is  evident  that  when  this  contains  two  of  these 
masses,  they  ought,  if  fecundated,  to  produce  two  embryos. 

In  the  first  case,  as  Saint-Cyr  points  out,  each  foetus  has  ordinarily  all 
its  annexes  distinct  and  completely  independent ;  or  it  may  be  that  the 
two  chorions  are  fused  together,  in  which  circumstance  the  two  fcetuses 
will  then  have  a  common  envelope.  In  the  second  hypothesis,  this  fusion 
of  the  chorions  appears  to  be  the  rule,  although  the  envelopes  may  also 
be  independent ;  and  in  the  third  case — that  of  the  two  vitelluses  con- 
tained in  the  same  vitelline  membrane — not  only  the  envelopes,  but  also 
the  foetuses  may  become  united  more  or  less  closely,  and  thus  give  rise 
to  double  monsters, 

Finally,_it  is  also  possible  that  two  ovules  may  become  detached  from 
the  ovarian  cluster,  though  not  simultaneously,  but  successively  ;  and  be 
fecundated,  one  after  another,  at  two  consecutive  copulations  within  a 
brief  period.  Occurrences  of  this  kind,  by  no  means  rare,  have  beer 
wrongly  adduced  as  instances  of  superfoetation. 

Mare. 

Of  all  the  domestic  animals,  the  Mare  is  the  one  which  least  frequently 
brings  forth  more  than  a  single  creature  at  a  birth  ;  and  Saint-Cyr  has 
only  been  able  to  collect  fourteen  instances,  though  we  have  been  more 
fortunate.  Rueff  admits  that  one  case  of  gemellar  gestation  may  occur 
in  this  animal  in  every  250  normal  cases;  but  that  the  young  are  nearly 


144 


OBSTE  TRIG  A  L  PH  YSIOL  OG  Y. 


always  born  dead,  or  die  soon  after  birth.     In  the  register  of  a  stud,  only 
one  instance  of  twins  was  found  in  every  236!-  births. 

Demoussy,  cited  by  Saint-Cyr,  observed  an  example  of  double  gestation ;  but  the 
foals,  though  alive  when  born,  perished  soon  after.  Lemaitre  gives  a  similar  instance  ; 
only  that  one  of  the  foetuses  was  expelled  at  four  months,  while  the  other  was  retained, 
was  foaled  alive  at  the  usual  time,  and  survived.  Trelut  has  seen  a  Mare  which,  at  the 
tenth  month  of  pregnancy,  cast  two  well-formed  foals.  She  had  been  put  to  the  stallion 
five  times — on  April  23,  May  4,  16,  and  25,  and  June  5;  she  aborted  on  March  15.  Her 
abdomen  was  enormously  large,  and  some  time  before  abortion  she  had  received  a  kick 
in  the  flank. 

A  fourth  example  of  double  gestation  is  related  by  Goux.  The  two  foals — a  colt  and 
a  filly — were  alive  when  born,  and  continued  to  thrive.  Saint-Cyr's  father,  an  agricul- 
turist, witnessed  an  analogous  occurrence,  the  progeny  also  surviving  ;  and  Saint-Cyr 
himself  saw  a  twin  birth  in  a  Mare,  one  of  the  foals,  which  was  born  dead,  weighing  25 
kilogrammes  ;  the  other,  which  lived,  weighing  nearly  26  kilogrammes. 

In  the  Veterinarian  are  found  a  number  of  instances  of  twin  foals  in  this  country. 
Mr.  Millington  (vol.  iv.,  p.  424)  gives  three  cases  of  this  kind,  the  foals  being  born 
alive.  In  vol.  ix.  (p.  450)  an  account  is  given  of  a  Mare  which  died  of  hydrops  uteri, 
in  which  were  twin  foals ;  in  vol.  xii.  (p.  288)  is  another  account  of  two  born  dead,  and 
in  vol.  xvii.  (p.  177)  a  similar  instance. 

A  most  unusual  case  of  twin-birth  is  related  in  the  North  British  Agricnlturist  for 
May  17th,  1876  : — A  Mare,  the  property  of  Mr.  Chapman,  farmer,  Halnaby,  gave  birth 
to  a  colt  and  filly  foal  on  the  2d  March,  1875,  both  living.  On  the  i6th  March,  1876, 
she  brought  forth  two  filly  foals,  thus  giving  birth  to  four  foals — one  colt  and  three  fillies 
— in  less  than  thirteen  months. 

The  Field  (May  10,  1873)  reports  a  Mare  in  Devonshire,  which  produced  twin  foals 
three  times  within  three  years.  The  Mare  went  full  time  in  each  instance,  but  only  one 
foal  (they  were  all  colts)  lived  for  any  length  of  time.  According  to  the  Liverpool  Mer- 
cury (July  23,  1845)  ^  Mare  at  Abringhall,  fifteen  years  old,  brought  iorth/our  colts  in 
the  space  of  fifteen  months  ! 

Raabe,  in  1852,  witnessed  a  triple  birth  in  a  five-year-old  Mare  ;  the  three  foals  were 
born  alive,  and  were  completely  developed,  but  they  soon  died. 

Two  instances  of  triple  birth  are  given  by  Saint-Cyr,  the  most  remarkable  being  that 
recorded  by  Paugoue.  This  occurred  with  a  Mare  which,  put  to  the  Ilorse  only  once, 
on  February  17th,  1843,  aborted  during  the  night  of  September  27-28,  two  foals  being 
found  in  one  chorion;  on  the  25th  of  the  following  February,  it  produced  a  third  foal, 
perfectly  formed,  and  which  lived.  In  the  second  case,  related  by  Devilliers,  the  Mare 
had  been  put  to  the  stallion  several  times  in  May,  June,  and  July.  On  March  loth  it 
produced  three  properly-formed  but  dead  foals,  one  having  apparently  ceased  to  live 
some  days  before. 

In  the  Veterinarian  for  1875  (P-  334)  allusion  is  made  to  an  agricultural  Mare  in  Nor- 
folk, eight  years  old,  and  not  known  to  have  been  previously  bred  from,  producing  three 
foals  at  a  birth.  The  first  was  dead,  and  appeared  to  have  been  so  for  several  days. 
The  second  was  born  alive  immediately  after  the  birth  of  the  first,  but  only  lived  about 
half  an  hour.  The  third  was  born  dead  seven  hours  after  the  second,  but  its  condition 
showed  that  at  the  time  parturition  commenced  it  was  alive.  The  foals  were  all  of  the 
same  color — bay — and  were  perfectly  formed.  The  Mare  made  a  good  recovery.  In 
the  same  journal  for  1867  (p.  595),  Mr.  Newman,  of  Havant,  reports  the  birth  of  three 
fine,  well-developed  foals,  two  of  which  were  born  alive  and  lived.  The  Mare,  of  the 
cart-breed,  had  gone  the  full  period  of  pregnancy. 

The  most  numerous  instances  of  twin  or  triple  gestation  in  the  Mare  are, 
however,  to  be  attributed  to  two  successive  fecundations,  of  which  Saint- 
Cyr  has  collected  eight  examples.  In  all  of  these,  strange  to  say,  the 
Mares  had  been  put  to  a  stallion  of  the  equine  and  asinine  species  in  suc- 
cession, and  brought  forth  each  a  foal  and  a  mule.  In  the  majority  of 
these  instances,  the  two  fecundations  were  within  a  brief  period — the  one 
succeeding  the  other  immediately,  or,  at  any  rate,  within  the  same  day  ; 
though  in  one  instance  there  was  an  interval  of  fifteen  days.  Which  was 
the  elder  of  the  two  foals  in  these  births — the  one  first  born  or  the  one 
first  conceived  ?  Though  in  the  human  species  such  a  question  might 
have  some  importance,  with  animals  it  has  only  a  physiological  interest; 


GESTATION.  145 

but   the  order  in  which  they  were   born  would,  nevertheless,  be  the  only- 
rational  assignment. 

The  female  Ass  more  frequently  brings  forth  twins  than  the  Mare  ;  but 
even  in  this  animal  such  an  occurrence  is  rare.  In  an  average  of  thirty 
she- Asses,  kept  for  the  production  of  milk  by  a  man  at  La  Chapelle  Saint- 
Denis,  only  four  had  twins  in  a  period  of  seventeen  years. 

Cow. 

Double,  and  even  triple,  births  are  not  so  unusual  in  the  Cow,  the  for- 
mer being  far  from  uncommon.  Indeed,  it  is  so  frequent  in  some  breeds, 
and  with  individuals,  that  it  has  been  suggested  to  produce  by  selection 
a  breed  of  Cows  which  would  habitually  have  twins. 

Mr.  J.  Macgillivray,  of  Banff,  in  an  excellent  little  "  Manual  of  Veterinary  Science 
and  Practice,"  published  in  1857,  writes  : — "  A  neighbor  of  mine,  Mr.  Peter  Low,  had  a 
Cow,  a  splendid  animal,  of  the  cross  breed,  which  had  twin  calves  yearly  for  six  suc- 
cessive years.  Two  of  her  female  progeny  have  had. twin  calves  repeatedly.  Mr.  Low 
kept  one  of  her  male  twins,  a  bull ;  to  him  two  Cows  have  had  twin  calves,  and  there 
are  a  number  of  Cows  in  calf  to  him  just  now.  From  this  and  other  similar  cases,  I 
think  there  is  no  doubt  but,  by  oroper  selection  and  management,  a  race  of  twin-bearing 
cattle  might  be  established."  '  And  again  he  says : — "  From  a  paper  now  lying  before 
me,  I  shall  record  what  I  believe  to  be  a  unique  case  of  a  calf-producing  Cow.  I  am 
indebted  for  the  particulars  to  Mr.  James  Stephen,  Balfluig  Cottage,  Alford.  '  Memo- 
randum regarding  a  small  Cow  of  the  black  Polled  breed,  which  belonged  to  the  late 
Mr.  Alexander  Stephen,  Farmton,  Alford  :— 

Year.  Number  of  Calves  at  a  birth. 

1842     I — first  calf. 

1843     3 — came  to  maturity. 

1843     4 — °"^  ^\^di ;  seven  in  one  year. 

1844  •  •  •        •  •• - — came  to  maturity. 

1845  3 — c^rne  to  maturity. 

1846  6 — died  prematurely. 

1847  2 — came  to  maturity. 

1848  4-'  " 

Rueff  says  that,  with  the  Simmen thaler  breed  of  cattle  at  Hohenheim, 
during  an  interval  of  ten  years,  there  were  four  per  cent,  twin  births. 

Triple  gestation  is  of  course  much  more  uncommon,  but  the  instances 
on  record  are  numerous. 

Dupuy  mentions  a  very  unusual  instance  of  fecundity  in  a  Cow  which,  at  three  births 
in  successive  years — 1817,  1818,  and  1819 — brought  forth  nine  calves,  only  two  of  which 
were  not  reared  by  the  mother  ;  these  calves  afterwards  had  only  one  offspring  at  each 
birth.  Rainard  speaks  of  one  of  his  pupils  delivering  a  Cow  of  three  calves  in  the 
neighborhood  of  Lyons ;  and  Roche-Lubin  gives  two  similar  instances.  In  one  of  these 
the  first  two  calves  were  born  alive  and  reared  by  their  mother,  but  the  third,  which  was 
in  a  bad  position,  was  removed  dead  six  days  later.  In  the  second  instance,  the  Cow, 
after  producing  a  living  and  properly-developed  calf,  continued  to  strain  and  make  fruit- 
less efforts  to  get  rid  of  the  other  foetuses,  until  she  died  five  days  afterwards,  when  two 
calves  attached  to  each  other  by  the  sternum  were  found  in  the  uterus.  Sperling  records 
the  case  of  a  Dutch  Cow  which  produced  three  calves;  the  first  was  a  male,  the  second 
a  heifer,  and  the  third  a  heifer  in  a  wrong  position  In  England  Mr.  Snowdon  has  seen 
a  Cow  which  brought  forth  a  living  calf  some  hours  after  a  dead  one,  and  in  a  few 
minutes  an  anidian  monster. 

In  the  Ipswich  yournal  for  October,  1875,  mention  is  made  of  a  Cow  which  produced 
six  calves  in  twentv  months,  all  living  :  first  three  fine  calves,  then  one,  and  again  two. 

The  Liverpool  Mercury  (April  9,  1847)  mentions  a  Cow  which  produced  sixteen  calves 
in  eight  years — two  calves  at  six  births,  three  at  one  birth,  and  one  at  another  birth. 
The  Mark  Lane  Express  (May  ii,  1852)  alludes  to  a  Cow  which  brought  forth  three 
calves  at  a  birth — making  eleven  calves  before  she  was  seven  years  old.  The  Chester 
Chronicle  (February  18,  1865)  reports  the  birth  of  three  full-sized  calves  by  a  Cow,  all 
of  which  did  well ;  and  the  Shrewsbury  Chronicle  (July  5,  1844)  gives  a  similar  instance, 

10 


146  OBSTETRICAL  PHYSIOLOGY. 

but  the  calves,  born  during  the  night,  were  found  dead  in  the  morning.  In  the  Field  for 
June  17,  1876,  the  birth  of  three  calves — a  Bull  and  two  Cows — is  reported.  They  were 
alive  and  doing  well. 

Quadrigemellar  gestation  is  also  sometimes  observed  in  the  Cow. 

Rainard  gives  two  instances  ;  and  Hamon  mentions  a  little  Breton  Cow  which,  in 
1858,  produced  four  calves — two  male  and  two  female,  the  last  two  dying  soon  after 
birth.  Gelle  gives  a  remarkable  instance  of  a  Cow  which,  in  1837,  had  three  calves,  in 
1838  two,  in  1839  two,  in  1S40  two,  and  in  1841  four  !  One  of  the  last  was  a  heifer  ;  all 
were  well-developed  and  successfully  reared,  and  the  last  four,  at  five  weeks  old,  weighed 
about  forty-five  pounds  each. 

The  Vetermartan  (vol.  xiii.,  p.  579)  gives  an  account  of  a  delivery,  with  assistance,  of 
four  dead  calves.  This  journal  also  (vol.  xiv.,  p.  15)  records  a  case  in  which,  with 
assistance,  a  Cow  was  delivered  of  four  calves — two  dead  at  birth  and  two  alive,  though 
these  soon  expired.  They  were  properly  developed,  and  appeared  to  have  been  healthy 
up  to  parturition;  they  weighed,  respectively,  25)^,  24,  ij^,  and  1734:'  lbs.  From  rhe 
structure  of  the  placenta,  it  was  concluded  that  each  foetus  had  been  contained  in  a 
separate  membrane  and  fluid.  The  birth  was  premature  by  two  months  and  nine  days. 
In  the  same  journal  (vol.  xvii.,  p.  424)  another  quadruple  birth  is  described  ;  the  calves 
were  well-developed  and  all  born  alive,  though  they  soon  after  died. 

According  to  the  Chester  Chronicle  (March  5,  1847),  ^  Cow  brought  forth  three  calves, 
and  in  three  days  a  fourth.  All  died  soon  after.  The /vV/o' (December  7,  1872)  de- 
scribes the  birth  of  four  calves  by  a  Cow  about  four  years  old,  and  which  had  twins  at  a 
previous  calving.  One  calf  died,  but  the  others  did  well.  The  Liverpool  Mercury 
(March  28,  1845)  reports  a  Cow  as  having  produced  four  calves — full-sized,  but  dead. 
Eddow's  Shrewsbury  Journal  (July  29,  1846)  alludes  to  a  Cow  which  gave  birth  to  four 
bull-calves,  three  of  which  livecf. 

Mr.  Cart  Wright,  of  Whitchurch,  gives  an  instance  of  four  calves  at  a  birth.  The  Cow 
and  calves  died  soon  after. 

The  Revue  Vcterinaire  of  Toulouse  (February,  1876)  gives  a  case  of  quadrigemellar 
parturition  in  a  Durham  Cow,  aged  twenty-two  months,  near  Rochefort.  Birth  occurred 
naturally  in  an  hour  ;  two  cow-calves  were  first  born,  then  two  males ;  three  did  not  live 
beyond  an  hour,  the  other  survived  thirty-six  hours.  • 

Quintuple  pregnancy  is  very  rare  in  the  Cow. 

In  the  Giornale  di  Veterinaria  for  June,  1855,  Professor  Lessona,  of  Turin,  describes 
a  quintuple  birth  in  a  Cow  in  Piedmont.  The  animal  was  twenty  days  from  its  full 
time.  The  abdomen  was  very  voluminous,  but  beyond  the  premature  delivery  there 
was  nothing  unusual  attending  the  birth.  The  progeny  consisted  of  three  females  and 
two  males,  and  each  weighed  about  37}^  pounds.  They  were  healthy  and  fully  de- 
veloped ;  but  the  mother,  either  through  her  premature  delivery  or  from  age,  was  unable 
to  suckle  them,  and  they  were  put  to  another  Cow  whose  milk  proved  unsuitable  for 
them,  as  they  had  an  attack  of  indigestion,  and  in  about  eight  days  after  birth  all  were 
dead.  Lessona  thinks  two  were  lodged  in  the  same  envelope  in  each  horn,  and  that  the 
fifth  foetus  with  a  single  placenta,  occupied  the  body  of  the  uterus  with  its  proper 
envelopes.  A  singular  fact  was  their  being  all  presented  for  delivery  in  a  normal  posi- 
tion— a  very  extraordinary  circumstance.  The  Cow  had  produced  twin  calves  the  pre- 
ceding year. 

In  the  Veterinarian  (vol.  xxxii.,  p.  200),  Mr.  Forbes,  of  Reigate,  mentions  a  Cow,  six 
years  old,  which  at  her  third  calving  produced — three  weeks  premature — five  calves  at 
a  birth — four  bulls  and  one  cow.  Three  of  the  calves  died  in  a  few  hours,  the  fourth  in 
a  day,  and  the  fifth  two  days  after  they  were  born.  Still  more  remarkable  is  the  case 
recorded  in  this  journal,  by  Mr.  Garrard,  as  having  occurred  at  Repton.  A  Cow,  cross- 
bred and  eleven  years  old,  and  which  had  never  previously  brought  forth  more  than  one 
calf  at  a  birth,  produced  five  living  healthy  calves,  all  of  which,  when  he  wrote  some 
days  afterwards,  were  alive  and  vigorous,  and  had  every  appearance  of  continuing  so. 
They  were  all  nearly  of  one  size,  and  were  larger  and  stronger  than  might  have  been 
supposed.  Four  were  bull-calves,  and  during  parturition  the  first  four  presented  in  a 
natural  position,  but  the  fifth  was  a  breech  presentation. 

The  Chester  Chronicle  (February  11,  1854)  reports  a  Cow,  between  ten  and  eleven 
years  old,  producing  five  calves — four  males  and  one  female — all  of  which  lived  The 
calves  were  nearly  of  the  ordinary  size,  and  were  strong  and  lively.  In  Eddow's  Shre^vs- 
btiry  Journal  (September  9,  1874),  mention  is  made  of  a  Cow  which  had  been  purchased 
as  barren,  but  which  in  due  course  produced  a  dead  calf,  on  the  following  day  another, 
and  so  on  until  four  were  born.     The  Cow  then  died,  and  on  being  opened  a  fifth  calf 


GESTATION.  147 

was  found.  Mr.  Litt,  of  Shrewsbury,  in  the  same  journal  gives  the  particulars  of  the  case 
of  a  Cow  which  died  within  a  fortnight  of  calving,  and  on  being  opened  no  fewer  than 
five  fully-developed  calves  were  found  in  the  uterus.  They  were  nearly  uniform  in  size, 
and  with  the  exception  of  one,  which  was  rather  emaciated,  they  were  in  a  remarkably 
well-nourished  condition.  They  consisted  of  four  females  and  a  male,  and  were  very 
little  smaller  than  ordinary  calves  at  birth,  being  about  the  usual  size  of  twins.  Mr. 
Litt  was  of  opinion  that,  had  they  been  born  at  the  proper  time,  they  would  have  lived. 
The  Cow  had  not  thriven  so  well  as  its  companions  for  some  time,  but  up  to  the  morn- 
ing of  the  day  previous  to  decease,  it  appeared  to  be  in  perfect  health.  Death  was 
probably  due  to  the  excessive  drain  upon  the  animal's  system  produced  by  so  many 
voung. 

Schumann,  in  1854,  reports  a  quintuple  birth — all  males,  and  dead-born.  Rueff  re- 
cords another,  in  which  all  the  calves  lived — and  one  which  occurred  at  Havingen,  in  a 
five-year-old  Cow.  Baron  also  refers  to  a  similar  instance.  Mr.  Garrard,  of  Ticknall, 
however,  has  a  more  favorable  report  of  a  birth  of  this  kind.  In  1854  a  Cow  gave  birth 
to  five  living  healthy  calves,  all  of  which  were,  when  he  wrote  (a  week  after  birth),  alive 
and  vigorous,  and  likely  to  continue  so.  They  were  nearly  all  of  one  size,  and  larger 
and  stronger  than  could  be  supposed.  Four  were  bull-calves.  The  Cow,  by  no  means 
a  large  one,  was  eleven  years  old  and  of  a  mongrel  breed,  and  had  never  produced  more 
than  one  calf  at  previous  gestations.  She  did  not  manifest  any  unusual  symptoms  of 
exhaustion ;  the  first  four  calves  presented  naturally ;  the  fifth  was  a  breech  presenta- 
tion. 

Kurds  speaks  of  a  Cow  which  aborted  seven  foetuses  ;  while  Kleinschmeid  {Magazin 
fiir  Thierheilku7tdc.  1857)  mentions  having  found  fifteen  embryos  in  the  uterus  of  an 
animal  of  this  species  ! 

Sheep. 

With  the  Sheep,  twins  are  a  very  common  occurrence  ;  and  it  is  a  say- 
ing that  in  a  good  flock  there  should  be  as  many  lambs  as  Ewes,  the  double 
births  compensating  for  the  losses.  Instances  of  extraordinary  fecundity 
are  also  by  no  means  rare,  and  would  appear  to  pertain  to  particular 
breeds.  Daubenton  states  that,  in  the  counties  of  JuUiers  and  Cleves, 
every  Sheep  brings  forth  two  or  three  lambs  twice  a  year — five  Sheep 
producing  twenty-five  lambs  in  twelve  months.  In  French  Flanders, 
according  to  Magne,  who  cites  Corneille  as  his  authority,  there  is  a  very 
prolific  breed  of  Sheep,  each  ordinarily  producing  three,  sometimes  four, 
five,  and  six,  rarely  seven  lambs,  at  two  births  during  the  year.  Tessier, 
speaking  of  this  breed,  while  admitting  that  twin  lambs  are  not  an  ordi- 
nary occurrence  with  Sheep,  assures  us  that  in  a  flock  composed  of  371 
Ewes,  there  were  22  double  births  ;  and  he  mentions  having  seen  a  Sheep 
that  was  twenty  years  old,  which  had  bred  every  year.  A  Ewe  at  Hohen- 
heim,  in  1845,  brought  forth  one  lamb,  the  first ;  in  1846,  two  ;  in  1847, 
five  ;  in  1848,  four;  1849,  three;  1850,  two — in  all  seventeen  lambs  at 
six  births.     Four  of  these  were  males,  and  thirteen  females. 

In  England  such  fecundity  is  not  very  uncommon. 

For  instance,  in  the  Chamber  of  Agriauture  Joiirnaliox  March,  1871,  there  is  a  notice 
of  extraordinary  prolificacy  related  by  Mr.  Angus,  of  Lowthorpe,  Hull,  who  says  : — 
"  Last  year  one  of  my  Ewes  of  the  Lincoln  breed  brought  forth  six  lambs,  all  living.  I 
had  great  difficulty  in  persuading  my  neighbors  to  believe  this,  although  the  fact  was 
quite  clear  and  we'll  attested.  I  gave  her  a  private  ear-mark,  and  last  Michaelmas  a 
separate  red  mark  also.  As  we  saw  this  spring  that  she  was  getting  heavy,  we  kept  her 
quite  separate  from  the  rest  of  the  Ewes,  and  last  Thursday  she  produced  another  six 
lambs.  Some  of  these  will  not  survive,  as  they  were  a  few  days  before  their  proper 
time  ;  but  all  are  complete  and  well  formed,  and  the  Ewe  is  now  suckling  one  lamb." 
"  The  especial  wonder  about  this  woolly  mother,"  adds  the  editor  of  the  journal,  "  is 
that  she  belongs  to  a  breed  in  which  it  is  rare  for  a  Ewe  to  drop  more  than  three  lambs, 
while  good  luck  among  the  Lincoln  flocks  is  '  one-half  pairs,'  with  occasionally  a  three." 

The  Carmarthen  Jourttal  (March,  1844)  alludes  to  four  Ewes  in  that  county,  which 
in  one  week  yeaned  fourteen  lambs  ;  one  had  five  lambs,  and  these  all  did  well.  The 
Chester  Chronicle  (May  25,  1867)  mentions  that  a  little  Welsh  Ewe  at  Birkenhead  had 


148  OBSTETRICAL  PHYSIOLOGY. 

two  lambs  in  the  spring  of  1864  ;  in  1865  three,  all  alive  ;  i866  four,  all  living  ;  and  in 
1876  five,  four  of  which  lived,  and  were  in  good  health,  BelVs  Weekly  Messenger  (June 
29,  1844),  states  that  a  farmer  in  Kent  had  a  Ewe  which  dropped  the  extraordinary  num- 
l)er  of  six  lambs,  four  of  which  it  reared,  and  the  other  two  were  brought  up  by  hand. 
The  previous  season  the  same  Ewe  produced  four  lambs,  all  of  which  were  reared  and 
turned  out  well.  According  to  the  Chester  Chro7iicle  (April  ii,  1868),  a  farmer  at  Otley, 
Yorkshire,  had  a  Ewe,  five  years  old,  which  had  produced  fifteen  lambs.  When  one 
year  old  it  had  two,  at  two  years  four,  at  three  years  two,  at  four  years  four,  and  at  five 
years  three.  The  Salopian  (April  6,  1872)  speaks  of  a  Ewe  at  Wem,  Salop,  which  gave 
birth  at  one  time  to  five  lambs  the  i^revious  year,  and  these  were  all  reared,  and  in  this 
year  six  were  born,  five  of  which  lived.  The  Chester  Chronicle  (April  19,  1873)  alludes 
to  a  Ewe  which  produced  an  annual  average  of  three  lambs  for  seven  years ;  the  animal 
itself  was  one  of  three.  The  Shrewsbury  Chronicle  (June  26,  1874)  reports  that  a  Shrop- 
shire Ewe  lambed  twice  in  six  months,  producing  twins  each  time;  and  the  Field  (May 
12,  1873)  gives  an  instance  of  a  Ewe  having  five  lambs,  one  of  which  died  in  a  few  days, 
l)ut  the  others  did  well.  The  Oswestry  Advertiser  (October  2,  1872)  instances  a  Ewe 
which  gave  nine  lambs  in  two  seasons — three  and  six — all  fine  lambs  and  in  perfect 
health.  And  in  the  Cambrian  newspaper  for  the  same  month,  it  is  mentioned  that  "  Mr. 
J.  M.  Harding,  of  the  Town-Hill  Farm,  Swansea,  has  just  had  an  extraordinary  piece  of 
good  luck  in  lambing.  From  a  small  flock  of  seventeen  Ewes,  he  has  had  no  less  than 
thirty-seven  lambs,  all  alive  and  doing  well.  Every  Ewe  has  brought  '  doubles,^  and 
three  have  brought  '  triplets.'  It  is  not  only  the  number  of  lambs,  but  they  are  all  strong 
and  healthy.  .  .  .  There  is  no  reason  to  doubt  that  the  remainder  of  the  flock  will 
be  equally  prolific." 

In  the  A^ottingham  yournal  for  1846,  it  is  stated  that  a  Ewe  in  that  locality  brought 
forth  five  lambs  at  a  birth,  all  alive  and  likely  to  continue  so. 

Mr.  Litt,  already  quoted,  mentions  the  case  of  five  Ewes  which  had  been  attacked 
with  symptoms  of  brain  disorder  shortly  before  lambing,  and  soon  died.  Each,  when 
opened,  was  found  to  have  four  lambs,  making  twenty  in  all. 

The  Lytm  Advertiser  for  February,  1872,  states  that  a  Ewe  in  that  locality  lambed  on 
the  nth  of  that  month,  the  lamb  living  twenty-four  hours  :  again  on  June  28th,  and  on 
January  21st,  1872,  bringing  forth  twin  lambs  on  the  last  occasion.  The  Ewe  thus 
lambed  three  times  in  a  year  and  ten  days. 

In  1875  ^^-  Robert  P.  Greenhill,  of  Elmbridge,  near  Droitwich,  was  in  possession  of 
a  Ewe,  seven  years  old,  which  had  produced  no  fewer  than  20  lambs — a  small  flock.  In 
the  first  year  she  gave  birth  to  2  ;  in  the  second,  i  ;  third,  3;  fourth,  3  ;  fifth,  4  sixth, 
4  ;  and  seventh,  3. 

And  at  Shaftesbury,  it  is  recorded  in  May,  1876,  that  a  farmer  had  some  Ewes  fatting, 
and  a  neighbor's  ram  got  with  them;  consequently,  13  of  them  proved  to  be  in  lamb, 
and  produced  no  less  than  31  lambs,  all  born  alive  (a  few  dead  since),  as  follows : — 

I  single  ....  ....  ....          ....          ....  I 

-8  twins  ....  ....  ....  16 

3  threes  ....  ....  9 

I  five  5 

13  ewes.  31  lambs. 

Other  and  similar  instances  might  be  quoted. 

It  may  be  remarked,  that  extraordinary  fecundity  in  Sheep  is  seldom 
observed  in  the  highest-bred  races,  which  are  usually  uniparous  ;  it  ap- 
pears to  pertain  more  to  the  common  breeds.  Not  only  this,  but  certain 
years  are  more  remarkable  than  others  for  double,  treble,  and  quadruple 
births  in"  this  species. 

Goat. 

The  Goat  is  generally  considered  a  uniparous  animal,  but  it  would  ap- 
pear that  this  is  a  mistake,  as  double  and  triple  births  may  be  said  to  be 
the  rule  ;  not  at  all  unfrequently  four  are  produced.  But  usually  with  the 
three  or  four  at  a  birth,  one  or  more  are  feeble  or  born  dead.  It  is  looked 
upon  as  exceptional  for  only  one  kid  to  be  produced  at  a  birth. 


J 


GESTATION.  149 

The  question  has  been  much  discussed  as  to  whether  these  multiple 
births  in  animals  ordinarily  uniparous,  are  the  result  of  one  or  successive 
copulations.  The  majority  of  the  authorities  in  such  matters  are  certainly 
of  opinion  that  a  single  copulation  will  suffice  to  fecundate  several  ovules, 
and  they  doubt  if,  after  a  fruitful  copulation,  it  is  possible  for  the  sperma- 
tozoa to  reach  the  ovary,  supposing  a  second  ovule  to  be  developed,  unless 
the  second  impregnation  takes  place  very  soon  after  the  first,  and  before 
the  fertilized  ovule  had  descended  into  the  uterus.  The  well-authenti- 
cated instances  of  superfoetation,  though  rare,  nevertheless  rather  militate 
against  this  opinion  ;  and  it  would  appear  to  be  impossible  to  explain  why 
one  animal  among  several  hundreds,  perhaps  thousands,  should  alone 
bring  forth  "  doubles  "  or  "  triplets,"  while  all  the  others,  placed  in  the 
same  hygienic  conditions,  have  only  one  offspring.  It  is  a  fact,  however, 
that  wdth  certain  breeds  of  Sheep  an  abundance  of  nourishment  and  plen- 
tiful years  dispose  to  these  multiple  births. 

What  has  been  said  of  uniparous  animals  does  not  at  all  apply  to  those 
which  are  multiparous  ;  for  although  the  latter  may  be  impregnated  at  a 
single  copulation,  and  bring  forth  several  young,  yet,  as  a  rule,  they  are 
fecundated  more  than  once,  and  in  fact  do  not  cease  to  seek  the  male 
until  after  several  copulations. 

In  these  cases  of  multiple  gestation  in  creatures  naturally  uniparous, 
one  of  .the  fcetuses  occupies  the  ordinary  situation  of  single  gestation  :  the 
head  towards  the  cervix  uteri,  the  larger  portion  of  the  trunk  in  the  body 
of  the  uterus,  and  the  hind  quarters  and  limbs  in  one  of  the  cornua.  The 
second  foetus  occupies  the  whole  of  the  other  cornu  ;  with  the  head 
turned  back,  or,  as  occurs  not  infrequently,  in  the  opposite  direction,  and 
so  on. 

The  duration  of  gestation  in  these  cases  is  generally  shorter  than  that 
of  single  pregnancy  in  the  same  animal,  probably  in  consequence  of  the 
unusual  distention,  as  well  as  derangement  of  the  principal  functions  in 
the  mother.  The  weight  of  the  young,  individually,  is  usually  less  than 
the  average  ;  but,  collectively,  it  may  be  very  much  greater  than  that  of 
one  young  creature  produced  at  a  birth.  Thus  in  the  quadruple  birth  re- 
corded by  Magdinier,  each  foetus  weighed  ten  to  eleven  kilogrammes  ;  in 
that  by  Bouchard  they  only  weighed  from  eight  to  nine  kilogrammes  ;  in 
the  quintuple  birth  described  by  Cassina,  each  calf  weighed  seventeen 
kilogrammes,  or  eighty-five  for  the  entire  birth — an  enormous  weight. 
Lignana,  another  Italian  veterinary  surgeon,  mentions  that  in  a  double 
birth  in  a  Cow,  one  of  the  calves  which  was  born  dead,  though  at  full 
time,  weighed  twenty  kilogrammes  ;  and  the  other  calf,  which  was  alive, 
weighed  forty-three.  In  the  double  birth  observed  at  Saulsaie,  in  which 
both  calves  were  born  alive,  one  was  twenty-eight  kilogrammes  and  the 
other  thirty -one. 

Free-martins. 

A  curious  fact  in  connection  with  this  subject  in  the  bovine  species,  is 
that  when  the  young  are  of  both  sexes,  the  female  is  in  general  unproduc- 
tive. This  fact  is  well  known  in  many  countries,  where  the  female  calf 
receives  a  particular  designation  :  as  "  Free-martin  "  in  Britain  ;  in  Hol- 
land, "  Queenen  ;  "  in  Germany,  "Zwitter,"  or  "Zwillingj"  in  Swabia, 
"  Zwicker  ;  "  in  Piedmont,  "  Mugn^  ;"  in  France,  "  Loures,"  "  Taures," 
etc.  The  old  Roman  agriculturists  knew  these  animals  as  "Taurae."  It 
is  very  rare,  indeed,  that  the  male  is  infecund.      Baumeister,  however. 


ISO 


OBSTETRICAL  PHYSIOLOGY. 


gives  an  instance  in  which  a  Bull — a  twin — was  put  to  a  hundred  cows, 
none  of  which  produced  a  calf.  In  Switzerland  it  is  the  belief,  that  when 
the  cow-calf  is  born  first,  it  will  not  be  sterile  ;  and  that  when,  on  the 
contrary,  the  male  is  born  before  the  female,  it  will  be  unproductive.  The 
female  twin  is  generally  a  hermaphrodite,  and  in  form  more  of  a  male 
than  a  female  ;  the  vulva  is  excessively  contracted,  and  the  vagina  a  ciil- 
de-sac.  The  mammae  are  also  feebly  developed,  sometimes  appearing  as 
a  mere  trifling  fold  of  skin,  at  others  as  a  voluminous  sack.  The  animal 
is  usually  long-legged,  with  muscular  hind-quarters.  Internally,  in  some 
instances  the  uterus  is  undeveloped  ;  in  others,  the  ovaries  are  absent, 
and  instead  of  them  there  are  testicles.  With  others,  again,  there  is  no 
trace  of  a  uterus,  the  vagina  ending  in  an  infundibulum  :  a  condition  which 
is  readily  ascertained  in  the  living  animal  by  introducing  the  finger.  The 
clitoris  is  sometimes  enormously  developed,  and  not  unusually  the  urine 
is  expelled  powerfully  backwards.  Ordinarily  the  "  free-martin  "  does  not 
evince  any  sexual  desire.* 

The  rule  does  not  always  hold  good,  however,  as  to  the  infecundity  of 
this  twin  calf,  as  instances  are  on  record  in  which  it  has  bred.  For  in- 
stance, in  the  Veterinaria?t  (vol.  ix.,  p.  22)  there  is  an  authenticated  case 
in  which  the  female  of  a  twin  birth,  when  five  months  old,  became  preg- 
nant, and  in  due  course  produced  a  calf.  The  next  birth  was  twin 
calves. 

Diagnosis  of  Multiple  Pregnancy. 

The  diagnosis  of  multiple  pregnancy  in  animals  ordinarily  uniparous,  is 
not  very  certain.  It  is  usual  to  say  that  the  signs  are  only  those  indica- 
tive of  a  single  foetus,  but  exaggerated.  The  belly  is  more  voluminous 
than  when  there  is  but  one,  especially  in  the  early  months  ;  the  respira- 
tion is  more  than  usually  embarrassed  ;  the  animal  lies  frequently,  and 
soon  moves  lazily  and  heavily,  while  the  posterior  limbs  become  oedema- 
tous.  These  signs,  it  will  be  remarked,  are  obscure,  as  a  large  foal  or 
calf  may  occasion  the  disproportionate  size  of  the  abdomen  and  altera- 
tion in  breathing  ;  so  that  at  best  they  only  afford  a  vague  presumption 
as  to  the  condition  of  the  mother.  It  is  also  said  that  the  belly  is  larger 
on  the  side  on  which  it  is  usually  least  enlarged — the  left ;  in  others,  both 
sides  are  enlarged  at  the  same  time,  and  there  the  movements  of  the 
young  are  most  evident.  But  this  sign,  in  addition  to  being  far  from 
constant,  depends  upon  the  relative  position  of  the  progeny  ;  as  when 
there  are  two  one  may  occupy  the  body,  the  other  the  cornu,  of  the  uterus. 
Neither  does  an  examination  per  rectum  or  vaginum  afford  any  certain 
indication  of  a  multiple  gestation ;  as  the  number  of  young,  supposing 
there  are  more  than  one,  cannot  be  sufficiently  distinguished. 

*  One  of  the  latest  recorded  examinations  of  these  creatures  is  given  in  the  CEsterreichische  Viertel- 
jahresschrift  for  1875  (p.  78),  and  was  brought  to  the  notice  of  the  Gresnter  Land  and  Forest  Society  of 
Austria,  the  veterinary  surgeon  to  which  furnished  the  anatomical  details.  The  Society  purchased  the 
calf  three  and  a  half  years  previously,  and  it  had  never  exhibited  any  signs  of  sexual  instinct  during  that 
period.  It  was  therefore  killed.  It  was  in  good  condition,  and  of  the  Miirzthaler  breed.  The  head  and 
physiognomy  had  a  most  sins^ular  appearance,  resembling  that  of  a  monkey,  though  the  horns  were 
strongly  developed.  The  udder  was  little  and  hard,  and  the  vulva  small  and  contracted,  although  normal  ; 
en  opening  the  labia,  no  trace  of  a  clitoris  could  be  found.  The  vagina  was  nine  to  ten  centimetres  in 
length,  and  instead  of  extending  forward  to  the  cul-de-sac,  which  is  often  very  dilated  in  Cows,  it  termi- 
nated abruptly  in  a  funnel-shaped  aperture,  and  here  the  genital  organs  ended  ;  for  the  cervix  uteri  was 
absent,  as  was  the  uterus  and  Fallopian  tubes,  and  it  vras  only  in  the  vicinity  of  the  external  angle  of  the 
ilium  that  were  found  small  ovaries  closely  and  curiously  enveloped  in  fat,  so  that  they  could  scarcely  be 
recognized.  The  glands  of  Bartholin  in  the  vagina  were  almost  as  large  as  an  egg,  and  were  full  of  blood  ; 
instead  of  the  valve  in  the  vieina  there  was  a  small  impermeable  opening.  On  incising  the  mammae  the 
gland  substance  was  found  to  be  absent,  and  in  its  stead  was  fibrous  and  adipose  tissue.  In  fine,  this  twin 
was  destitute  of  uterus  and  oviducts,  and  the  vagina  was  short  and  constricted. 


GESTATION.  i^i 

Auscultation,  if  it  could  be  successfully  applied  to  the  larger  animals — 
which  are  usually  uniparous — would  doubtless  greatly  aid  in  diagnosing 
whether  a  gestation  was  single  or  multiple.  The  distinct  pulsation  of  the 
foetal  hearts,  especially  if  at  a  distance  from  each  other,  and  if  the  num- 
ber of  pulsations  were  different  in  the  respective  situations,  should  be 
conclusive  proof  of  multiple  pregnancy.  It  would,  of  course,  be  important 
to  note  the  different  situations  of  the  pulsations,  as  the  action  of  the  foetal 
hearts  might  be  at  times  synchronous.  Care  would  also  have  to  be 
observed  not  to  confound  the  beating  of  the  maternal  heart  with  that  of  a 
fojtus. 

Position  of  the  Foetus  in  Multiple  Pregna7icy. 

The  relative  position  of  the  young  in  the  uterus  in  the  cases  already 
briefly  alluded  to,  is  important  to  remember.  With  regard  to  each  other, 
it  may  be  said  that  they  usually  occupy  four  different  positions  :  i.  Each 
foetus  may  be  isolated  and  enveloped  in  its  own  proper  membranes  ;  2. 
If  there  are  two  foetuses  they  have  a  common  envelope  in  the  chorion,  and 
otherwise  have  a  second  separate  sac  ;  3.  Both  may  be  developed  in  the 
same  cavity  and  the  same  amniotic  fluid,  their  membranes  being  com- 
mon, and  no  partition  existing  between  them  ;  4.  One  foetus  may  be  con- 
tained within  the  other  by"  inclusion,"  as  in  some  of  the  monstrosities  of 
which  we  will  speak  hereafter.  It  may  be  necessary,  however,  to  state 
that  the  included  foetus  may  be  contained  in  the  abdominal  cavity  of  the 
other  individual,  constituting  deep  and  abdominal  inclusion  ;  or  it  may  be 
enveloped  in  a  subcutaneous  tumor — when  it  is  superficial  and  cutaneous. 

In  the  first  variety  of  gestation,  the  envelopes,  where  they  are  in  con- 
tact, adhere  together  by  means  of  a  fine  connective  tissue  ;  the  placentae 
are  often  confounded  (in  ruminants),  or  united  by  a  kind  of  membranous 
connection,  though  their  circulation  remains  distinct.  In  such  a  case  the 
young  may  be  expelled  from  the  uterus  together — a  frequent  occurrence 
in  the  Goat,  according  to  Rainard  ;  but  more  commonly,  after  the  birth 
of  the  first  foetus,  the  uterus  contracts  on  itself,  enclosing  the  remaining 
progeny,  which  may  not  be  born  until  some  days  after — long  enough 
sometimes  to  give  rise  to  the  belief  that  it  is  a  case  of  superfoetation. 
This  apparently  prolonged  retention  of  the  second  foetus  is  generally  due 
to  the  fact,  that  the  first  is  expelled  prematurely,  because  of  the  excessive 
distention  experienced  by  the  uterus  ;  this  organ,  having  thus  got  rid  of 
its  embarrassment,  and  become  relieved,  can  then  maintain  the  second 
foetus  until  the  usual  time  expires.  An  illustrative  case  is  given  in  the 
Memoires  de  la  Societe  du  Calvados  for  1831-32.  A  Mare  gave  birth  to  a 
dead  foal  after  four  months'  gestation,  and  at  the  ordinary  time  a  living 
foal. 

If  one  of  the  foals  dies  in  the  uterus,  the  other  being  contained  in  a 
separate  envelope,  may  continue  to  live  and  grow.  In  somewhat  rare 
cases,  the  dead  foetus  remains  in  the  uterus,  becomes  desiccated,  and  is 
not  expelled  until  the  birth  of  its  companion  at  the  usual  period  ;  or, 
which  is  more  common,  it  acts  in  the  uterus  as  a  foreign  substance  whose 
presence  is  irritating,  and  by  inducing  contractions  of  that  organ  it  is 
extruded,  while  the  living  foetus  is  retained  and  grows  until  the  normal 
time  for  delivery. 

The  foetus  that  has  died  during  gestation  may  be  kept  in  the  uterus  for 
a  long  time,  through  close  adhesions  existing  between  that  organ  and  the 
placenta.     A  case  is  on  record  in  which  a  foetus  was  retained  in  this  man- 


152 


OBSTE  TRIG  A  L  PHYSIOL  OG  Y 


ner  for  two  years.  Rainard  gives  an  instance  of  a. Mare  which  retained 
a  dead  foetus  for  a  year  ;  the  animal  was  then  fecundated  again,  but  hav- 
ing perished  while  pregnant  with  the  second  foal,  an  examination  of  the 
Uterus  was  madS,  and  the  two  young  creatures  were  found — the  first 
being  mummified. 

Death  of  the  foetus  in  these  multiple  cases  appears  to  be  due  either  (i) 
to  the  stronger  vitality  of  the  one  which  lives,  and  which,  by  attracting  to 
itself  a  larger  share  of  nutriment,  starves  the  other ;  (2)  to  the  too  con- 
siderable increase  in  volume  of  one  foetus,  which  compresses  and  atrophies 
the  other  ;  (3)  or  to  the  separation  of  the  foetal  from  the  maternal  placentae, 
which,  of  course,  causes  an  interruption  to  the  circulation  of  the  young 
animal,  and  a  suspension  of  nourishment  and  the  decarbonization  of  its 
blood. 

In  the  second  variety  of  gestation,  in  which  the  chorion  is  common  to 
the  two  foetuses,  but  which  are  yet  separated  by  the  amnion,  there  is  only 
one  placenta ;  the   two   having  a  circulation   in  common,  through  their 


Fig.  53. 
Twin  Pregnancy  ; 


Cow. 


placentae  and  the  umbilical  vessels  communicating  by  their  vascular  rami- 
fications. In  this  case  the  expulsion  of  one  foetus  necessarily  brings 
about  that  of  the  other.  This  also  occurs  when  both  are  contained  in  the 
same  envelopes. 

I  believe  only  two  instances  are  on  record  of  inclusion :  that  of  the 
first  mentioned  variety,  in  which  one  foetus  was  found  in  the  abdominal 
cavity  of  the  other,  Bartholin,  the  celebrated  anatomist,  at  the  com- 
mencement of  the  seventeenth  century  described  the  case  of  a  Mare 
which  brought  forth  a  mule,  in  the  abdomen  of  which  was  found  another  ; 
and  Gurlt  {Magazin  fur  Thierheilkunde,  1869,  p.  347)  mentions  an 
instance  in  which  one  foetus  was  developed  within  the  abdominal  cavity 
of  a  calf,  and  consisted  of  an  incomplete  left  hind  leg»  a  membraneous 


J 


HYGIENE  OF  PREGNANT  ANIMALS. 


153 


organ  representing  the  uterus,  and  the  skin  and  some  vessels.  It  may  be 
remarked,  however,  that  Rainard  witnessed  an  instance  of  this  abdominal 
inclusion  in  a  goose.  The  egg  was  double  the  ordinary  size,  and  it  had 
another  inside  of  about  the  ordinary  dimensions  ;  each-  had  a  perfectly 
formed  shell.  The  subcutaneous  tumors  of  young  animals,  containing 
either  a  whole  foetus  or  Dortions  of  a  pre-existing  one,  are  common  in 
animals. 


CHAPTER  VI. 
Hygiene  of  Pregnant  Animals. 


The  hygienic  measures  to  be  observed  in  the  management  of  animals 
during  gestation  are,  in  general,  those  which  should  prevail  always,  irre- 
spective of  this  condition.  But  besides  these  general  principles,  there  are 
a  few  particular  precautions  to  be  attended  to,  in  order  that  this  period 
may  be  safely  and  successfully  passed  through,  and  these  precautions  are 
all  the  more  necessary  as  the  period  of  birth  approaches.  Unlike  the 
human  female,  pregnant  animals  do  not  require  those  careful,  numerous, 
and  minute  attentions  so  essential  to  her  health  and  the  welfare  of  her 
offspring  ;  indeed,  too  much  nursing  and  pampering,  by  removing  animals 
further  from  their  natural  condition,  is  unnecessary,  and  likely  to  do  more 
harm  than  good. 

When  an  animal  is  believed  to  have  been  fecundated,  it  should  not  be 
allowed  near  the  male  again  ;  as  in  the  artificial  state  in  which  domesti- 
cated creatures  are  usually  kept,  attempts  at  coitus  may  do  harm  ;  though 
it  must  be  confessed  that  among  Cows  the  bull  often  remains  in  the  same 
pasture  with  them,  and  they  calve  as  regularly  and  as  safely  as  if  they 
were  not  so  exposed. 

With  those  animals  which  are  employed  in  labor — as  the  Mare,  and 
sometimes  the  Cow — it  is  well  not  to  work  them  severely  nor  fatigue  them 
much,  and  particularly  as  pregnancy  is  advanced  ;  and,  on  the  other  hand, 
absolute  repose  is  pernicious.  Exercise  is  most  beneficial,  and  the  most 
difficult  cases  of  parturition  occur  among  animals  to  which  this  is  denied. 
The  pregnant  Mare  will  accomplish  ordinary  and  accustomed  work,  par- 
ticularly if  it  be  slow,  without  any  harm,  perhaps  with  benefit,  until  the 
seventh,  eighth,  or  ninth  month,  when  more  care  must  be  observed ;  but 
moderate  exercise  should  always  be  allowed  up  to  the  period  of  parturi- 
tion. Harness  is  preferable  to  saddle  work  for  pregnant  Mares  ;  and  fast 
trotting,  galloping,  jumping,  travelling  over  broken  ground,  or  severe  and 
sudden  exertion,  injuries,  or  shocks  of  any  kind,  are  to  be  avoided — in 
fact,  extremes  should  be  guarded  against. 

If  the  animal  must  be  employed  for  riding,  the  use  of  spurs  should  be 
interdicted,  because  of  the  sudden  contraction  of  the  abdominal  muscles 
which  their  application  induces,  and  which  may  lead  to  abortion. 

Should  the  animal  not  be  usefully  employed  in  this  way,  then  it  ought 
to  be  regularly  exercised  in  hand,  or  placed  in  a  paddock  provided  with 
shelter  from  inclement  weather. 

The  Cow,  if  employed  in  labor,  may  be  worked  moderately  until  the 
sixth  or  seventh  month.  If  kept  for  milk  production,  the  milking  should 
also  cease  about  this  period  ;  though  with  well-fed  Cows  it  is  often  pro- 
longed until  near  parturition.     Nevertheless,  there  can  be  no  doubt  that 


154 


OBSTETRICAL  PHYSIOLOGY. 


this  practice  is  prejudicial  to  the  foetus,  by  arresting  or  retarding  its  de- 
velopment, through  diverting  into  the  mammary  glands  the  materials 
which  should  be  disposed  of  in  the  uterus. 

Exercise  at  pasture  is  beneficial  to  all  animals,  even  the  Pig  and  Bitch 
are  greatly  benefited  by  movement. 

T\iQ.food  oi  pregnant  animals  is  an  important  consideration.  Creatures 
in  this  condition  should  be  well  fed,  and  especially  if  they  have  to  accom- 
plish a  certain  amount  of  labor  or  yield  milk.  The  appetite  is  generally 
increased,  and  there  is,  as  has  been  already  observed,  a  tendency  to  fatten. 
This  tendency  should  be  somewhat  guarded  against,  as  it  may  prove 
troublesome  ;  particularly  if  it  is  allowed  to  proceed  to  an  extreme  degree, 
when  it  may  retard  the  development  of  the  foetus,  induce  abortion,  cause 
difficult  parturition,  or  give  rise  to  serious  after-consequences.  This  pre- 
caution is  more  to  be  observed  in  the  second  than  the  first  half  of  preg- 
nancy, when  the  food  should  be  plentiful,  but  not  in  excess,  and  flesh 
more  abundant  in  the  animal  than  fat. 

The  food  should  also  be  of  good  quality,  very  nutritive,  easy  of  diges- 
tion, and  not  likely  to  induce  constipation. 

Indigestion  should  be  carefully  guarded  against,  and  unaccustomed, 
hard,  damp,  bulky,  fermentable,  mouldy,  or  otherwise  hurtfully  altered 
food,  should  be  avoided,  as  it  is  likely  to  prove  indigestible,  occasion  tym- 
panitis, and  produce  other  injurious  results. 

Grazing  on  pastures  is  favorable  to  the  pregnant  condition  of  herbivor- 
ous animals,  and  especially  if  the  land  is  not  too  broken,  or  sloping,  and 
the  herbage  is  good  ;  as  they  take  their  own  exercise,  and  breathe  a  purer 
atmosphere  than  that  of  stables  or  sheds.  But  it  must  be  remembered 
that  they  should,  if  possible,  be  protected  from  damp,  fogs,  cold  rain, 
stormy  weather,  etc.  If  the  herbage  is  not  sufficiently  abundant  and 
nutritive,  it  should  be  supplemented  by  an  additional  allowance  of  food. 

In  connection  with  food,  it  may  be  well  to  observe  that,  besides  the 
ordinary  saline  matters  which  it  is  beneficial  to  add  to  the  ration,  espe- 
cially when  it  is  prepared  for  the  animals,  in  those  regions  where  inflam- 
mation of  the  joints  of  young  creatures,  and  other  morbid  conditions,  due 
to  the  deficiency  of  certain  mineral  constituents  in  the  economy,  are  noted, 
it  may  be  necessary  to  add  these  constituents  to  the  food  of  the  pregnant 
animal.  * 

The  phosphates  so  necessary  for  the  formation  of  certain  tissues  of  the 
body,  for  instance,  may  be  deficient  in  the  herbage  ;  and  this  may  be  com- 
pensated for  by  giving,  in  addition  to  bran,  meal,  oil-cake,  etc.,  and  even 
properly-prepared  bone-dust. 

The  water  should  be  pure,  and  plentiful  at  all  times  ;  as  then  the  ani- 
mals will  drink  only  moderate  quantities,  and  when  necessary. 

A  point  to  be  particularly  attended  to,  is  not  allowing  pregnant  animals 
to  drink  very  cold  water,  nor  eat  food  at  a  low  temperature.  We  have 
seen  that  the  foetus  is  extremely  susceptible  to  the  action  of  cold,  and 
abortion  is  by  no  means  unusual  through  the  operation  of  this  suscepti- 
bility. 

Very  cold  water,  frozen  food — such  as  roots,  or  herbage  covered  with 
white  or  hoar  frost — should  therefore  be  withheld  from  pregnant  animals, 
as  they  are  likely  to  induce  abortion,  metritis,  and  other  serious  accidents, 
either  through  their  direct  action  upon  the  foetus,  or  indirectly  through 
the  derangement  they  may  set  up  in  the  digestive  apparatus. 

With  regard  to  dwellings^  the  hygienic  rules  which  should  always  be 


HYGIENE  OF  PREGNANT  ANIMALS. 


155 


L 


observed  in  buildings  in  which  animals  are  kept,  ought  to  be  rigorously 
enforced  with  regard  to  those  in  which  pregnant  creatures  are  lodged. 
Cleanliness  is,  above  all  things,  necessary  to  be  observed.  Near  foaling 
time — three  weeks  or  a  month — the  Mares  should  be  kept  apart  in  a 
roomy  loose-box,  and  when  convenient,  within  sight  of  the  other  horses 
with  which  it  has  been  accustomed  to  associate.  The  Cow  is  usually  al- 
lowed to  remain  in  its  ordinary  stall  in  the  cow-shed  ;  but  overcrowding 
and  want  of  space  should  not  be  allowed,  and  every  Cow,  towards  the 
end  of  gestation,  ought  to  have  plenty  of  room  in  its  stall,  if  a  separate 
stall  cannot  be  allotted.  Stables,  sheds,  and  loose-boxes  should  have 
wide  doors,  to  prevent  injury  to  the  females.  With  stalls,  the  floor 
should  slope  very  little  indeed,  from  before  to  behind  ;  as  if  the  inclina- 
tion is  at  all  marked,  the  weight  of  the  gravid  uterus  is  thrown  back- 
wards, and  this  may  lead  to  abortion,  prolapsus  of  the  vagina,  and  even 
eversion  of  the  uterus.  The  cow-shed  ought  to  be  kept  very  clean  and 
free  from  bad  smells,  and  have  plenty  of  fresh  air.  The  stalls  should 
have  plenty  of  litter,  so  as  to  prevent  the  Cows  soiling  themselves. 
Should  a  case  of  abortion  occur  in  a  stable  or  shed,  among  pregnant 
Cows,  the  one  which  has  aborted  ought  to  be  removed  at  once,  and  the 
place  it  occupied  thoroughly  cleansed  and  disinfected,  every  trace  of  the 
accident  being  most  scrupulously  obliterated. 

Cows  which  afford  indications  of  approaching  abortion,  ought  also  to 
be  removed  from  the  vicinity  of  other  pregnant  animals,  and  kept  apart 
from  them  so  long  ai  there  is  any  vaginal  discharge  ;  the  same  precau- 
tions which  must  be  adopted  with  regard  to  thorough  disinfection  and 
cleansing,  are  likewise  necessary  here.  It  is  not  advisable  to  have  Cows 
bring  forth  among  others,  whose  period  of  gestation  has  not  arrived. 

The  cleanliness  of  the  animals  themselves  is  not  to  be  overlooked  ;  as 
neglect  of  grooming  and  freeing  the  skin  from  dirt,  must  operate  per- 
niciously not  only  on  the  mother,  but  on  the  foetus.  ^ 

Mental  and  physical  tranquillity  are  essential  conditions  of  successful 
gestation.  Harsh  or  cruel  treatment  on  the  part  of  grooms,  cow-keepers, 
shepherds,  and  others,  should  be  sternly  suppressed  ;  and  fear,  generally 
produced  by  young  dogs  hunting  the  animals,  and  particularly  pregnant 
Sheep,  is  especially  to  be  averted,  if  possible.  It  is  not  wise  having 
animals  of  other  species  in  the  same  field  or  pasture  with  those  which  are 
pregnant,  more  especially  towards  the  period  of  parturition. 

With  an  irritable  or  timid  primipara  of  the  larger  animals,  it  is  well  to 
be  gentle,  and  to  accustom  it  to  manipulation,  particularly  about  the  ud- 
der, in  order  that  it  may  the  more  readily  allow  its  progeny  to  approach 
it  without  danger. 

Surgical  operations,  and  medication  in  general,  should  be  proscribed 
as  hurtful  during  this  state,  unless  they  are  urgently  needed  for  the  cure 
of  disease.  Above  all,  it  is  necessary  to  guard  against  the  use  of  drastic 
purgatives,  or  even  laxatives,  for  the  relief  of  constipation  which  may 
not  exist ;  as  with  some  animals  these  agents,  by  increasing  the  peris- 
taltic action  of  the  bowels,  indirectly  excite  contraction  of  the  uterus.  If 
there  is  constipation,  suitable  diet  is  a  safer  remedy  than  purgatives. 
Powerful  narcotic,  sedative,  and  other  medicinal  agents,  if  they  do  not 
injure  the  mother,  may  imperil  the  life  of  the  fcetus. 

We  have  no  sufficiently  trustworthy  facts  to  prove  that  female  animals 
are  amenable  to  those  mental  influences  which,  in  the  human  species, 
and  known  as  "  maternal  impressions,"  have  such  a  marked  effect  on  the 
development  or  characteristics  of  the  foetus. 


156  PA  THOLOG  Y  OF  GESTA  TION. 

BOOK   III. 

PATHOLOGY   OF   GESTATION. 

Tu'E. pathology  of  gestation  may  be  said  to  include  those  diseases  and  ac- 
cidents which  constitute  deviations  from  the  regular  or  normal  series  of 
physiological  phenomena  characteristic  of  this  condition.  These  devia- 
tions are  somewhat  numerous  and  various,  and  we  will  follow  Saint-Cyr 
in  classing  them  under  three  distinct  heads  :  anomalies,  diseases,  and  acci- 
dents.    We  will  study  these  in  this  order. 


CHAPTER  I. 
Anomalies   in  Gestation. 

^The  anomalies  occurring   in   gestation   are   superfcetation,  extra-uterine 
pregnancy,  and  spurious  pregnancy. 

SECTION  I. — SUPERFCETATION. 

The  term  superfoetation  {fo'Jus  super fcetutn — one  foetus  on  another)  has 
been  employed  to  designate  those  cases  of  conception  in  which  an  ani- 
mal, already  pregnant,  has  been  supposed  to  conceive  a  second  time  be- 
fore the  termination  of  the  primary  gestation.  In  ordinary  double  or 
triple  gestation,  the  same  copulation  has  produced  the  young  at  once  ; 
but  in  superfoetation  they  are  supposed  to  be  formed  at  a  more  or  less 
wide  interval  of  time,  and  of  course  by  different  copulations. 

The  belief  in  the  possibility  of  such  an  occurrence  in  woman  was  com- 
mon among  the  old  writers,  and  cases  are  adduced  in  support  of  this 
view ;  but  its  correctness  has  been  much  disputed  by  some  recent  au- 
thorities. 

Aristotle  admitted  the  likelihood  of  superfoetation  taking  place  in 
woman,  because  during  pregnancy  she  was  always  with  her  husband  ; 
but  he  denied  its  possibility  in  the  Mare,  although  he  was  aware  that  it 
might  receive  the  male  several  times.  In  all  probability,  he  imagined 
that  the  instinct  of  the  Mare  would  repel  the  stallion  after  impregnation. 
The  naturalists  and  hippiatrists  who  succeeded  him,  have  also  denied 
that  such  an  abnormal  occurrence  could  take  place  in  the  Mare  ;  be- 
cause, they  declared,  after  conception  the  orifice  of  the  uterus  is  closed, 
so  that  the  semen  of  the  male  cannot  be  introduced  ;  every  double  birth, 
they  also  maintained,  was  due  to  two  ova  being  impregnated  at  the  one 
copulation. 

But  numerous  facts  recorded  by  competent  authorities,  would  go  to 
prove  that  superfoetation  is  not  only  probable,  but  possible  ;  and  that  if, 
generally,  there  is  only  one  successful  copulation  possible,  on  the  other 
hand  there  are  instances  well  vouched  for,  in  which  two  successive  copu- 
lations have  been  followed  by  two  independent  impregnations.  In  unip- 
arous  animals  such  cases  have  been  frequently  observed,  the  most  con- 
vincing of  which  is  the  production  of  a  mule-foal  and  a  horse-foal  by  the 
same  Mare  at  one  birth. 

An  occurrence  of  this  kind  is  mentioned   in   the  Memoires   de  VAcademie  Royale  des 
Sciences  for  1753 ;  a  Mare  at  Chatillon-sur-Sevre  brought  forth  a  horse  and  a  mule  foal. 


A  NOMA  LIES  IN  GES  TA  TION.  i  ^  7 

Demoussy  speaks  of  a  M.  Mail  lard,  a  wealthy  farmer  and  breeder  of  horses,  who  had 
occasion  to  observe  a  similar  occurrence. 

In  the  Journal  Veterinarie  Pratique  for  1826,  there  is  an  account  of  a  Mare 
which,  covered  on  the  same  day  by  a  male-ass  and  stallion,  brought  forth  in  eleven 
months  a  well-formed,  though  weak  mule  foal,  and  a  full-developed,  but  dead  horse 
foal.  In  the  same  journal  for  1836,  there  is  another  case  of  this  kind  recorded.  A  Mare 
had  been  put  to  an  Ass  stallion  at  St.  Maixent,  and  was  shut  up  in  an  enclosed  space; 
into  this,  however,  a  Horse  stallion,  two  years  old,  broke,  and  covered  this  animal 
several  times  in  the  course  of  the  same  day.  The  Mare  obstinately  refused  to  be 
covered  when  afterwards  put  to  the  Horse,  according  to  custom.  At  the  usual  period  of 
parturition  it  produced  two  foals,  one  evidently  belonging  to  the  equine  species,  and  the 
other  a  well-characterized  mule.  These  two  young  creatures,  when  three  months  old, 
were  presented  to  M.  de  Vaublanc ;  they  were  then  being  suckled  by  the  Mare,  and 
were  in  perfect  health.  The  fact  was  verified  by  the  Mayor  of  the  Commune,  and 
communicated  to  the  administration  of  the  Stallion  depot  of  St.  Maixent. 

In  Moll  and  Gayot's  "  Connaissance  General  du  Cheval,"  Ayrault  states  that  in 
Poitou,  France,  a  Mare  was  put  to  a  stallion  Ass  on  March  7,  1855,  ^'""^^  ^'"^  ^he  28th, 
being  still  "in  season,"  was  put  to  a  Horse.  The  following  year,  during  the  night  of 
April  14-15,  this  Mare  produced  a  colt  foal  at  eight  o'clock,  and  a  filly  mule  at  eleven 
o'clock ;  so  that  the  oldest  foetus  was  born  three  hours  after  the  youngest. 

In  the  Journal  des  Vetirinaires  dii  Midi  for  1859,  Dr.  Chabaud  relates  that  in  the 
Commune  of  VernioUe  (Ariege),  a  Mare  was  put  to  a  stallion  Ass.  As  oestrum  con- 
tinued, it  was  put  to  a  stallion  fifteen  days  afterwards.  Nothing  unusual  occurred  during 
gestation,  and  when  parturition  took  place,  a  fine  healthy  foal  was  born,  and  after  ten 
minutes'  straining,  to  the  astonishment  of  the  owner,  a  good  well-formed  mule.  The 
Mare  suckled  the  two,  and  they  did  well. 

In  the  Journal  des  Veterinaires  du  Midi  for  1864,  M.  Gilis  gives  a  similar  account  of 
a  Mare  that  had  been  covered  by  a  stallion,  then  some  minutes  afterwards  by  an  Ass, 
and  in  twelve  months  had  two  foals,  perfect  in  their  conformation — one,  a  mule,  died, 
soon  after  birth,  and  the  other,  a  horse  foal,  did  well. 

Lanzillotti-Buonsanti  mentions  a  Mare  which,  on  March  28,  1851,  was  put  to  an 
English  stallion,  and  on  April  5,  to  a  Barb;  on  February  28,  1852,11  produced  two 
foals,  each  resembling  one  of  the  stallions.  Lessona  speaks  of  a  Mare  which  was  put 
to  a  Horse  in  1852,  and  sixteen  days  afterwards  to  a  Persian  stallion  ;  at  eight  months' 
pregnancy  it  dropped  a  horse  foal,  and  in  two  hours  after  a  mule  foal* 

In  the  Veteritiarian  (vol.  xxx.,  p.  78),  Mr.  Evans  refers  to  a  Mare  which  was  put  three 
times  to  the  Horse,  about  six  weeks  intervening  between  each  time.  Two  months  prior 
to  the  ordinary  period  of  parturition  from  the  last  coitus,  two  foals  were  produced, 
one  alive  and  full  grown,  the  other  so  immature  that  it  died  immediately.  The  same 
journal  (vol.  xxxix.,  p.  444)  contains  another  instance,  in  which  a  Mare  was  put  to  a 
Cart-Horse  on  May  20,  but  showing  symptoms  of  oestrum  subsequently,  was  again  put 
to  him  on  June  19.  At  the  commencement  of  the  following  April,  two  foetuses  were 
born,  each  being  in  a  different  stage  of  development,  and  one  of  them  apparently  a  month 
older  than  the  other.     The  same  Mare  had  aborted  the  previous  year. 

In  the  Journal  Veterinaire  Pratique  for  1828,  there  is  an  instance  given  of  what  was 
supposed  to  be  superfoetation.  A  fine-woolled  ewe,  impregnated  at  the  usual  season  in 
1823,  evinced  in  the  following  year,  at  the  period  of  parturition,  the  ordinary  signs  of 
giving  birth  ;  but  these  subsided  without  any  produce  being  born,  and  the  animal  quite 
recovered.  The  foetus  was  in  the  abdomen, -and  could  be  easily  felt.  In  1824,  this  ewe 
was  again  impregnated;  in  the  early  days  of  March,  1825,  the  mammae  contained  milk, 
and  soon  after  the  symptoms  of  parturition  became  manifest;  but,  as  before,  they  dis- 
appeared without  any  result.  The  animal  then  lost  condition,  became  gradually  weaker, 
and  was  not  long  in  succumbing.  On  opening  it,  a  perfectly  developed  lamb  was  found 
in  the  right  horn  of  the  uterus,  and  in  the  left  another  well-formed  foetus  of  the  male 
sex  was  discovered.  The  latter,  with  its  envelopes,  as  well  as  the  uterine  cavity,  were 
normal,  except  that  a  portion  of  the  fluid  had  escaped  and  the  foetus  was  dead; -the 
cervix  uteri,  however,  was  constricted   by   the  presence  of  a  newly- formed  mass  of 

*  All  these  instances  are  paralleled  in  the  human  female,  by  various  authorities.  Buffon,  quoted  by 
Foder^  and  Churchill,  mentions  a  woman  at-  Charleston,  South  Carolina,  who,  in  1714,  was  delivered  of 
twins  within  a  very  short  time  of  each  other,  the  one  being  black,  the  other  white.  On  examination,  the 
woman  confessed  that  on  a  certain  day,  immediately  after  her  husband  had  left  her,  a  negro  entered  her 
room,  and  by  threatening  to  murder  her  in  case  of  refusal,  obtained  connection  with  her.  Dr.  Moseley 
alludes  to  the  case  of  a  negro  woman  who  brought  forth  two  children  at  a  birth,  both  of  a  size,  one  of  which 
was  a  negro  and  the  other  a  mulatto.  On  being  interrogated  upon  the  cause  of  their  dissimilitude,  she 
said  she  perfectly  well  knew  the  cause  of  it ;  which  was  that  a  white  man  belonging  to  the  estate  came  to 
her  hut  one  morning  before  she  was  up,  and  she  suffered  his  embraces  almost  instantly  after  her  black 
husband  had  quitted  her.  Similar  illustrations  are  quoted  by  De  Bouillon.  Trotti.  Guerarde,  Delmas, 
Dunglison,  and  others- 


158  PATHOLOGY  OF  GESTATION. 

matter,  which  was  so  hard  that  it  could  scarcely  be  cut  through — a  circumstance  that 
appeared  to  explain  the  impossibility  of  delivery. 

Hering  [Repert.  fiir  Thierheilkunde,  Jahrgang  ix.,  p.  i),  alludes  to  instances  of  super- 
foetation  in  the  Cow  and.  Sheep. 

In  the  Memotres  of  the  Veterinary  Society  of  Calvados,  vol.  ii.,  M.  Lemaitre  describes 
the  case  of  a  Mare  which  aborted  on  December  2,  and  on  the  following  June  brought 
forth  a  foal  which  continued  to  live.  Trelut,  in  the  Jourttal  des  Velerviaircs  diK  Midi 
for  1844,  mentions  a  Mare,  eleven  years  old,  which  was  put  to  the  Horse  on  April  23,  on 
the  4th,  6th,  and  25th  of  May,  and  again  on  June  5,  1845.  ^^  December  this  Mare 
received  some  kicks  on  the  belly  and  flank  from  a  Horse,  but  this  did  not  impair  her 
health.  On  March  i  it  slipped  up,  and  on  thei  5th  it  aborted  two  foals  without  suffering 
any  ill  effects.  The  first  foal  had  the  tongue  protruding  from  the  mouth,  the  mucous  mem- 
branes were  very  pale,  the  hair  of  body  and  mane  and  tail  were  present,  the  eyes  were 
closed,  the  skin  was  colorless  and  looking  as  if  macerated,  and  the  hair  was  easily 
removed  ;  the  blood-vessels  only  contained  a  few  drops  of  pale  blood ;  and  the  muscles, 
pale  and  flaccid,  did  not  show  any  signs  of  decomposition.  The  second  foal  had  the 
skin  smooth  and  shining,  but  no  trace  of  hair  ;  the  eyes  were  open ;  the  mucous  mem- 
branes bright  red  ;  the  muscles  firm  and  red ;  and  the  heart  and  vessels  filled  with  red 
blood. 

Cauzit,  in  the  yoiirnal de  Med.  Veterinaires  de  Lyoti  for  1859,  gives  an  instance  of  super- 
foetation  in  a  Mare,  fecundation  having  occurred  at  an  interval  of  eight  days ;  and  Cha- 
baud,  in  the  Journal  des  Vet  du  Midi  for  1859,  mentions  another  case,  in  which  fecunda- 
tion must  have  occurred  at  fifteen  days'  interval. 

One  of  the  most  recent  cases  is  reported  from  the  United  States  of 
America. 

On  the  20th  of  February,  1876,  a  five-year-old  Mare  belonging  William  Driesbach,  of 
Sparta,  N.  Y.,  foaled  a  dead  colt,  fully  developed  and  otherwise  promising  in  those  points 
which  go  to  make  up  a  good  Horse.  The  Mare  appeared  to  be  well,  and  to  the  surprise 
of  her  owner,  on  the  2d  of  April  following,  six  weeks  after  the  birth  of  her  foal,  gave 
birth  to  another  colt,  which  was  sound,  healthy,  well  developed,  and  in  all  respects  as 
promising  a  colt  as  could  be  found  in  the  state. 

From  the  facts  already  accumulated  it  may,  then,  be  concluded  that 
superfcetation  in  the  Mare  may  occur,  and  indeed  has  occurred,  several 
times.  It  has  been  argued  against  these  facts  that  superfcetation  is  im- 
possible, because  a  Mare  that  has  once  conceived  would  be  exceedingly 
liable  to  abortion  if  submitted  to  a  second  copulation  ;  but  it  is  more 
than  doubtful  that  abortion  should  be  the  inevitable  consequence  of  re- 
peated copulation  ;  and  we  have  the  human  species  to  adduce  in  proof  of 
the  comparative  innocuousness  of  sexual  intercourse  during  pregnancy. 
So  far  as  researches  have  gone,  however,  it  must  be  confessed  that  these 
double  conceptions  have  only  occurred  in  uniparous  animals  by  successive 
copulations  on  the  same  day,  or  within  a  few  days  ;  and  we  are  therefore 
without  any  indication  that  this  could  occur  in  them  at  longer  intervals. 
This,  it  will  be  evident,  is  no  very  strong,  proof  of  superfcetation  having 
taken  place  ;  for  in  the  case  of  the  mule  and  horse  foal,  it  only  proves 
that  a  double  conception  may  occur  from  intercourse  with  two  different 
animals  within  a  very  short  period.  If  a  longer  period — say  three  or  four- 
months — intervened,  then  superfcetation  would  be  admissible,  and  would 
perhaps  be  undeniable,  provided  there  was  nothing  abnormal  in  the 
uterus — such  as  a  double  organ. 

Rainard  remarks  that  torsion  of  the  neck  of  the  uterus  in  the  Cow, 
though  preventing  the  birth  of  the  foetus,  may  nevertheless  permit  new 
conceptions.  With  inversion  of  the  uterus  and  torsion  of  the  cervix, 
parturition  is  impossible  ;  so  that  instead  of  attempting  to  deliver  by  a 
sanguinary  and  dangerous  operation,  the  success  of  which  is  very  doubt- 
ful, the  animal,  if  not  killed  for  consumption  as  food,  is  generally  left  to 


ANOMALIES  IN  GESTA  TION  i^g 

the  efforts  of  nature  ;  should  the  season  be  favorable  it  is  allowed  to  re- 
main at  pasture,  and  frequently  after  some  suffering  the  creature  regains 
its  condition,  even  becomes  fat,  and  may  then  be  advantageously  sold  to 
the  butcher.  Towards  the  spring-time,  such  an  animal  might  conceive 
again  without  having  been  delivered  of  the  first  foetus. 

In  multiparous  animals  there  can  scarcely  be  a  doubt  that  superfoeta- 
tion  may  take  place,  and  perhaps  of  all  those  which  have  been  domes- 
ticated the  Rabbit  furnishes  the  most  striking  example.  With  this 
creature  a  new  fecundation  may  occur  in  the  middle  of  pregnancy.  This, 
of  course,  can  be  accounted  for  by  the  anatomical  disposition  of  the 
generative  organs,  the  two  cornua  of  the  uterus  opening  into  the  vagina 
independently  ;  so  that  a  primary  fecundation  may  occur  only  from  one 
ovary  in  the  corresponding  horn,  the  other  remaining  open  and  unoccu- 
pied. 

In  the  Bitch,  many  observers  have  assured  themselves  that  superfoeta- 
tion  is  by  no  means  unfrequent.  Rainard,  Blaine,  and  others  speak  of  it. 
Blaine  says,  "  I  am  disposed  to  think  that  Bitches  are  capable  of  super- 
foetation  ;  that  is,  they  conceive  more  than  once.  If  this  is  the  case,  a 
Bitch  may  copulate  to-day,  and  become  impregnated,  that  in  a  day  or  two 
she  may  copulate  again,  and  again  become  impregnated.  This  is  not 
frequent,  I  believe  ;  but  it  certainly  does  happen,  or  we  could  not  account 
for  the  different  periods  at  which  the  progeny  sometimes  appear.  I  have 
known  a  week,  and  in  one  case  even  ten  days,  intervene  between  the 
puppings  ;  but  one  or  two  days  is  not  at  all  uncommon.  As  a  still  more 
convincing  proof,  the  whelps  often  appear  of  different  kinds." 

It  must  be  remembered  that  the  Bitch  remains  in  "  heat  "  for  three  or 
four  days,  and  will  seek  for  repeated  intercourse  with  the  male  during 
that  period.  It  must,  therefore,  either  be  concluded  that  the  last  inter- 
course was  the  successful  one,  or  that  one  or  more  ova  were  impregnated 
at  each  copulation. 

So  far  as  our  knowledge  at  present  extends,  we  can  neither  positively 
negative,  nor  absolutely  admit,  the  possibility  of  superfoetation  in  the 
larger  domesticated  animals.  The  cases  recorded  have  not  been  sufficiently 
investigated  to  convince  those  who  deny  the  likelihood  of  two  conceptions 
taking  place  after  a  certain  interval ;  and  it  must  be  admitted  that  a  true 
explanation  of  such  a  singular  occurrence  has  not  yet  been  offered.  A 
lapse  of  time  occurring  between  the  birth  of  two  animals  is  no  strong 
proof  of  a  second  impregnation  during  conception  ;  for,  as  we  shall  see 
hereafter,  when  twins  are  conceived  from  the  same  intercourse,  it  may 
and  does  happen  that  one  ovum  does  not  attain  maturity  so  soon  as  the 
other,  and  is  either  rejected  or  retained  after  a  more  or  less  lengthened 
interval — a  circumstance  which  might  mislead.  And  again,  with  regard 
to  the  size  of  twins,  it  is  not  at  all  unusual  to  find  one  larger  and  more 
developed  than  the  other,  though  both  were  produced  at  the  same  period. 
Putting  aside  the  question  of  superfoetation  in  animals,  the  anatomical 
disposition  of  whose  generative  organs  evidently  permits  such  an  occur- 
rence, a  little  consideration  will  show  that  usually  there  are  physical 
obstacles  which  offer  an  insurmountable  barrier  to  a  second  impregnation, 
after  conception  has  been  achieved  for  a  short  time.  Soon  after  that 
event  has  taken  place,  the  entrance  to  the  uterus  is  closed  by  the  shut  sac 
enveloping  the  embr\'o,  and  which  adheres  closely  to  the  inner  surface  of 
the  organ  throughout  its  entire  extent — covering  the  orifices  of  the  os 
uteri  and  Fallopian  tubes.     In  addition  to  this,  the  canal  of  the  cervix  is 


i6o  PATHOLOGY  OF  GESTATION. 

during  gestation  rendered  still  more  impervious  by  the  thick  viscid  mucus 
secreted  by  its  glands.  Such  being  the  case,  it  will  be  obvious  that  a 
second  impregation  cannot  occur,  if  it  be  necessary  for  this  purpose  that 
the  spermatozoa  pass  into  the  uterus,  or  even  to  the  ovaries  ;  for  the 
whole  is  hermetically  sealed  after  a  certain  time.  For  a  second  impregna- 
tion to  be  accomplished  during  conception,  fecundation  must  take  place 
before  this  closing-up  of  the  uterus  and  Fallopian  tubes — an  interval  too 
brief  after  the  primary  impregnation  to  make  much  difference  in  the 
respective  developments  of  the  young  animals.  In  cases  in  which  there 
is  a  double  uterus,  or  in  which  conception  occurs  in  only  one  horn,  super- 
foetation  is  possible,  and  one  parturition  may  not  be  followed  by  another 
for  some  considerable  time. 

SECTION  II. — EXTRA-UTERINE    PREGNANCY. 

In  studying  the  development  and  progress  of  the  ovule,  after  its  escape 
from  the  ovary  and  impregnation  by  the  spermatozoa  of  the  male,  we  saw 
that  a  peculiar  arrangement  existed  in  the  presence  of  the  fringed  border 
at  the  extremity  of  the  Fallopian  tube,  which  grasped  the  ovule  and  per- 
mitted it  to  be  conveyed  into  the  canal  on  its  way  to  the  uterus.  From 
certain  causes  which  are  not  yet  clearly  understood,  it  sometimes  chances 
that  the  ovule,  instead  of  taking  this  its  normal  course,  either  remains 
in  the  ovary,  is  arrested  in  its  progress  through  the  tube,  or,  escap- 
ing the  fimbriated  extremity  of  the  latter,  falls  into  the  peritoneal 
cavity,  or  glides  between  the  folds  of  peritoneum  constituting  the  broad 
ligament,  or  between  the  serous  and  mucous  membrane  of  the  uterus  ;  in 
all  of  which  situations  nature  makes  an  effort  to  afford  space  and  nutrition 
for  the  embryo,  and  thus  supply  the  place  of  the  uterus.  This  effort, 
however,  as  might  be  anticipated,  is  only  partially  successful,  and  after 
attaining  a  more  or  less  imperfect  development,  the  fcetus  perishes  from 
lack  of  nourishment. 

This  abnormal  deviation  from  ordinary  gestation,  happily  very  rare  in 
the  domesticated  animals,  has  received  various  names :  such  as  Extra- 
uterine pregnancy,  Exfoetation,  Conceptio  vitioxa,  etc.  The  first  is  that 
usually  employed ;  and  the  different  varieties  are  commonly  designated 
from  the  situation  the  ovum  occupies.  Thus  we  have  (i)  Ovarian  foetation 
when  the  ovum  is  detained  in  the  ovary  ;  (2)  Ovario-tubal,  when  lodged 
partly  in  the  F'allopian  tube  and  partly  in  the  ovary  ;  (3)  Tubal,  when 
the  tube  is  the  situation  j  (4)  Inte7-stitial,  when  the  ovum  enters  the 
parietes  of  the  uterus  at  the  termination  of  the  tube,  but  is  arrested 
between  the  fibres  before  it  can  reach  the  cavity  of  that  organ  ;  (5)  Utero- 
tubal, a  compound  of  the  two,  the  ovum  being  partly  in  the  tube  and 
partly  in  the  uterus ;  (6)  Utero-tubo-abdominal,  when  the  foetus  is  in  the 
peritoneum,  the  umbilical  cord  passing  through  the  tube  to  the  uterus  ; 
(7)  Tubo-abdominal,  when  the  foetal  envelopes  are  fixed  in  the  tube,  but 
the  foetus  is  developed  in  the  peritoneal  cavity  ;  and  (8)  Ventral  or 
abdominal  fostation,  when  the  embryo  is  formed  and  develops  in  the 
abdomen. 

Extra-uterine  pregnancy  is  not  at  all  common  in  the  domesticated 
animals,  and  appears  much  more  rare  in  them  than  in  woman  ;  and 
several  of  the  varieties  just  enumerated  have  never,  to  my  knowledge, 
been  observed  in  them.  This  may  be  fully  accounted  for  by  the  different 
disposition  of  their  generative  apparatus,  the  much  less  tendency  of  these 


ANOMALIES  IN  GESTA  TION  i6i 

to  disease,  functional  disorder,  or  deformity,  and  also,  doubtless,  to  their 
function  being  only  that  of  reproduction.  With  regard  to  anatomical 
arrangement  as  averting,  to  some  extent  at  least,  this  misplaced  gestation, 
we  may  point  out  that  of  the  Mare  as  typical — though  the  same  indica- 
tion is  applicable  to  the  case  of  the  other  large  animals.  In  this  creature, 
the  escape  of  the  ovum  into  the  abdominal  cavity  can  only  occur  through 
some  malformation  or  anomaly  in  the  conformation  of  the  fimbriated 
extremity  of  the  tube,  which,  in  the  normal  condition,  is  applied  to  the 
base  of  the  ovary,  and  envelops  it  during  the  genital  excitement.  Neither 
is  it  likely  that  its  course  through  the  cavity  of  the  tube  can  be  checked, 
as  this  is  short  and  direct ;  and  the  comparative  thinness  of  the  uterine 
walls  almost  precludes  the  probability  of  the  ovum  lodging  itself  in  them. 

Ovarian  fcetatton  has  seldom  been  observed,  so  far  as  my  researches 
have  led  me  ;  though  its  occurrence  in  the  domesticated  animals  is 
far  from  being  impossible.  It  has  been  divided  into  two  kinds  ;  internal 
ovarian^  when  the  embryo  is  developed  in  the  Graafian  vesicle  or  interior 
of  the  ovary  ;  and  external  ovarian^  when  the  ovum  has  left  the  vesicle 
and  grows  beneath  the  envelope  of  the  ovary.  The  only  instances  on 
record  are  given  by  Rohlwes,  Gurlt,  and  Plot.  The  first  observed  this 
rare  form  of  gestation  in  a  Mare  which  had  been  pregnant  twenty-one 
days.  The  ovary  w^as  greatly  enlarged,  and  contained  a  small  embryo  in 
a  vesicle.     Plot  observed  it  in  a  Cow,  and  also  in  three  Sows. 

Tubal foetation^  in  which  the  embryo  is  developed  in  the  Fallopian  tube, 
is  also  exceedingly  rare,  if  the  paucity  of  cases  reported  is  any  criterion. 
Rohlwes  mentions  having  found  the  bones  of  a  foetus  in  the  left  Fallopian 
tube  ;  and  Carus  says  this  form  has  been  noted  in  the  Rabbit.  Car- 
sten  Harms  speaks  of  it  causing  fatal  internal  haemorrhage,  by  rupture  of 
the  tube,  through  the  incapacity  of  the  latter  to  distend  sufficiently  for 
the  development  of  the  foetus. 

In  interstitial foitation,  the  embryo  is  developed  between  the  membranes 
forming  the  walls  of  the  uterus  ;  the  muscular  fibres,  at  the  point  where 
this  occurs,  are  separated,  and  the  cyst  containing  the  embryo  is  situated 
between  the  serous  and  mucous  membrane.  This  variety  has  not  been 
noted  in  the  lower  animals,  I  believe  ;  neither  have  the  remaining  forms, 
except  the  abdominal^  some  very  rare  cases  of  which  are  on  record. 

Abdominal  or  ventral  foetation,  may  present  two  varieties  ;  the  ovum 
may  !;"^it  itself,  after  escaping  from  the  ovary,  directly  in  the*  cavity  of 
the  abdomen,  and  there  be  developed  ;  or  it  may  be  developed  at  some 
other  point — the  ovary,  Fallopian  tube,  etc.,  and  fall  into  the  abdomen 
after  rupture  of  the  pouch  which  contained  it.  In  the  first  instance  it  is 
WdiXSi^A  primary,  and  in  the  other  secondary  abdominal foetatio7i.  Extremely 
rare  though  both  varieties  are  in  animals,  yet  perhaps  the  first  variety  is 
less  frequent  than  the  second. 

The  following  cases  of  abdominal  fcetation  are  given  as  examples  : — 

M.  Mollard,  in  the  Rccueil  de  Med.  Veterinaire  for  1838,  gives  the  case  of  the  foetus  of 
a  Goat,  which  was  found  in  the  abdomen  of  its  parent  by  a  butcher.  The  uterus  was 
perfectly  intact,  and  did  not  exhibit  any  trace  of  gestation  ;  the  foetus  itself  was  attached 
to  the  umbilical  region  of  the  mother  by  vessels  and  very  short  ligaments,  and  was 
enclosed  and  much  compressed  by  an  envelope  somewhat  resembling  the  omentum ; 
this  membrane  was  adherent,  throughout  its  extent,  to  the  skin  of  the  young  animal. 
In  this  instance  there  is  an  absence  of  anatomical  details  which  detracts  from  the  inter- 
est and  certainty  of  the  case.  In  a  more  recent,  and  perhaps  the  only  sufificiently 
attested  instance  of  primary  abdominal  fcetation  on  record,  we  find  these  details  very 
satisfactorily  furnished  by  the  able   director  of  the  Belgian  Veterinary  School  at  Brus- 

II 


1 62  PA  THOL OG  Y  OF  GESTA  TION. 

sels,  M,  Thiernesse,  in  the  Bulletin  de  P Academic  Royale  de  Medecine.  A  third  year 
veterinary  student  was  at  home  with  his  parents  in  April,  1871,  when  a  fat  Pig  was 
killed  for  food.  On  its  abdomen  being  opened,  there  were  found,  floating  among  the 
convolutions  of  the  intestines,  two  foetuses,  which  were  detached  from  the  lumbar  region, 
where  they  were  each  suspended  by  a  vascular  peduncle  about  three  inches  long,  behind 
the  great  mass  of  the  intestines,  and  between  the  two  cornua  of  the  uterus.  These 
were  sent  to  Professor  Thiernesse  immediately,  with  the  information  that  the  Pig  had 
been  at  least  two  years  old,  and  in  September,  1S70,  had  given  birth  to  three  well-formed 
young  ones ;  after  which,  in  con.sequence  of  being  considered  a  bad  breeder,  through 
having  brought  such  a  small  litter,  it  was  laid  up  for  fattening.  Until  it  was  killed  it 
exhibited  no  signs  of  functional  derangement,  and  manifested  the  usual  indications  of 
rutting  every  three  or  four  weeks  ;  being  kept  apart,  however,  it  had  no  opportunity  of 
satisfying  its  desires.  It  was  certain,  then,  that  these  two  foetuses  were  of  the  same  con- 
ception as  those  born  in  September,  and  they  must  have  lived  until  their  parent  was 
sacrificed  ;  as  they  did  not  show  the  slightest  alteration.  They  were  closely  contained 
in  a  complete  membranous  envelope  of  an  ovoid  shape,  provided  at  one  point  with  a 
vascular  pedicle  whose  extremity,  detached  from  the  abdominal  parietes  of  the  mother, 
resembled  a  red  spongy  cord  not  unlike  the  ovary  in  form,  and  which  Thiernesse 
believed  it  to  be,  fancying  that  the  impregnated  ovum  had  fixed  itself  there  and  grown. 
This  was  not  the  case,  however ;  for  dissection  proved  it  to  be  a  simple  vascular  paren- 
chyma— a  kind  of  cotyledon  organized  on  the  peritoneum  of  the  young  creature ;  and 
the  student  had  seen  the  two  ovaries  in  the  Pig,  after  the  removal  of  the  foetuses.  This 
vascular  body  at  the  extremity  of  each  foetal  pedicle  was  therefore  a  new  formation, 
formed  at  the  same  time  as  the  foetus,  and  by  a  hsematosic  elaboration  necessary  to  the 
latter  Consequently,  there  was  here  a  case  of  primary  abdominal  extra-uterine  gesta- 
tion, concomitant  with  a  normal  uterine  gestation.  On  examining  the  foetuses,  they  were 
found  to  be  females ;  the  least  developed  weighed  about  23^  ounces,  and  measured, 
from  the  snout  to  the  base  of  the  tail,  about  12  inches  ;  and  from  the  dorsal  spine  to 
the  distal  extremity  of  the  thoracic  limb,  5  inches.  The  other  was  a  little  larger, 
weighed  29^  ounces,  and  was  14  inches  long  and  7  inches  high.  Their  conformation 
was  symmetrical,  and  development  complete.  Each  had  four  teeth  well  grown  up  in  each 
jaw — the  canine  and  lateral  incisors  ;  and  in  the  largest  foetus  the  middle  incisors  of  the 
lower  jaw  were  equally  developed,  while  the  two  first  hiolars  were  being  cut  in  both 
jaws.  Those  two  foetuses  were,  then,  even  a  little  beyond  the  ordinary  development 
of  those  whose  natural  gestation  is  about  to  terminate.  Each  was  attached  by  an 
umbilical  cord  to  the  membranous  sac  containing  it ;  which  sac,  applied  immediately  to 
the  velvety  skin,  and  even  adhering  to  it  at  some  points,  was  composed  of  a  thin 
chorion,  provided,  for  a  small  extent  of  its  external  surface,  with  a  very  thick  vascular 
placenta,  and  responding  by  its  inner  face  to  a  complete  amnion,  as  well  as  a  very  small 
allantois  whose  cavity  was'  like  that  of  the  latter,  destitute  of  fluid,  but  communicated 
with  the  bladder  by  a  very  distinct  urachus.  All  the  organs  of  these  creatures  were 
fully  formed,  and  there  was  nothing  anomalous  observed.  On  this  case  Thiernesse 
rem'arks,  that  it  would  appear  that  the  glandular  arrangement  of  the  uterus  is  not  indis- 
pensable to  the  formation  of  the  embryo,  and  that  absence  of  these  glands  may  be  effi- 
ciently compensated  for  by  an  organ  developed  on  or  in  any  other  in  the  abdominal 
cavity  whefe  the  impregnated  ovum  may  graft  itself  ;  that  under  the  stimulating  influ- 
ence produced  by  tlie  contact  of  the  ova,  this  new  organ  constitutes  a  kind  of  extra- 
uterine cotyledon  analogous,  up  to  a  certain  point,  to  the  maternal  placenta  resulting 
from  the  hypertrophy  of  the  uterine  mucous  membrane,  and  which  acts  very  well  as  such, 
though  with  less  functional  energy.  This  is  evidenced  in  the  development  of  these  two 
foetuses,  which  required  about  ten  months  to  bring  them  to  their  present  growth — a 
period  more  than  double  that  of  ordinary  gestation  in  the  Pig.* 

A  few  other  instances  of  abdominal  foetation  will. complete  what  we  have  to  offer  in 
the  way  of  illustration  of  this  abnormal  pregnancy. 

The 'first  case  is  reported  by  M.  Simon,  of  Yonne,  France.  A  celebrated  sheep- 
breeder  in  his  canton  had  a  Sheep  which,  though  carrying  a  dead  lamb  for  two  years, 
yet  produced  another  at  the  end  of  this  period,  and  which  lived.  It  appears  that  the 
Sheep  was  seven  years  old,  and  had  been  put  to  the  ram  with  the  others  of  the  flock  to 
which  it  belonged.  At  the  usual  period  of  lambing,  the  animal  made  attempts  at  deliv- 
ery, but  was  unsuccessful ;  and  an  examination  made  by  a  veterinary  surgeon  proved 
that  the  foetus  could  not  be  extracted  ;  it  was  therefore  predicted  that  the  Sheep  would 
for  the  future  prove  sterile.  At  this  period  the  mammae  were  enlarged  for  five  or  six 
days,  and  fever  was  present ;  then  all  the  general  symptoms  of  this  condition  gradually 
disappeared,  the  appetite  returned,  and  the  animal  was  well.  The  foetus  could  be  felt 
at  the  lower  part  of  the  belly.     Two  years  afterwards,  to  the  great  astonishment  of  the 

*  "  Anuales  de  M^d.  Vdt^rinaire  de  Bruxelles,"  1871,  p.  420. 


ANOMALIES  IN  GESTA  TION  163 

owner,  the  Sheep  brought  forth  a  lamb,  which  it  suckled,  and  which  grew  up.  The 
mother  was  then  put  by  for  fattening,  and  when  ready  for  the  butcher  it  was  examined 
by  M.  Simon.  By  taxis,  he  distinctly  felt,  a  little  to  the  right  of  the  lower  part  of  the 
abdomen,  an  elongated,  hard,  irregular,  insensible  tumor,  slightly  curved  shape,  and 
presenting  along  the  curvature  very  prominent  asperities,  which  were  distinguished 
as  those  of  the  vetebral  column  of  a  dead  foetus.  The  animal  being  killed  and  opened, 
the  uterus  was  found  contracted,  and  situated  in  the  upper  region  of  the  abdomen ;  it 
offered  no  signs  of  gestation.  The  intestines  were  then  removed  and  the  right  side  of 
the  rumen  lifted  up,  when  the  tumor  was  discovered  which  had  been  felt  externally ; 
it  was  firmly  attached  to  the  abdominal  wall,  and  consisted  of  a  pouch  containing  the 
foetus.  No  particular  mention  is  made  of  the  condition  of  the  walls  of  the  uterus,  and 
the  foetus  and  its  envelopes  having  been  sent  to  M.  Renault,  then  directorof  the  Alfort 
Veterinary  School,  unfortunately  no  report  as  to  the  anatomical  peculiarities  of  these 
was  published.  The  case  would,  however,  appear  to  be  one  of  primary  extra-uterine 
abdominal  foetation.*  ^ 

The  second  case  is  given  by  S.  Della-Rovere,  veterinary  surgeon  of  Angliano 
{Archivio  della  Veterinai'ia  Italiani,  1868),  who  was  called  to  give  his  attention  to  a 
Cow  in  parturition,  and  which  had  been  already  in  the  hands  of  an  empiric  for  some 
time.  It  was  aged  14  years,  and  was  very  emaciated.  By  a  vaginal  exploration  the  os 
uteri  was  found  completely  closed,  so  that  torsion  of  the  uterus  was  at  first  apprehended  ; 
but  it  was  soon  discovered  that  such  was  not  the  catse.  During  the  examination  the 
expulsive  movements  continued,  and  Della-Rovere  felt  under  his  hand  the  limbs  of  a 
foetus  pressing  against  the  margin  of  the  vulva.  Withdrawing  his  arm,  by  palpation 
along  the  floor  of  the  vagina  he  satisfied  himself  of  the  presence  of  the  two  fore-limbs 
and  head  of  a  foetus.  An  incision  was  consequently  made  through  the  vaginal  wall  at 
the  point  corresponding  to  the  foetal  limbs,  and  by  the  opening  so  made  he  extracted  a 
living  healthy  calf,  which  was  given  to  another  Cow  to  rear.  Some  minutes  afterwards, 
the  straining  persisting,  another  exploration  was  made,  when  a  second  calf,  much 
smaller  and  dead,  was  removed.  The  Cow  died  three  days  after  this  operation. 
Unfortunately,  the  veterinary  surgeon  could  not  make  a  careful  examination,  as  when 
informed  of  the  death  of  the 'animal,  it  had  already  been  cut  up  ;  so  that  he  was  unable 
to  ascertain  by  what  means  the  foetuses  were  nourished,  and  how  the  umbilical  cords  were 
attached.  The  uterus  was  quite  contracted  and  small,  with  numerous  folds  in  the  inte- 
rior, as  if  the  animal  had  not  bred  for  several  months  ;  on  the  left  side  of  the  organ,  at 
its  lower  third,  was  a  long  irregular  cicatrix,  with  a  small  round  opening  at  its  inferior 
extremity,  through  which  a  goose  quill  could  scarcely  be  passed.  From  inquiry,  it  was 
ascertained  that  the  Cow  had  been  overturned  by  another  while  at  pasture  during  the 
early  months  of  gestation  ;  but  it  never  showed  any  signs  of  inconvenience  from  this 
accident,  and  was  regularly  worked  in  the  plough.!  This  is  an  example,  probably,  of 
the  second  form,  the  foetuses  having  escaped  through  the  walls  of  the  uterus  by  a  tear 
made  in  that  organ.     Other  instances  of  the  variety  will  be  given  hereafter. 

In  the  Veterinarian  (vol.  vii.,  p.  606),  Mr.  Berry  mentions  a.  Cow  which,  being  preg- 
nant, exhibited  all  the  signs  of  approaching  parturition  at  the  usual  time  ;  and  after 
showing  symptoms  of  fever  and  uneasiness  from  distended  udder  for  some  days,  was  at 
last  examined /^r  z/a^/ww;/,  but  no  calf  was  found  in  the  uterus,  though  it  could  be 
"  touched"  above  the  flank.  Being  satisfied  that  it  was  a  case  of  extra-uterine  gesta- 
tion, the  Caesarean  operation  was  performed;  but  the  animal  was  so  exhausted  that  it 
died  before  the  business  was  completed.  The  operation  brought  to  light  "a  mass  of 
fungous  matter,  weighing  not  less  than  seventy  pounds,  in  the  centre  of  which  lay  a 
remarkably  fine  heifer  calf,  fully  matured,  and  evidently  a  very  short  time  dead.  The 
most  minute  examination  was  instituted,  but  no  connection  appeared  between  the  womb 
and  the  part  enclosing  the  calf,  except  by  external  adhesion." 

In  the  same  journal  (vol.  xiii.,  p.  66)  Mr.  Metherell,  of  Spalding,  describes  a  foetus 
which  was  found  in  the  lumbar  region,  behind  the  left  kidney  of  a  Sheep,  and  attached 
to  the  peritoneum. 

In  this  journal  also  (vol.  xv.,  p.  103I,  Mr.  Green,  of  Fareham,  writes  of  an  examination 
he  made  of  the  body  of  a  full  grown  Ewe.  On  making  an  incision  along  the  linea  alba, 
through  the  abdominal  and  recti  muscles,  there  was  presented  to  view  a  foetal  lamb  in 
the  cavity  of  the  abdomen,  wholly  deprived  of  its  membranes,  its  back  lying  on  the 
abdominal  muscles,  the  support  or  attachment  being  formed  on  the  off-side,  and  effected 
by  means  of  intervening  bands  of  lymph  from  the  cheek,  and  continuing  backwards  to 
the  antero-spinous  process  of  the  ossa  innominata,  wholly  enveloping  the  off-fore  ex- 
tremity. The  union  formed  between  the  foetus  and  the  peritoneal  covering,  at  the  inner 
surface  of  the  right  abdominal  muscles  in  the  umbilical  regionj  was  its  head,  the  pos- 

*  "  Recueil  de  M^d.  Vet^rinaire,"  1857,  p.  298. 

t  "Journal  des  V^t^rinairesdu  Midi,''  1869,  p.  1S9. 


1 64  PA  THOL  OG  Y  OF  GESTA  TION. 

terior  parts  extended  as  far  back  as  the  ensiform  cartilage,  and  the  uniting  medium  was 
very  firm.  The  left  side,  from  the  third  cervical  vertebra  to  the  tail,  was  imbedded  in 
the  omentum.  The  hind  extremities  were  firmly  fixed  to  each  other,  also  to  the  abdo- 
men :  being,  in  fact,  quite  immovable.  The  fore  extremities  were  attached  to  each 
other  as  far  down  as  the  carpus,  and  thence  by  bands  of  lymph  to  the  lower  surface  of 
the  neck.  The  nose  of  the  foetus  was  twisted  to  one  side  ;  there  were  no  eyes ;  the 
ears  were  small,  and  fixed  to  the  occiput,  being  in  texture  like  the  parotid  gland;  the 
spine  was  curved,  and  the  tail  fixed  between  the  hind  legs;  the  anterior  maxillary  bones 
were  alone  covered  with  wool ;  the  abdominal  muscles  were  very  thick ;  the  spleen, 
pancreas,  kidneys,  and  bladder,  as  well  as  the  rectum,  were  all  absent,  and  the  sex  could 
not  be  distinguished.  It  weighed  within  an  ounce  of  five  pounds.  In  the  Ewe,  the 
cervix  of  the  uterus  was  obliterated  by  small  excrescences,  "  of  the  character  and 
appearance  of  the  inner  surface  of  that  organ.  The  animal  had  never  exhibited  any 
unusual  symptoms,  except  that  she  had  proved  barren  in  the  previous  spring,  having 
been  with  the  ram  before  then." 

The  same  journal  (vol.  xxix.,  p.  344)  alludes  to  a  good-sized,  fully-formed  lamb,  found 
in  what  appeared  to  be  a  tumor  or  bag  attached  to  the  rumen  of  a  fat  Sheep  killed  for 
food.  The  skin  of  the  foetus  was  covered  with  wool  where  it  had  not  been  torn  in  pro- 
cess of  removal  from  its  adherences.  The  uterus  of  the  Ewe  was  small,  and  there  was 
no  evidence  of  rupture. 

Gurlt  (Pathol.  Anatomic,  1831)  describes  an  instance  of  abdominal  gestation  in  a 
Sheep,  in  which  the  maternal  placenta  was  attached  to  the  mesentery ;  and  Plot  alludes  to 
a  similar  occurrence  in  a  Bitch,  the  foetal  membranes  adhering  to  the  mesentery  and  kid- 
neys; while  Fornari  mentions  a  placenta  formed  on  the  rumen  of  a  Goat.  Below  gives 
a  detailed  description  of  a  mummy  (/////(?/^fl'/£'«)  weighing  1870  grammes,  which  was 
found  in  the  abdominal  cavity  of  a  Sheep. 

A  very  interesting  notice,  one  of  the  most  recent,  is  given  by  Baillet  [Rectieil  de  Med. 
Veterinaire,  1875,  p.  26).  As  inspector  of  the  abbatoir  at  Bourdeaux,  his  attention  was 
called  to  the  carcase  of  a  six-year  old  Cow,  in  very  fine  condition,  which  had  just  been 
slaughtered.  On  opening  the  abdomen,  an  ovoid  mass,  not  unlike  in  appearance  the 
manyplus  of  the  stomach,  appeared  at  the  anterior  part  of  the  right  sac  of  the  rumen  ; 
it  had  formed  adhesions  with  the  omentum,  rumen,  diaphragm,  liver,  and  right  hypo- 
chondrium.  When  detached  it  measured  18  by  14  inches  in  diameter,  and  weighed  45 
pounds.  It  was  of  a  nacrous  white  hue,  and  provided  with  numerous  firm,  membranous 
prolongations  of  a  red  color  ;  a  hard  rounded  body  could  be  felt  within  it.  When  cut, 
it  was  found  to  be  a  sac,  the  wall  of  which  was  about  one-fifth  of  an  inch  thick,  and  firm 
and  resisting.  No  trace  of  vascularization  could  be  made  out  on  its  inner  surface,  which 
adhered  to  a  dead  foetus  so  tenaciously,  that  some  degree  of  force  was  required  to  destroy 
the  intimacy  existing  between  it  and  the  hair  on  the  dorso-lumbar  region  of  the  calf.  A 
small  quantity  of  turbid,  yellow,  colorless  fluid,  in  which  floated  some  debris  of  horn 
and  some  hairs,  occupied  the  bottom  of  the  sac.  There  were  no  proper  foetal  envelopes, 
and  the  creature  appeared  to  have  been  grafted  on  the  inner  face  of  this  fibrous  cham- 
ber. It  was  a  full-time  foetus  ;  though  by  its  general  development  it  looked  as  if  arrested 
by  the  limited  space  in  which  it  had  been  enclosed.  Bent  longitudinally,  its  head  was 
fixed  between  the  fore  legs.  The  surface  of  the  body  was  covered  by  slightly  humid 
hair,  which  was  easily  removed,  particularly  within  the  arms  and  thighs,  where  the  skin 
was  cf  alight  yellow  color.  The  compression  it  had  undergone  had  produced  a  general 
flattening  of  the  muscles;  the  eyelids  were  quite  distinct,  though  there w^as  not  a  vestige 
of  eyes ;  a  shred  of  umbilical  cord,  black  and  withered,  still  remained.  There  was  no 
unpleasant  smell,  even  when  the  body  was  opened.  Thevicera  were  dry  and  looked  as 
if  macerated  ;  the  muscles  were  pale,  but  firm  ;  and  the  bones  were  intact,  their  extremi- 
ties being  provided  with  a  cartilaginous  covering.  The  uterus  of  the  Cow,  though  care- 
fully examined,  offered  no  evidence  in  explanation  of  this  abnormal  gestation.  Some 
corpora  lutea  \td  to  the  supposition  that  it  had  been  bred  from,  or  at  least  that  its 
ovaries  had  been  the  seat  of  the  process  which  accompanies  fecundation.  There  was 
nothing  in  the  condition  of  the  Cow's  carcase  to  indicate  that  this  strange  state  had 
caused  it  any  suffering  or  inconvenience. 

Professor  Stockfleth,  of  Copenhagen,  describes  another  instance  (  Tidsskrift for  Ve- 
terinitrer,  1875)  of  a  Cow  in  which,  after  it  had  been  slaughtered  for  food,  a  large  round 
tumpr  Avas  found  in  the  abdominal  cavity.  This  tumor  was  attached  by  a  cord  to  the 
abdomen,  and  it  contained  a  foetus  covered  by  a  dense  white  membrane,  through  which 
the  dark-brown  epidermis  retaining  the  hair  appeared,  but  which  came  off  with  the 
covering.  The  calf  lay  rolled  up  with  its  head  and  feet  together,  and  was  in  every 
respect  normal.  The  uterus  of  the  Cow  was  contracted  in  a  natural  manner,  and  one 
of  the  ovaries,  which  was  somewhat  larger  than  usual,  contained  a  corpus  luteum. 
There  was  no  connection  between  the  uterus  and  the  membranes  surrounding  the  foetus, 
neither  had  the  membranes  any  cotyledons. 


ANOMALIES  IN  GESTA  TION. 


165 


The  length  of  time  during  which  these  extra-uterine  foetuses  may  be  re- 
tained, varies  according  to  circumstances.  In  the  human  species,  a  case 
is  recorded  in  which  the  foetus  remained  in  the  abdomen  for  fifty-six 
years  ;  and  a  great  many  instances  are  published  in  which  retention  has 
continued  from  three  months  up  to  the  last-named  period.  In  animals, 
this  retention  of  the  misplaced  foetus  may  also  continue  for  a  long  time  \ 
and  though  death  usually  occurs  if  delivery  is  delayed  much  beyond  the 
the  usual  period  of  pregnancy,  yet  development  appears  to  progress  in 
the  ordinary  manner,  and  subject  to  the  laws  of  normal  gestation.  It  is 
indeed  astonishing  to  find  the  ovum  fix  itself,  and  become  developed  into 
the  embryo  and  foetus,  by  drawing  nourishment  in  "the  strange  situation 
in  which  it  chances  to  fall  :  the  placenta,  cord,  and  envelopes  being  pres- 
ent just  as  if  it  had  found  its  way  into  the  natural  receptacle.  It  does 
not  appear  to  be  quite  decided  whether  the  ovum,  in  primary  abdominal 
foetation,  receives  an  additional  covering  analogous  to  the  decidua ; 
though  it  is  very  probable  that  it  does,  and  that  this  membrane  may  per- 
form a  similar  office  in  the  nutrition  of  the  foetus.  The  part  of  the  ab- 
dominal or  other  surface  to  which  the  ovum  adheres,  receives  an  in- 
creased vascular  supply  for  the  occasion,  its  vicarious  function  being  as 
actively  carried  on  as  if  it  were  the  lining  membrane  of  the  uterus. 

Not  unfrequently,  retention  is  brought  to  a  termination  by  the  death  of 
the  parent,  through  the  disordered  state  of  health  induced  by  the  living 
foetus,  or  through  absorption  of  the  septic  matter  it  engenders,  if  putre- 
faction sets  in  after  its  decease.  On  other  occasions,  and  these  are  com- 
paratively not  very  unfrequent  in  the  lower  animals,  an  effort  is' made  by 
nature  to  get  rid  of  what  really  in  time  becomes  a  foreign  body  by  arti- 
ficial openings.  In  these  cases  the  foetus  may  be  passed  whole  or  by 
fragments  through  the  abdominal  parietes,  the  intestines,  or  the  vagina 
— in  almost  every  case  the  former,  owing  to  the  quadrupedal  position  of 
,the  domesticated  animals.  Several  occurrences  of  this  kind  are  to  be 
found  in  the  literature  of  Veterinary  Science  ;  but  we  will  notice  only  the 
following  in  this  place  : 

M.  Drouard  [Recueil  de  Med.  Veterinaire,  1842)  reports  that  a  Sheep  -which  had 
lambed  the  preceding  year  without  any  accident,  was,  at  its  second  gestatron,  seized 
with  sudden  but  unavailing  throes  of  parturition.  Nothing  appeared  ;  the  os  uteri  re- 
mained closed,  and  the  waters  did  not  escape.  The  animal  continued  in  this  state  for 
three  or  four  days,  after  which  the  symptoms  subsided,  and  in  a  month  they  had  disap- 

jeared.  About  this  time,  however,  the  appetite  became  lessened,  rumination  began  to 
irregularly  performed,  the  strength  was  diminished,  and  the  animal  often  lay  for  a 

)ng  time.  For  fifteen  days  it  remained  in  this  state,  very  dull,  the  eyes  sunk. in  their 
orbits,  the  respiration  frequent,  and  the  pulse  almost  imperceptible.  An  cedematous 
swelling  appeared  beneath  the  belly,  and  the  skin  at  this  part  was  cold  and  brown  col- 
ored. Scarifications  made  in  it  permitted  the  discharge  of  a  foul-smelling  sanguineous 
fluid,  indicative  of  gangrene.  Finally,  ulceration  set  in  over  this  swelling,  and  soon  a 
foetus  covered  with  wool  showed  itself :  this  was  extracted  after  enlarging  the  opening. 
It  was  in  an  advanced  stage  of  decomposition,  and  in  the  abdomen  of  the  mother  it  lay 
with  the  head  and  fore  limbs  towards  the  pelvis,  the  croup  being  inclined  towards  the 
diaphragm.  It  was  extracted  by  the  fore  part  of  the  body,  and  the  opening  was  closed 
by  suture,  leaving  only  an  orifice  for  the  escape  of  the  pus  •  a  retaining  bandage  around 
the  body  to  support  the  sutures,  applications  to  the  skin,  and  diffusible  stimulants  in- 
ternally, was  the  treatment.  As  the  appetite  did  not  return  for  eight  days,  tonic  and 
nourishing  draughts  were  administered.  After  this  period  it  rallied,  but  there  was  an 
abundant  discharge  of  pus  ;  the  orifice  through  which  it  flowed  enlarged,  and  at  last  gave 
exit  to  the  after-birth,  as  well  as  a  portion  of  the  omentum,  which  was  of  a  deep  reddish- 
brown  tint,  and  had  to  be  excised.  The  gangrenous  condition  of  the  wound  also  de- 
manded attention  ;  the  margins  were  pared,  and  new  sutures  employed.  By  attention 
and  careful  nursing  the  wound  had  cicatrized  by  the  forty-fifth  day,  and  in  six  months 


1 66  PA  THOLOG  Y  OF  GESTA  TION, 

the  animal  was  fat  again.  Unfortunately,  it  was  sold  to  the  butcher  without  the  veteri- 
nary surgeon  being  allowed  the  opportunity  of  examining  its  carcase  after  it  was  killed ; 
as  it  would  have  been  interesting  to  note  whether  this  was  a  case  of  primary  or  second- 
ary abdominal  foetation.  Probably  in  this  instance  peritonitis  was  averted  by  adhesions 
being  formed  around  the  part  to  which  the  foetus  was  attached — the  whole  mass  becom- 
ing encysted  immediately  over  the  abdominal  surface  where  ulceration  took  place. 

Coquet  [Instructiojts  Veteri7iaire,vo\.  ii.),  so  long  ago  as  1784,  mentions  that  a  farmer 
at  Neufchatel  bought  a  Cow  that  appeared  to  be  ill,  in  the  hope  of  being  able  to  cure  it. 
Instead  of  amending,  however,  it  became  worse,  and  a  profuse  diarrhoea  set  in  of  serous 
and  putrid  matters.  It  was  soon  noticed  that  these  ejecta  contained  hard  substances, 
which  were  recognized  as  bones.  The  farmer  brought  several  of  these  to  Coquet, 
among  which  was  a  cannon-bone,  a  calcis,  several  ribs,  a  portion  of  a  lower  jaw,  several 
fragments  of  the  knee  anc^  hock,  and  a  maxillary  bone.  Coquet  thought  at  first  that 
these  could  only  come  from  the  uterus ;  but  the  owner  positively  assured  him  that  they 
were  passed  with  the  faeces.  As  the  case  appeared  to  be  hopeless,  the  animal  was  let 
alone  ;  it  died  in  about  a  month,  and  the  following  lesions  were  noted  :  the  colon  was 
much  enlarged  from  its  last  flexture  to  the  commencement  of  the  rectum — about  two 
and  a  half  feet,  and  its  walls  measured  more  than  an  inch  in  thickness ;  they  were  very 
dense,  dark-colored,  inflamed,  and  gangrenous ;  the  inferior  surface  was  perforated ; 
and  the  intestine  contained  at  that  part  a  considerable  quantity  of  bones,  similar  to  those 
which  had  been  voided,  but  more  voluminous  and  irregular,  like  the  pelvic  bones  and 
those  of  the  spine  and  head.  The  uterus  was  a  little  larger  than  in  the  non-pregnant 
state,  but  its  fundus,  which  corresponded  to  the  diseased  and  perforated  intestine,  was 
likewise  engorged,  indurated,  and  very  thick,  though  there  was  no  appearance  of  a  cica- 
trix. The  cervix  was  so  contracted  that  a  stylet  could  not  be  passed  into  it,  and  its 
cavity,  which  was  empty,  could  scarcely  be  discerned.  The  peritoneum  and  mesentery 
in  the  neighborhood  of  the  affected  parts  were  swollen  and  inflamed ;  while  the  serosity 
effused  into  the  pelvic  cavity  was  sanguinolent  and  putrid.  The  other  viscera  were 
healthy. 

Haubner  reports  a  case  recorded  by  Janke,  of  a  Cow  five  years  old,  when  in  its  sev- 
enth month  of  pregnancy,  gradually  losing  its  appetite,  while  the  size  of  the  abdomen 
increased.  It  was  supposed  to  be  affected  with  ascites,  and  was  therefore  killed ;  when 
a  foetus,  contained  in  its  envelopes,  was  discovered  in  the  abdominal  cavity.  The  uterus 
had  the  same  appearances  as  in  the  non-pr^nant  state.  The  same  author  mentions 
the  case  of  a  Sheep  which  had  not  lambed  at  the  usual  time,  but  which,  two  months 
afterwards,  exhibited  a  tumor  on  the  abdomen  in  which  the  fore  limb  of  a  lamb  could 
be  felt.  The  tumor  was  opened,  the.  lamb  extracted,  and  the  wound  closed  by  suture. 
The  Sheep  recovered  and  remained  in  good  health. 

Beiiz  and  Bagge,  of  the  Copenhagen  Veterinary  School,  found  in  the  abdomen  of  a 
little  Bitch,  aged  thirteen  years,  a  foetus  which  appeared  to  occupy  the  mesentery  of  the- 
small  intestines.  All  the  soft  parts  of  the  creature  had  disappeared,  and  it  looked  like 
a  skeleton.     The  Bitch  did  not  show  any  signs  of  suffering  during  life. 

Saussol  {Recueil  de  Med.  Veterinaire,  1828)  reports  that  a  Ewe,  three  years  old, 
had  been  with  the  Ram  like  the  other  Ewes,  but  never  exhibited  any  signs  of  preg- 
nancy. About  two  months  after  being  with  the  Ram,  the  shepherd  observed  a  hard 
tumor  about  an  inch  behind  the  umbilicus,  and  which  gradually  increased  in  size,  until, 
fifteen  or  sixteen  months  after  it  was. first  seen,  Saussol  was  called  in.  The  tumor  was 
then  the  size  of  a  goose's  egg,  and  felt  like  an  abscess.  It  was  punctured,  when  a  quan- 
tity of  pus  escaped,  and  with  it  the  bones  of  a  foetus.  These  bones  were  separated 
from  eaeh  other,  and  were  discolored  ;  the  head,  however,  was  entire,  ^nd  less  altered 
than  the  other  parts.  The  first  incision  being  enlarged,  it  was  found  that  the  abdom- 
inal muscles  were  nearly  double  their  ordinary  thickness,  and  at  this  particular  point 
formed  a  pouch  in  which  the  foetus  was  lodged,  but  covered  only  by  the  skin.  No  com- 
munication existed  between  the  pouch  and  the  abdominal  cavity.  The  opening  was 
closed  by  suture  and  soon  healed,  but  the  animal  did  not  thrive  and  was  sold. 

Dickinson,  in  the  Veterinarian  (vol.  xxviii.,  p.  196),  relates  the  case  of  a  Sow  which 
he  was  called  in  to  attend.  The  animal  had  been  ill  for  some  time,  and  its  period  of 
gestation  had  expired  four  weeks  previously;  though  as  no  indications  of  approaching 
parturition  were  noticeable,  it  was  supposed  a  mistake  had  been  made  in  the  date. 
The  symptoms  were  :  loss  of  appetite,  obstinate  constipation,  a  peculiar  or  painful 
grunt,  and  lying  on  the  left  side  with  a  limb  extended,  as  if  to  relieve  the  abdomen  from 
the  weight.  When  standing  it  would  support  itself  by  leaning  against  the  wall,  and 
then  gradually  drop  down  as  easily  as  possible.  A  hard  mass  could  be  distinctly  felt  on 
manipulating  the  abdomen,  especially  towards  the  left  side  ;  the  pain  on  pressure  was 
intense.  Medical  treatment  was  of  no  avail,  and  on  the  fourth  day  it  succumbed.  _  At 
the  autopsy,  the  peritoneal  membrane  was  found  to  be  inflamed,  the  visceral  portions 
being  most  affected.    The  uterus  had  been  seriously  injured,  evidently  by  the  operation 


A  NOMA  LIES  IN  GESTA  TION  r  6  7 

of  "spaying."  The  right  horn  and  its  ovary,  with  a  portion  of  the  body  of  the  uterus 
and  vagina,  were  absent.  A  mass  about  the  size  of  a  man's  head,  enveloped  in  false 
membranes,  was  situated  in  the  left  iliac  region,  and  connected  with  the  left  horn  of  the 
uterus,  which  was  still  continuous  with  its  ovary  and  the  vagina.  On  dissecting  the 
tumor,  the  osseous  remains  of  seven  Pigs  were  discovered,  enclosed  in  separate  cavi- 
ties. Seven  heads  and  all  the  bones  were  collected.  They  were,  however,  denuded  of 
all  soft  parts,  as  if  they  had  been  subjected  to  maceration. 

Symptoms,  Course,  a?id  Termifiations . 

We  have  already  to  some  extent  indicated,  in  recording  the  history  of 
several  of  the  most  interesting  cases  of  extra-uterine  pregnancy  mentioned 
in  veterinary  literature,  the  character  of  the  symptoms,  and  the  termina- 
tions which  mark  this  accident.  The  symptoms  are  generally  those  of 
conception  and  gestation.  The  ovum  grafts  itself  on  some  part  with 
which  it  chances  to  be  in  contact ;  an  embryo  results,  the  placenta  being 
attached  to  the  neighboring  textures  and  developing  with  the  increase  of 
the  young  creature  ;  these  changes  being  accompanied  by  the  ordinary 
external  signs  of  uterine  pregnancy.  In  the  majority  of  cases,  tl^^e  par- 
turition should  occur  in  the  usual  course,  the  premonitory  indications  of 
that  phenomenon  are  very  slight  or  altogether  absent ;  though  the  animal 
may  now  and  then  make  expulsive  efforts,  which  continue  perhaps  for  a 
few  days,  and  then  subside  gradually,  or  recur  at  intervals.  In  the  most 
favorable  cases,  when  the  fcetus  perishes,  it  becomes  enkysted  and  mum- 
mified ;  the  fluids  and  soft  parts  are  absorbed,  and  the  remaining  por- 
tions become  dry  and  parchment-like  ;  or  the  creature  may  undergo  a 
process  of  calcification  by  the  deposition  of  carbonate  and  phosphate  of 
lime  in  its  tissues,  which  preserve  its  shape,  and  convert  it  into  a  "  litho- 
paedion  "  or  "  osteopjedion."  In  this  condition  the  foetus  may  remain 
for  an  indefinite  period  in  the  abdomen  of  the  mother,  without  causing 
much,  if  any  inconvenience  :  indeed,  a  most  perfect  state  of  health  may 
exist,  and  the  animal  become  remarkably  fat,  or  it  may  conceive  and 
bring  forth  as  favorably  as  if  nothing  abnormal  existed  ;  the  indications 
of  anomalous  gestation  being  only  discovered  by  chance  when  the  animal 
dies  from  some  disease  which  has  no  relation  to  this  accident,  or  is  killed 
for  food. 

Such  a  happy  result  of  the  accident  is,  however,  very  far  from  being 
%  the  rule,  and  the  chances  are  many  that  fatal  termination  will  be  the 
consequence  of  extra-uterine  gestation.  Expulsive  efforts  or  other  causes, 
may  lead  to  rupture  of  the  kyst  in  which  the  foetus  is  contained  ;  and 
this,  with  the  fluids  and  deh'ts  of  membranes,  falling  into  the  abdominal 
cavity,  may  give  rise  to  such  a  severe  form  of  peritonitis  that  death  will 
ensue  in  one  or  two  days.  In  other  instances  the  kyst  inflames,  and 
suppuration  is  established,  with  putrefaction  and  partial  solution  of  the 
fcetus  ;  and  if  the  mother  does  not  at  once  succumb  to  pyaemia  or  septi- 
kaemia,  adhesions  and  communications  are  formed  between  the  kyst  and 
neighboring  organs,  and  the  remains  of  the  yopng  animal,  chiefly  the 
bones,  are  expelled  either  directly,  as  by  ulceration  of  the  abdominal 
I  walls  after  the  development  of  an  abscess,  or  indirectly,  as  through  the 
intestine,  etc.  After  the  foreign  matters  have  been  completely,  or  even 
only  partially,  eliminated  in  this  way,  the  fistulous  openings  by  which 
they  escaped  ciatrize  after  a  variable  period  of  suppuration,  and  the  female 
recovers — as  has  been  observed  in  Sheep  and  Goats. 

More  frequently,  however,  it  loses  condition,  becomes  emaciated  and 
feeble,  and  perishes  in  a  state  of  marasmus  ;  or  it  succumbs  to  hectic 


1 68  PA  THOL  OG  Y  OF  GESTA  TION. 

fever,  septikaemia,  or  one  of  the  many  accidents  which  the  presence  of 
such  a  body  may  produce.  The  course  of  external  ovarian  gestation, 
which  has  been  stated  by  Gurlt  to  occur  in  the  domesticated  animals, 
appears  to  be  as  follows  :  the  envelopes  of  the  ovary  rupture  towards  the 
second  or  third  month  of  the  embryo's  development,  when  the  latter  falls 
into  the  abdominal  cavity,  where  it  constitutes  what  we  have  termed 
'•  abdominal  "  gestation,  leaving  only  a  cicatrix  on  the  ovary.  With 
regard  to  internal  ovarian  pregnancy,  the  ordinary  termination  is  rupture 
of  the  organ,  and  fatal  haemorrhage. 

Diagnosis  and  Treatment. 

There  is  absolutely  nothing  in  the  early,  or  even  in  the  later  stages  of 
extra-uterine  pregnancy,  especially  ovarian  and  tubal,  to  indicate  the  ex- 
istence of  any  deviation  from  normal  gestation  ;  and  when  at  length  the 
animal  exhibits  indications  of  approaching  parturition,  there  may  be 
grave  doubts  as  to  the  actual  state  of  affairs,  though  the  absence  of  cer- 
tains signs  may  give  rise  to  suspicion.  The  animal  is  uneasy  and  strains, 
yet  the  vulva  is  not  enlarged,  and  the  flow  of  mucus  observed  in  the  pre- 
liminary stage  of  ordinary  parturition  is  not  apparent.  Exploration  of 
the  cervix  uteri  by  the  vagina,  will  prove  the  absence  of  induration  or 
morbid  tumefaction,  as  well  as  dilatation  or  contraction  of  the  os,  not- 
withstanding the  length  of  time  that  has  elapsed  and  the  expulsive  efforts. 
Palpation  and  inspection  of  the  abdomen  may  also  furnish  certain  infor- 
mation with  regard  to  volume,  and  the  situation  of  the  enlargement. 
C  ireful  exploration  of  the  abdominal  cavity  by  the  rectum,  will  be  found 
advantageous  in  cases  of  abdominal  gestation  uncomplicated  with  uterine 
pregnancy.  Not  only  can  the  condition  of  the  uterus  be  satisfactorily 
determined,  but  perhaps  a  tumor  independent  of  that  organ  may  be  dis- 
covered, and  in  which  a  foetus,  or  parts  of  one,  can  be  felt.  In  such  a 
case,  efforts  must  be  made  to  check  the  attempts  at  parturition,  though  it 
must  be  confessed  that  they  are  not  likely  to  be  successful.  Sedatives, 
large  doses  of  opium,  chloral,  hot  water  applications  to  the  abdomen,  and 
other  measures  of  this  kind  are  indicated.  If  the  diagnosis  is  well  estab- 
lished, and  the  animal  can  be  utilized  for  food,  it  is  generally  better  to 
have  it  destroyed  if  in  fair  condition.  In  cases  in  which  the  period  of 
parturition  has  passed,  and  when  the  animal  has  been  unwell  for  some 
time,  exhibiting  loss  of  appetite,  with  marked  depression,  quickened 
pulse  and  increased  temperature,  and  nothing  else  to  account  for  these 
symptoms,  then  we  may  suspect  the  existence  of  extra-uterine  gestation 
and  putrefaction  of  the  foetus. 

In  the  smaller  animals — such  as  the  Sheep,  Goat,  Bitch,  etc.,  abdomi- 
nal palpation  can  be  readily  resorted  to,  and  often  with  most  satisfactory 
results. 

When  elimination  of  the  foetus  has  commenced  in  any  of  the  modes  just 
described,  active  interference  may  or  may  not  be  necessary,  according  to 
circumstances.  The  fistulous  openings  which  may  be  occasioned  by  the 
eliminative  process,  must  be  dealt  with  as  ordinary  fistulae.  Should  the 
foetus  chance  to  be  alive,  it  is  scarcely  possible  that  it  can  be  removed 
by  operation  without  greatly  endangering  the  life  of  the  mother.  If  in 
abdominal  gestation  a  tumor,  simulating  an  abscess,  forms  on  any  part 
of  the  abdomen,  this  may  be  carefully  opened,  and  the  foetus  extracted 
with  a  successful  result.  The  accessory  treatment,  such  as  careful  nurs- 
ing and  hygienic  measures,  must  not  be  neglected. 


ANOMALIES  IN  GESTA  TION  169 

SECTION  III. SPURIOUS  OR  PSEUDO-PREGNANCY. 

Spurious  pregnancy  is  a  designation  applied  by  veterinary  obstetrists 
to  certain  accidents,  characterized  by  the  development  of  special  patho- 
logical productions,  which  may  probably  be  due  to  a  previous  conception, 
and  which,  more  or  less,  simulate  normal  pregnancy.  They  are  far  from 
common,  and  the  principal  of  them  are  described  as  moles,  uterine  kysls, 
and  hydrops  uteri*     These  we  will  allude  to. 

Moles. 

Moles,  or  more  correctly  speaking  perhaps,  anidian  monsters,  are  more 
or  less  voluminous  fleshy  masses  constituted  by  a  blighted  embryo,  the 
membranes  of  which  have  continued  to  perform  their  function,  and  to 


nourish  the  abnormal  growths.  They  are,  as  a  rule,  met  with  only  in 
ruminants,  and  especially  the  bovine  species,  though  Roell  mentions  their 
occurrence  in  the  Mare  ;  and  in  nearly  every  case  they  appear  to  be  one 
of  twins,  the  development  of  which  has  been  arrested  at  a  certain  period. 
The  mole  {mola  cruentd)  is  more  particularly  characterized  by  the  per- 
sistence of  an  umbilical  cord  which,  though  degenerated,  yet  seems  in  the 
majority  of  cases  to  maintain  relations  between  the  tumor  and  the  uterus. 
With  regard  to  the  tumor  itself,  it  is  generally  easy  to  distinguish  the  dis- 
torted remains    of  an  embryo — such   as   skin,  bones,  muscles,  and  even 

*  I  am  not  aware  that  the  curious  and  obscure  form  of  pseudo-pregnancy  occurring  in  woman  and  Aq' 
sx^xviAzA.  pseudo-.-yesis  by  the  late  Dr.  Simpson,  has  ever  been  observed  in  animals. 


1 7  o  PA  THOL  OGY  OF  GESTA  TION. 

organs  of  sense  in  some  cases.  These  anidian  monsters  have  not  at- 
tracted much  attention  ;  so  we  will  venture  to  give  a  short  analysis  of 
some  instances  recorded  in  the  annals  of  Veterinary  Science. 

In  the  Rectieil  de  Med  Vetirinaire  for  1828  (p.  370),  Saussol  describes  the  case  of  a 
Cow  three  months  in  calf,  and  which,  when  harnessed  to  a  carriage,  fell  on  its  abdomen 
with  great  force  against  a  stone.  After  this  accident  it  lost  condition,  pined  away,  and 
at  last  died.  When  opened,  instead  of  an  ordinary  foetus,  there  was  found  an  oval- 
shaped  consistent  fleshy  mass,  of  a  reddish  violet  color,  floating  in  a  rusty-tinted  fluid, 
and  which  had  obtained  its  nourishment  by  means  of  a  single  cord — no  doubt  emana- 
ting from  some  cotyledon.  This  tumor  contained  the  skeleton  of  a  fcefiis,  the  bones  of 
which  were  normal  and  not  displaced,  being  held  together  by  means  of  ligaments. 

Leaux  ( Journal  de  Med.  Veterinatre  de  Lyon,  1846)  states  that  a  Cow  seven  months 
pregnant,  after  two  days'  violent  straining,  ejected  a  dead  foetus  and  a  large  tumor,  and 
died  immediately  afterwards.  The  tumor  weighed  five  kilogrammes,  was  of  no  par- 
ticular shape,  was  reddish-brown  in  color,  soft  but  very  vascular  and  covered  by  a  fine, 
apparently  pseudo-membranous,  envelope.  No  trace,  of  peduncle  or  uterine  adhesion 
could  be  detected.  The  whole  mass  was  of  a  fibrous  texture,  and  composed  of  a  mul- 
titude of  small  vesicles  containing  an  amber-colored  serqsity. 

The  Reciicil  de  Med.  Veterinaire  for  1858,  contains  the  description  of  an  anidian 
monster  found  in  a  sheep  which  had  given  birth  to  a  dead  lamb,  and  was  sacrificed. 
This  monster  had  neither  head  nor  tail,  was  about  two  feet  long,  and  sixteen  -inches 
broad  at  the  widest  part.  The  limbs  were  rudimentary,  without  any  trace  of  digits, 
and  there  was  neither  anus,  vulva,  or  scrotum.  A  protuberance  took  the  place  of 
the  neck  and  shoulders  ;  while  in  the  centre  of  the  mass  was  only  a  cavity  filled  with 
serum,  in  which  floated  a  rudimentary  stomach  and  intestines.  There  was  no  trace  of 
liver,  spleen,  kidneys,  diaphragm,  heart,  or  lungs,  and  there  were  a  few  bones,  sup- 
posed to  be  misshapen  ribs;  the  remainder  was  composed  of  infiltrated  connective 
tissue. 

Mr.  Snowdon,  in  the  Veterinarian  for  1856  (p.  218),  states  that  on  January  30th  a 
Cow  produced  a  healthy  female  calf.  _  Nothing  unusual  was  observed  during  the  day, 
but  about  six  p.m.  the  animal  appeared  to  be  in  pain,  when  Mr.  Snowdon  was  called. 
He  found  a  membranous  sac  hanging  from  the  vagina,  to  nearly  as  low  as  the  Cow's 
hocks.  This  was  punctured,  but  only  a  small  quantity  of  fluid  escaped,  though  a  mole 
appeared,  which  was  attached  to  the  placental  membranes  by  an  umbilical  cord.  This 
was  divided,  and  the  animal  continuing  in  pain,  an  examination  was  made/^r  vaginam, 
when  another  calf  was  found  in  the  uterus.  This  was  delivered,  when  it  was  discovered 
to  be  a  male  calf,  well  developed,  but  dead.  The  Cow  did  well  afterwards.  The 
anidian  monster  was  in  shape  a  flattened  ovoid,  about  two  inches  in  thickness,  and  six 
inches  by  four  in  size.  It  was  covered  with  long  red  hair  ;  though  at  the  border,  where 
the  umbilical  vessels  enter,  was  a  hairless  spot.  On  the  opposite  border  was  '  the  rudi- 
ment of  a  lower  jaw,  containing  four  well-developed  incisor  teeth,  three  of  which  had 
cut  the  gum.  Above  this  was  a  small  cartilaginous  ear,  and  near  it  something  like  an 
eyelid.  Several  bones  were  contained  in  the  mass,  one  of  which  had  the  shape  of  the 
bones  of  the  skull ;  though,  as  a  whole,  it  felt  spongy  and  elastic.  Its  weight  was 
fourteen  ounces. 

In  the  Annales  de  Med.  Veteriiiaire  for  1859,  May  mentions  having  delivered  a  normal 
calf,  and  afterwards  the  Cow  expelled  an  oval  mass  the  size  of  a  child's  head,  covered 
with  a  fine  velvety  skin,  and  showing  at  one  point  an  umbilical  cord.  This  skin  en- 
veloped a  vascular  spongy  tissue,  mixed  with  muscular  and  glandular  portions,  and  in 
its  centre  was  a  small  soft  bone  about  an  inch  in  length, 

Lavocat  {Journal  de  Vet.  du  Midi,  1866)  relates  that  having  delivered  a  Cow  of  a 
well-formed  calf,  and  before  the  removal  of  the  membranes,  a  kind  of  downy  ball  was 
expelled,  which  was  only  attached  to  the  latter  by  a  vascular  prolongation,  comparable 
to  an  umbilical  cord.  The  mass  was  oval  in  shape,  as  large  as  a  lamb's  head,  every- 
where covered  with  hair,  and  at  the  middle  was  what  appeared  to  be  a  regularly-formed 
umbilical  cord.  At  one  of  its  extremities  was  a  shallow  cavity  terminating  in  a  cul- 
de-sac,  the  irregular  margin  of  which  bore  the  incisor  teeth  projecting  beneath  the  gums. 
There  was  no  trace  of  thoracic  or  abdominal  cavities  or  organs  ;  neither  was  there 
brain,  spinal  cord,  or  nerves.  Some  bony  fragments  were  found,  among  which  were  the 
rudiments  of  a  lower  jaw  bearing  the  teeth  already  mentioned.  The  remainder  of  the 
tumor  was  made  up  of  very  vascular  cellulo-adipose  tissue,  the  meshes  of  which  were 
filled  with  serosity. 

In  the  Veterinarian  (vol,  xliv.,  p.  275),  Mr,  Creswell  describes  an  anidian  monster 
produced  by  a  white  short-horn  Cow,  two  hours  after  delivery  of  a  healthy  and  well- 
developed  bull-calf  of  a  roan  color.    This  monstrosity  was  round,  and  about  the  size  of 


A  NO  MA  LIES  IN  GESTA  TION  1 7 1 

the  crown  of  a  hat  (?).  It  weighed  eighteen  ounces  some  time  after  it  had  been  found, 
but  was  much  larger  and  heavier  when  first  expelled;  it  was  thickly  covered  with 
long  fine  lo/iiie  hair,  which  was  longest  and  thickest  on  one  side  ;  at  the  part  where  it 
was  thinnest  there  was  a  nude  spot  at  the  point  of  attachment  of  the  placental  membrane, 
and  near  the  external  border  other  two  bare  places  which  were  deeply  concave  and 
red  colored,  one  having  a  slight  eminence  in  the  centre.  The  entire  mass  was  soft  and 
pulpy,  as  if  the  interior  was  composed  of  cells  containing  fluid.  No  traces  of  bone 
could  be  felt,  and  as  it  was  decided  to  keep  the  specimen  intact,  nothing  more  of  its 
structure  was  reported. 

Rainard  and  others  mention  having  found  fibrous  moles  {mola  racc- 
f/iosii)  in  the  uterine  cornua  of  the  Bitch,  Pig,  and  some  other  multiparous 
animals  during  gestation  ;  and  most  frequently  in  the  last  dilatation  of 
one  horn,  rarely  in  both  ;  and  sometimes  between  two  of  the  dilatations 
which  contain  living  foetuses.  They  are  spheroidal,  soft,  irregular  in 
shape,  and  look  like  flesh  ;  they  appear  to  be  composed  of  fibres  run- 
ning in  every  direction.  In  the  dilatation  of  the  horn  containing  them, 
traces  of  a  zonular  uterine  placenta  have  been  observed.  Rainard  was 
of  opinion  that  they  were  embryos  whose  development  was  checked  by 
disease. 

Demoussy  states  that  the  presence  of  a  foetal  mole  in  the  Mare  gives 
rise  to  the  same  phenomena  as  real  pregnancy — enlargement  of  the  ab- 
domen, sinking  of  the  croup  and  flanks,  sluggish  gait,  and  altered  respira- 
tion ;  and  that  the  diagnosis  is  the  presence  or  absence  of  movement  in 
the  foetus. 

Uterine  Kysts. 

Uterine  kysts  are  pathological  productions,  somewhat  analogous  to  the 
vesicular  degeneration  of  the  human  placenta,  in  which  the  placental  villi 
are  distended  with  fluid,  enlarged,  elliptical,  transparent,  and  loosely  con- 
nected, while  their  vessels  become  obliterated  and  disappear.  This  con- 
stitutes what  has  been  designated  a  "  vesicular  mole." 

Liautard  (Journal  de  Med.  Veterinaire  de  Lyon,  1859)  was  to  called  to  assist  a  Cow  in 
parturition,  on  January  28,  1854.  The  animal  was  eight  months  old,  and  its  abdomen 
had,  within  the  previous  eight  days,  assumed  unusual  dimensions  ;  while  the  very  vio- 
lent expulsive  efforts  it  made  were  followed  by  no  result.  When  the  hand  was  intro- 
duced into  the  vagina,  the  os  was  found  to  be  moderately  dilated,  and  in  it  was  found  a 
fluctuating  tumor  which  was  at  first  thought  to  be  the  bag  of  the  waters.  At  each  ex- 
pulsive effort  this  tumor  was  much  protruded,  but  labor  did  not  progress.  Another 
more  thorough  exploration  resulted  in  pushing  the  tumor  back,  and  passing  the  hand 
through  the  os  into  the  uterus  ;  then  it  was  discovered  that  the  tumor  was  not  formed 
by  the  foetal  envelopes,  and  that  it  adhered  by  one  of  its  extremities  to  the  inferior 
surface  of  the  uterus,  at  the  point  where  the  mucous  membrane  entered  the  os.  Its 
shape  was  oblong,  and  in  size  it  was  as  large  as  an  ostrich's  egg ;  it  was  a  uterine  kyst. 
While  this  obstacle  was  being  pushed  forward,  a  sudden  effort  made  by  the  Cow  carried 
into  the  os,  then  into  the  vagina,  and  at  last  externally,  the  bag  of  the  waters,  which  on 
rupturing  exposed  the  fore  feet  of  a  foetus ;  this  was  withdrawn  by  a  few  gentle  pulls, 
but  it  was  dead,  and  appeared  to  be  about  seven  months  developed.  On  the  hand 
being  re-introduced  into  the  uterus,  the  kyst  was  soon  found ;  it  had  been  compressed 
during  delivery,  but  now  it  had  assumed  its  original  size,  and  was  lying  in  front  of  the 
internal  orifice  of  the  os.  Exploring  still  farther,  two  other,  but  smaller  and  more  cir- 
cumscribed, tuniors  of  the  same  character  were  felt  in  the  middle  of  the  body  of  the 
uterus.  In  consequence  of  this  discovery,  the  owner  of  the  animal  was  recommended 
to  have  it  sold  to  the  butcher  as  soon  as  it  had  recovered  sufficiently.  This  advice  Avas 
not  followed,  however,  and  the  Cow  appeared  to  be  quite  well  soon  after,  yielding,  as  it 
did,  twelve  litres  of  milk  daily.  In  two  months  it  was  put  to  the  Bull,  and  in  time  was 
supposed  to  be  pregnant,  as  the  abdomen  gradually  became  more  voluminous.  Never- 
theless, it  remained  emaciated,  its  quantity  of  milk  diminished,  there  was  tympanitis  at 
intervals,  and  this  appeared  to  be  relieved  only  after  an  abundant  emission  of  urine. 
When  eleven  months  had  elapsed  since  the  previous  abortion,  and  the  period  for  par- 


17' 


PATHOLOGY  OF  GESTATION. 


turitiou  had  arrived,  it  was  so  wasted  that  Liautard  was  again  called  in.  It  was  then 
observed  that  the  Cow  almost  every  instant  brought  its  limbs  together  under  the  body, 
arched  its  back  very  mach,  and  made  feeble  but  long-continued  expulsive  efforts,  which 
were  immediately  followed  by  the  escape  of  a  small  quantity  of  odorless  seruin.  From 
time  to  time,  also,  there  appeared  in  the  right  flank  a  variable-sized  tumor,  which  did 
not  look  unlike  the  transient  prominences  the  foetus  makes  during  the  later  period  of 
pregnancy ;  this  appearance  was  accompanied  each  time  by  2.  glott  gloti  sound.  Abdom- 
inal exploration  did  not  discover  the  foetus  in  this  tumor;  but  direct  exploration, 
which  was  easily  made,  proved  that  the  kyst  recognized  eleven  months  previously  had 
become  considerably  increased ;  while  the  rupture  of  some  fibrous  bands  during  this 


l'"ig-  55- 

Hydatid  Kyst  or  Mole;    Human. 

The  Kyst,  which  filled  the  Uterus,  has  been  opened,  and  gives  exit  to  a  number  of  Hydatid  Vesicles. 
The  Section  shows  two  Membranous  Layers,  the  first  of  which,  a  aa,\%  external,  and  is  analo- 
gous to  the  Epichorion  or  Decidua ;  while  the  second,  b  b  b,\sz.  fine  transparent  Membrane, 
apparently  the  remains  of  the  Chorion,  c  c  c,  Granular  Vesicles;  d  d  d.  White  Vessels, 
some  of  which  appear  on  the  Surface  as  Granulations,  and  ot  hrs  act  as  Pedicles  to  the 
Globules  at  their  extremity  ;  e  e  e.  Oblong  Vesicles  which  appear  to  be  Constricted  or  Dilated 
Vesicles  ;  fff,  Budding  Vesicles. 


investigation,  allowed  the  escape  of  some  dozen  litres  of  fluid.  No  foetus  could  be  dis- 
covered in  the  uterus,  but  there  were  numerous  kysts,  some  agglomerated,  others  iso- 
lated, and  which  made  the  interior  of  the  organ  feel  lumpy  at  various  points.  Several 
of  these  kysts  were  doubtless  ruptured  during  the  manipulation,  for  when  the  arm  was 
withdrawn  there  was  an  emission  by  the  vulva  of  another  dozen  litres  of  fluid.  This 
condition  of  the  uterus  accounted  for  the  apparent  pregnancy.  No  treatment  was  at- 
tempted, and  eight  days  afterwards,  the  Cow  having  died,  an  examination  was  made 
of  the  carcase,  when  the  following  lesions  were  noted :  On  removing  the  digestive 
organs  the  uterus  appeared  as  an  enormous  irregular  mass,  measuring  from  the  cervix 
to  the  extremity  of  the  horns  three  feet  seven  inches ;  an  incision  made  in  its  lower 


) 


ANOMALIES  IN  GESTA  TION.  173 

face  gave  exit  to  about  fifteen  litres  of  fluid.  There  was  no  foetus :  the  mucous  was 
separated  from  the  muscular  layer  by  the  infiltrated  connective  tissue,  and  the  knife 
had  opened  four  large  kysts,  the  most  voluminous  of  which  was  situated  towards  the 
middle  of  the  body  of  the  organ,  and  was  as  large  as  the  head  of  a  child.  All  the 
kysts  contained  an  abundant  serous  fluid,  and  they  all  offered  the  same  organization  : 
being  formed  by  strong  septa  into  several  compartments,  which  were  in  reality  so  many 
smaller  kysts  enclosed  by  a  common  envelop — the  mucous  membrane.  On  the  upper 
wall  of  the  uterus  were  three  more  kysts,  all  resembling  the  others,  though  they  were 
less  voluminous.     The  cotyledons  were  abnormally  developed. 

This  is  a  good  example  of  uterine  kysts  producing  the  appearance  of 
pregnancy,  and  also  offering  an  obstacle  to  parturition. 

In  January,  1807,  Rodet  {Rectteil  de  Med.  Veterinaire,  1824)  was  called  to  see  a  Mare 
which  was  believed  to  be  pregnant,  and  which  appeared  to  be  suffering  from  tedious 
labor ;  and  the  symptoms — among  which  were  those  of  violent  colic,  and  energetic 
expulsive  efforts — might  certainly  have  afforded  good  reason  for  the  supposition. 
Rodet's  first  attempts  to  relieve  the  Mare  having  proved  unsuccessful,  in  three  hours  he 
made  an  exploration  per  rectum,  and  discovered'that  the  uterus  was  as  largely  developed 
as  at  the  full  period  of  gestation,  though  its  contents  did  not  feel  like  an  ordinary  foetus. 
Making  a  vaginal  exploration,  he  was  astonished  to  find,  instead  of  an  unformed  foetus 
or  mole,  several  somewhat  large  excrescences  moving  about  in  the  uterus,  the  interior  of 
which  they  appeared  to  fill.  Thinking  that  these  were  true  polypi  with  a  wide  base, 
and  covered  and  maintained  by  the  mucous  membrane,  he  submitted  the  animal  to  medi- 
cal treatment.  This  was  attended  with  good  results  ;  the  animal  recovered,  and  during 
the  three  months  it  was  under  observation  there  was  no  relapse  ;  after  that  period  it 
was  lost  sight  of. 

Hydatid  kysts  have  been  mentioned  as  occurring  in  the  domesticated 
animals,  and  simulating  pregnancy  ;  but  the  authorities  who  allude  to 
these  instances  have  not  offered  any  details.  They  appear  to  be  related 
to  conception  and  pregnancy,  and  in  some  instances  they  may  be  a  de- 
formed embryo. 

The  Veterinarian  (vol.  xx.,  p.  187)  gives  an  interesting  account  of  an 
immense  tumor  in  the  uterus  which,  in  the  living  animal,  led  to  the  belief 
that  the  Mare  was  in  foal. 

Hydrops    Uteri  or  Hydwmeira, 

Hydrops  uteri,  as  the  designation  implies,  is  a  collection  of  fluid  in  the 
uterus  ;  though  it  may  not  be  of  a  serous  character  in  every  case,  but 
may  sometimes  be  purulent.  There  are  many  instances  of  this  condition 
recorded  in  British  and  foreign  veterinary  literature,  as  occurring  in  the 
Mare  and  Cow — the  animals  which  most  frequently  receive  attention, 
though  the  Sheep  and  Bitch  sometimes  suffer  from  this  disease.  This 
condition  appears  to  be  related  to  gestation ;  it  is  allied  to  mole 
pregnancy,  and  sometimes  closely  simulates  real  pregnancy.  It  may  also 
be  due  to  injury  to  the  uterus. 

Rainard  says:  "When  this  collection  is  forming,  the  abdomen 
gradually  enlarges  as  in  ordinary  gestation  ;  the  animal  looks  healthy, 
and  there  is  scarcely  any  difference  between  this  state  and  that  of 
pregnancy  before  the  second-third,  or  even  the  second-half  of  gestation. 
It  is  rare  that  these  collections  persist  more  than  five  or  six  months 
without  being  evacuated  at  least  once,  and  it  is  usual  to  see  this  evacua- 
tion take  place  every  month,  or  at  least  every  two  months.  The  fluid  is 
greyish-colored,  and  it  is  often  as  much  as  an  ordinary  bucketful." 

Saint-Cyr,  in  alluding  to  the  cases  recorded  since  Rainard  v/rote  these 
lines,  remarks  that  it  is  usually  after  a  copulation  which  is  supposed  to 


174 


PATHOLOGY  OF  GESTATION. 


be  successful  that  these  collections  form.  The  collections  are  gradually- 
developed,  and  are  accompanied  by  all  the  signs  of  ordinary  ges- 
tation, with  the  exception,  of  course,  of  the  movements  of  the  foetus. 
Then,  at  a  certain  time,  there  appear  the  precursory  indications  of 
parturition  or  abortion:  expulsive  efforts  —  certainly  less  energetic, 
painful,  or  prolonged,  as  a  rule,  than  those  of  natural  parturition,  and 
rather  resemble  those  of  micturition  or  defecation.  The  cervix  uteri 
slowly  enlarges,  though  the  hand  introduced  into  the  vagina  discovers  it 
— the  OS — to  be  almost  impervious,  and  neither  fcetus  nor  membranes 
can  be  felt  ;  when  it  is  dilated,  there. is  at  once  a  gush  of  fluid,  the  aspect 
and  c^ality  of  which  varies.  It  is  often  greyish-colored,  thick,  and 
more  or  less  foetid  ;  though  it  may  also  be  clear  and  serous.  Its  evacua- 
tion may  occur  at  very  variable  periods — as  at  one  hundred  and  eighty 
days,  five  and  a  half  months,  thirty-two  weeks,  or  forty-six  weeks,  after 
the  supposed  successful  copulation,  according  to  the  various  writers  who 
have  described  these  cases. 

Many  instances  are  on  record  (see  the  Veterinarian,  vol.  xlvi.  p.  562)  ;  but  we  will 
only  quote  one,  which  is  the  most  recent : — 

Suchanka  {GLstcrr.  Vierteljahr.  f.  Wissenshaftliche  Veterindrkunde,,  i^j ^,  p.  76)  was 
summoned,  on  February  11,  to  give  an  opinion  as  to  whether  a  certain  Cow  was  in  calf. 
The  animal  was  five  years  old,  and  had  been  put  to  the  bull  on  Aprd  21,  1874;  it 
should  therefore  have  already  calved.  Many  persons  had  declared  that  it  was  in  calf ; 
but  the  owner  was  doubtful,  and  as  the  animal  was  unprofitable,  he  determined  to  kill 
it.  Suchanka  explained  that,  according. to  all  experience,  the  Cow  should  have  calved 
long  before,  and  that  it  would  be  impossible  for  him  to  give  a  decided  opinion  unless 
the  owner  gave  his  consent  to  an  examination  of  the  Cow,  which  entailed  some.  risk. 
This  consent  being  given,  the  examination  was  made.  The  general  health  of  the  animal 
was  not  disturbed ;  oestrum  had  ceased ;  the  abdomen  was  distended,  and  the  tem- 
perature was  normal.  On  "  touching  "  the  lower  part  of  the  right  flank,  there  was  a 
perceptible  rebound,  and  on  percussion  a  hollow  sound  was  elicited  ;  there  was  slight 
swelling  of  the  vulva,  with  other  indications  which  might  lead  one  to  expect  that  a 
calf  would  soon  be  dropped.  On  making  an  exploration  per  rectum,  the  uterus  was 
discovered  to  be  much  distended  in  the  right  flank  and  fluctuating;  but  nothing  of  a 
foetus  could  be  detected.  On  examination  per  vagitiam,  that  cavity  was  found  to  be 
filled  with  a  yellow  gelatinous  matter,  which  on  being  removed  permitted  the  open  os 
uteri  to  be  felt.  The  latter  syrry^tom,  the  fluctuation,  and  the  absence  of  any  trace  of 
a  foetus,  led  Suchanka  to  doubt  whether  the  case  was  one  of  normal  pregnancy,  and  to 
believe  that  he  had  to  deal  either  with  an  abnormal  embryo  or  disease  of  the  uterus. 
He  recommended  that  the  Cow  should  be  killed.  This  being  done,  the  uterus  was 
found  to  be  of  enormous  size,  and  more  especially  towards  the  right  cornu  :  this  dis- 
tention being  due  to  the  presence  of  twenty-five  to  thirty  litres  of  a  thin,  reddish- 
brown,  but  somewhat  glutinous  fluid. 

There  was  nothing  solid  in  the  uterus,  the  walls  of  which  were  very  thin  and  flabby, 
and  the  cotyledons  flatter  than  in  health ;  the  mucous  membrane  was  smooth,  though 
thickened  in  the  left  cornu,  of  an  unhealthy  color,  and  covered  with  a  watery  mucus. 
This  was  the  first  case  of  the  kind  which  fell  under  Suchanka's  observation,  and  in  the 
absence  of' any  thing  to  show  that  it  was  the  result  of  abortion,  he  was  of  opinion  that  it 
was  an  instance  of  hydrops  uteri. 

There  are  two  forms  of  hydrometra — cedematous  hydrometra  and  ascitic 
hydrometra.  The  former  exists  when  the  walls  of  the  uterus  are  in- 
filtrated with  serum,  and  may  acquire  a  thickness  of  four  or  five  inches  ; 
the  latter  is  an  accumulation  of  fluid  in  the  cavity  of  the  uterus.  Hy- 
drometra has  been  observed  in  the  Mare,  Cow,  and  Bitch  ;  rarely  in  the 
Sheep. 

Recovery  has  often  followed  the  evacuation  of  the  fluid,  when  it  has 
been  in  the  uterine  cavity  ;  in  some  cases  the  condition  has  become  so 
aggravated  as  to  cause  death,  or  necessitate  the  destruction  of  the  animal.  * 


DISEASES  OF  THE  PREGNANT  ANIMAL.  175 

The  diagnosis  is  arrived  at  by  manual  exploration,  and  by  the  absence 
of  some  of  the  most  characteristic  indications  of  pregnancy. 

When  the  condition  is  diagnosed,  and  there  is  reason  for  interference, 
the  indications  for  treatme?it  are  plain  :  carefully  dilate  the  os,  evacuate 
the  contents  of  the  uterus,  and  inject  astringent  and  antiseptic  lotions  (as 
carbolic  acid  i  to  20)  at  intervals  into  its  cavity.  Give  gentle  laxatives 
frequently ;  guard  against  retention  in  the  bladder,  from  which  the  urine 
may  be  removed  by  means  of  a  catheter,  if  necessary  :  and  give  nourish- 
ing food,  with  tonics. 


CHAPTER  II. 

Diseases  of  the  Pregnant  Animal. 

Owing  to  animals  being  kept  in  a  more  natural  state,  generally,  than  the 
human  species,  when  pregnant  they  are  much  less  exposed  to  the  risks 
and  inconveniences  of  that  condition  than  woman.  The  difference  in  the 
attitude  of  the  body  may  also  tend  much  to  obviate  those  serious  acci- 
dents, and  prevent  those  unpleasant  consequences,  which  so  often  attend 
gestation  in  the  human  female. 

Nevertheless,  notwithstanding  this  immunity,  pregnancy  in  animals 
brings  about  certain  modifications  in  the  female  organism  which  may 
sometimes  call  for  serious  notice,  either  when  it  leads  to  a  morbid  predis- 
position, or  in  its  influence  on  the  progress  of  certain  diseases  already  ex- 
isting at  the  time  of  conception,  or  which  have  developed  during  gestation. 
There  are  also  maladies  which  are  peculiar  to  this  condition,  some  of  them 
of  great  importance. 

SECTION    I. — INFLUENCE    OF    GESTATION    ON    ORDINARY    DISEASES. 

The  influence  of  pregnancy  on  the  course  of  the  ordinary  diseases  of 
animals  has  not  yet  been  well  ascertained,  though  it  has  long  been  ob- 
served that  such  an  influence  exists,  and  has  often  been  productive  of 
marked  effects. 

And  these  may  have  been  due,  directly  or  indirectly,  in  some  cases  at 
least,  to  the  condition  of  the  blood  in  the  female,  the  red  globules  of  which 
are  greatly  diminished,  and  the  proportion  of  albumen  is  also  notably 
decreased,  w^hile  the  serum,  on  the  contrary,  is  much  above  the  normal 
standard.  The  amount  of  fibrine  likewise  varies,  though  this  variation  is 
neither  so  constant  nor  so  uniform  as  in  the  other  constituents  ;  but  it 
generally  increases  towards  the  termination  of  pregnancy.*  Owing  to 
this  decrease  in  the  solid  portion  of  the  blood,  and  particularly  in  the  red 
globules,  the  pregnant  female  is  more  anaemic  than  plethoric.  It  is  none 
the  less  exposed  to  inflammatory  attacks,  however,  owing  to  the  excess  of 
fibrine  \  but  as  Saint-Cyr  justly  remarks,  these  phlegmasia^  assume  a 
particular  physiognomy,  and  run  a  very  different  course,  to  those  observed 
in  ordinary  conditions,  and  more  especially  with  regard  to  depletive 
measures,  which  have  to  be  carefully  resorted  to — or,  we  might  say, 
abstained  from. 

*  In  woman,  it  has  been  noted  that  the  normal  proportion  of  red  globules  is  from  125  to  127  per  1000 
and  that  durint;  pregnancy  this  proportion  falls  to  120,  115,  95,  90,  and  even  87  per  1000  of  the  total  mass 
of  the  blood  ;  while  the  albumen  descends  from  an  average  of  70J4  to  6'9,  66,  and  62  per  1000. 


176  PA  THOL OG  Y  OF  GESTA  TION. 

The  mechanical  effects  of  the  foetus,  and  the  immense  volume  of  the 
uterus,  must  also  produce  disturbance  of  most  essential  functions,  and 
more  especially  those  of  the  abdominal  and  thoracic  organs.  Therefore 
it  is,  that  during  pregnancy  such  affections  as  indigestion,  colic,  tympani- 
tis, enteritis,  or  pneumonia,  are  so  frequently  followed  by  abortion  and 
slow  convalescence,  or  death  of  the  animal. 

Chronic  diseases  have  in  general  but  little  influence  on  gestation.  It 
has  been  imagined  that  "  broken  wind  "  in  the  Mare  is  much  relieved 
during  pregnancy  ;  but  some  observations  would  go  to  prove  that  it  is 
rather  aggravated — though  the  troublesome  cough  does  not  appear  to 
militate  against  the  foetus  reaching  its  full  period. 

Acute  aiseases  are  more  serious,  and  especially  those  of  an  epizootic  kind, 
which  often  cause  abortion  or  induce  premature  labor.  Contagious 
pleuro-pneumonia  of  cattle,  for  instance,  often  produces  abortion,  and 
death  is  more  frequent  as  pregnancy  is  well  advanced.  Sheep-pox  is 
also  more  serious,  more  often  fatal  in  pregnant  Sheep,  and  most  frequently 
followed  by  abortion. 

A  number  of  observers — among  them  Saint-Cyr,  Bouley,  Roll,  Lafosse, 
and  Reynal — have  remarked  that  the  cattle-plague  does  not  appear  to 
have  any  very  particular  influence  on  gestation  ;  and  the  same  have  been 
said  of  eczema  epizootica  ("foot-and-mouth  disease").  But  this  Conti- 
nental experience  does  not  harmonize  with  that  relating  to  these  two 
diseases  in  our  own  country.  Abortion  has  been  a  notorious  sequel  of 
both  maladies,  and  more  especially  of  "foot-and-mouth  disease,"  in 
which  the  losses  from  this  cause  have  sometimes  amounted  to  twenty, 
thirty,  fifty,  and  even  more,  per  cent. 

Painful  and  nervous  diseases  are  also  more  serious  during  pregnancy 
than  at  other  times.  It  would,  however,  seem  to  be  an  error  to  attribute 
the  non-appearance  of  certain  disorders  during  gestation  to  the  influence 
of  this  condition  ;  as  Spinola  has  done,  with  regard  to  rabies,  etc. 

SECTION    II. DISEASES    PECULIAR    TO    PREGNANCY. 

As  has  been  already  stated,  the  diseases  peculiar  to  the  pregnant  con- 
dition are  fewer,  not  so  frequent,  and  usually  much  less  serious  in  animals 
than  in  the  human  female.  The  chief  maladies  or  morbid  conditions 
which  have  been  noted  in  animals  are  cramp,  pica  or  malacia,  constipation, 
oedema,  hydrops  amnii,  paraplegia,  and  amaurosis,  cough,  and  albuminuria. 

Cramp. 

Cramp — by  which  is  meant  a  tonic,  involuntary,  and  extremely  painful 
contraction  of  one  or  more  voluntary  muscles — is  sometimes  observed 
in  the  Mare  during  the  second  half  of  gestation,  the  muscles  of  the  thigh, 
and  chiefly  the  principal  extensor  of  the  metatarsus,  being  almost  exclu- 
sively involved.  When  effected,  the  animal  either  suddenly  or  rapidly 
flexes  and  extends  the  limb — striking  the  ground  hurriedly  and  energeti- 
cally with  the  foot,  as  if  a  fly  had  settled  on  the  leg,  or  the  whole  limb  is 
gradually  and  rigidly  elevated  without  flexure  of  the  joints,  except  those 
of  the  phalanges,  which  are  half-fixed,  the  anterior  aspect  of  the  hoof 
being  directed  towards  the  ground  ;  at  the  same  time  the  muscles  of  the 
leg  are  hard,  tense,  and  painful  to  manipulate,  and  the  animal  b«trays  the 
torture  it  experiences  by  its  expression  and  attitudes.  This  manifestation 
is  increased  if  the  Mare  is  compelled  to  walk,  its  first  steps  being  extremely 


DISEASES  OE  THE  PREGNANT  ANIMAL.  ijy 

difficult ;  while  "the  limb  is  maintained  in  a  perfectly  rigid  condition,  and 
the  indications  of  pain  most  marked.  In  a  short  time  these  symptoms 
disappear,  and  movement  js  restored.  The  cramp  may  pass  from  one  hind 
limb  to  another  alternately,  and  appears  to  be  due  to  the  compression 
exercised  on  the  sciatic  nerve  in  its  course  over  the  sacro-ischiatic  liga- 
ment. This  cramp  has  much  analogy,  in  its  symptoms,  to  luxation  of  the 
patella  ;  from  this  it  may  be  distinguished,  however,  by  the  latter  occur- 
ring most  frequently  in  young  animals,  by  the  displacement  of  the  patella, 
and  by  the  total  inability  to  flex  the  limb  until  the  patella  has  been  re- 
placed. 

Cramp  is  of  no  moment,  and  can  be  relieved  by  walking  the  animal 
for  a  few  paces,  or  by  smart  friction.  It  disappears  altogether  after  par- 
turition. 

We  have  already  noted  that  the  appetite  of  pregnant  animals  is  some- 
times depraved,  and  that  they  will  ingest  foreign  matters  :  such  as  plaster 
licked  from  the  walls,  wood  gnawn  from  their  stable-fittings,  earth,  etc. 

When  depending  on  derangement  of  the  digestive  functions,  this 
depraved  appetite  may  be  corrected  by  the  careful  administration  of 
tonics,  antacids,  and  attention  to  the  quantity  and  quality  of  the  food. 
The  herbivora  should  be  allowed  common  salt  in  their  food  or  to  lick. 

Constipation. 

Constipation  is,  of  course,  due  to  many  causes,  some  of  which  have  no 
relation  to  pregnancy.  This  condition,  however,  is  not  at  all'rare,  par- 
ticularly in  the  carnivora  during  gestation  ;  and  in  all  animals  it  may  be 
largely  remedied,  or  altogether  removed,  by  suitable  diet  and  exercise. 
Purgatives  should  be  avoided,  and  only  mild  laxatives  resorted  to  if  neces- 
sary. For  the  Bitch,  which  appears  to  suffer  most  frequently  from 
constipation,  Saint-Cyr  recommends  the  administration,  every  day  for 
eight  or  ten  days,  of  five  to  eight  grammes  of  white  mustard.  Castor 
or  linseed  oil,  or  even  boiled  linseed,  answer  well  for  the  larger  animals. 

CEdema. 

The  infiltration  of  serosity  into  the  connective  tissue  of  certain  parts  of 
the  body  of  pregnant  animals — almost  exclusively  the  Mare — is  some- 
what allied  to  the  anasarca  serosa  of  woman.  The  period  at  which  it  is 
manifested  depends  much  upon  breed,  conformation,  and  individual  tem- 
perament, as  well  as  upon  the  season  and  hygienic  conditions.  With 
common-bred,  lymphatic  Mares  deprived  of  sufficient  exercise,  it  appears 
at  an  early  period — from  the  eighth  month  of  gestation,  and  sometimes 
earlier — particularly  in  the  winter.  With  better  bred  animals  it  is  later, 
and  in  summer  may  not  appear  at  all  in  those  which  are  well-bred.  It 
commences  usually  at  the  inferior  part  of  the  hind  limbs,  gradually 
ascending  to  the  hocks,  or  higher  -,  the  fore  limbs  are  also  attacked, 
though  not  so  markedly ;  and  the  swelling  extends  to  the  lower  surface 
of  the  abdomen.  Here  it  commences  by  a  soft  tumor  in  front  of  the 
udder  ;  this  increases  in  size  and  spreads  over  that  gland,  as  high  as  the 
vulva,  down  the  inner  surface  of  the  thighs,  and  towards  the  chest,  ster- 
num, and  fore-arms.  It  readily  disappears  or  diminishes  with  exercise, 
and  is  probably  due  to  the  pressure  exercised  by  the  foetus  on  the  pelvi- 
crural  vessels,  as  well  as,  perhaps,  to  the  anaemic  condition  of  the  system. 
The  exemption  of  the  Cow  from  oedema  has  been  ascribed  to  the  great 

12 


178  PA  THOLOG  Y  OF  GESTA  TION. 

development  of  the  mammary  veins  in  this  animal,  and  their  free  commu- 
nication with  others,  which  permits  a  ready  return  of  the  blood  from  the 
hind  limbs. 

There  is  nothing  serious  in  this  cedema  of  pregnancy,  as  in  nearly 
every  case  it  can  be  counteracted  by  exercise  or  hand-rubbing,  and  it 
disappears  in  a  day  or  two  after  birth. 

If  it  causes  inconvenience,  frictions  with  soap  or  turpentine  liniments, 
bandaging,  or  even  slight  scarifications,  may  be  employed  ;  but  the 
occasions  for  these  must  be  very  rare  indeed. 

Hydrops  Amnii. 

When  there  is  an  unusual  secretion  of  the  amniotic  fluid,  it  constitutes 
what  has  been  termed  "  dropsy  of  the  amnion  "  {hydrops  amjiii  or 
hydramnios)  :  a  condition  which,  when  very  marked,  is  serious  for  the 
mother  as  well  as  the  foetus.  A  number  of  cases  have  been  recorded, 
and  Saint-Cyr  has  enumerated  thirteen,  ten  of  which  occurred  in  the 
bovine,  two  in  the  equine,  and  one  in  the  caprine  species.  Gierer,  who 
has  published  an  interesting  account  of  several  cases,  observes  that  it  is 
most  frequently  met  with  in  poor,  badly-fed  animals — and  particularly  in 
Cows,  in  which  improper  hygiene  has  produced  a  morbid  excitement  of 
the  generative  organs  ;  the  result  of  which  is  that  the  act  of  exosmose 
and  endosmose  does  not  take  place  equally  through  the  walls  of  the 
placentae  and  placentulae. 

Symptoms. — It  is  not  until  the  fifth  or  sixth  month  of  pregnancy,  or 
even  later,  that  indications  of  this  condition  are  evident.  Then  the  abdo- 
men rapidly  enlarges,  especially  to  one  side — generally  the  right ;  and  in 
a  short  time  it  has  acquired  a  greater  volume  than  it  has  towards  the  end 
of  gestation.  At  this  period  the  health  becomes  deranged,  and  colic, 
with  or  without  tympanitis,  is  not  unfrequent.  General  debilit}'  is  so 
marked,  that  the  animal  can  scarcely,  if  at  all,  stand  ;  the  appetite  is 
lost,  rumination  is  suspended,  defecation  and  micturition  are  irregular, 
oedematous  swelling  of  the  limbs  and  abdomen  ensue,  with  dyspnoea, 
which  increases  so  quickly  in  intensity  that  asphyxia  is  often  imminent. 
The  muscular  parietes  of  the  abdomen  have  in  some  cases  been  ruptured, 
and  the  entire  mass  of  the  uterus,  with  its  contents,  has  formed  a  subcu- 
taneous hernia.  The  ordinary  period  of  gestation  may  be  completed  ;  or 
abortion  may  occur  at  the  seventh  or  eighth  month,  when  all  the  indica- 
tions of  such  an  occurrence  are  present.  The  uterine  contractions,  owing 
to  the  relaxed  condition  of  this  organ,  and  its  distended  and  paralyzed 
fibres,  are  weak,  the  pains  feeble  and  unsustained,  the  os  does  not  dilate, 
and  the  act  of  parturition  is  consequently  tediou^. 

Diagnosis. — The  state  of  the  abdomen  might  lead  to  the  supposition 
that  the  case  was  one  of  tympanitis  or  twin  pregnancy.  Abdominal 
percussion,  and  the  "  touch,"  as  well  as  auscultation,  should  aid  in 
diagnosing  this  condition.  Rectal  examination  will  reveal  the  immense 
size  of  the  uterus,  which  forms  a  great  globular  mass  in  the  abdominal 
cavity,  and  almost  completely  fills  the  pelvis,  though  nothing  of  a  foetus 
can  be  detected  ;  while  vaginal  exploration  discovers  the  cervix  uteri 
effaced,  the  os  closed,  and  the  posterior  part  of  the  uterus  projecting 
more  or  less  into  the  vagina  ;  pressure  on  this  prominent  portion  proves 
that  it  contains  fluid,  though  usually  no  foetus  can  be  felt,  as  it  is  beyond 


DISEASES  OF  THE  PREGNANT  ANIMAL. 


179 


the  touch,  and  almost  lost  in  the  small  ocean  of  fluid  surrounding  it.  In 
rare  cases  the  os  is  partially  dilated,  and  the  fcetal  membranes  protruding 
more  or  less  into  the  vagina  ;  usually,  however,  scarcely  one  or  two  fingers 
can  be  introduced  into  it. 

Results. — The  occurrence  of  hydrops  amnii  is  nearly  always  fatal  to 
the  foetus.  In  none  of  the  thirteen  cases  aHuded  to  by  Saint-Cyr  was  it 
alive  ;  in  a  certain  number  it  appeared  to  have  lived  up  to  the  period  of 
parturition  or  abortion  ;  in  others  it  had  been  arrested  in  its  development, 
and  was  dead  for  some  time.  In  a  Goat,  the  two  foetuses  were  in  a  state 
of  general  anasarca,  and  completely  infiltrated. 

The  mother  may  or  may  not  survive.  Of  the  above  cases  three  perished 
from  the  disease  ;  one  was  killed  as  incurable  ;  another  recovered  after  a 
long  time  ;  one  was  subsequently  sold  for  food  ;  five  got  well  so  rapidly 
and  completely  as  to  be  bred  from  again.  The  results  have,  as  a  rule, 
been  more  favorable  as  assistance  has  been  prompt  and  early. 

After  death  the  uterus  is  found  excessively  dilated,  pale  in  texture,  with 
ecchymoses  on  its  surface.  The  fcetal  membranes  vary,  sometimes  being 
thickened  and  dense,  and  other  times  attenuated  and  friable.  The 
liquor  amnii  has  been  found  contained  in  alveoli,  or  cells,  formed  by  the 
processes  uniting  the  allantois  to  the  amnion  ;  so  that  the  membranes 
might  be  torn  in  several  places  without  all  the  fluid  escaping — in  this 
respect  resembling  the  vitreous  humor  of  the  eye.  The  liquor  is  usu- 
ally limpid  and  transparent,  or  of  a  pale  citron  color,  with  a  slightly 
sweetish  taste  ;  its  quantfty,  as  has  been  remarked,  is  always  considera- 
ble :  as  much  as  50,  70,  100,  120,  150,  and  even  180  litres  having  been 
found. 

One  example  of  this  condition  will  suffice.  It  is  given  by  Mr.  Cartwright,  of  Whit- 
church, and  the  subject  was  a  thorough-bred  racing  Mare,  whose  extreme  "  size  "  while 
pregnant  was  ascribed  to  the  presence  of  twin  foetuses,  and  also,  it  would  appear,  to 
an  excessive  quantity  o£  fluid  in  the  uterine  cavity.  The  period  for  parturition  arrived 
without  any  signs  of  milk-secretion  or  relaxation  of  the  pelvis,  and  the  abdomen  meas- 
ured thirteen  feet  in  circumference.  Symptoms  resembling  slight  colic  appeared, 
which  were  not  relieved  by  medicine,  and  the  abdomen  became  so  tense  and  hard  that 
it  was  feared  the  muscular  parietes  would  give  way ;  strong  bandages  were,  therefore, 
placed  round  the  body,  though  through  these  having  been  fastened  too  tight,  the  Mare 
fell  apparently  asphyxiated.  However,  on  their  being  loosened  recovery  took  place, 
and  her  sufferings  subsided  so  much  that  food  and  water  were  taken,  and  general 
amendment  seemed  to  have  set  in.  Next  morning,  however,  the  unfortunate  creature 
was  found  with  an  extensive  rent  in  the  right  iliac  region,  from  which  the  small 
intestines  escaped.  It  was  destroyed,  and  on  opening  the  abdomen  the  uterus  alone, 
with  the  exception  of  some  portion  of  the  small  intestines,  was  the  only  organ  visible, 
it  being  of  extreme  dimensions,  and  very  pale  and  flaccid ;  it  contained  about  twelve 
gallons  of  serous  fluid,  as  well  as  two  dead,  but  perfectly  developed,  colt  foetuses. 
These  were  of  such  a  size,  that  it  was  surmised  parturition  could  not  have  been  safely 
accomplished,  even  had  there  been  no  dropsy. 

Indications. — The  chief  indication  is  to  evacuate  at  least  a  portion  of 
the  fluid,  by  rupturing  the  membranes,  as  medical  treatment  has  always 
"proved  inefficacious.  It  must  be  remembered  that  the  fcetus  is  always 
pdead  ;  and  even  if  alive,  with  the  view  of  saving  the  life  of  the  mother, 
it  should  be  sacrificed.  Though  opening  amniotic  sac,  and  removing  a 
certain  quantity  of  the  liquor,  need  not  necessarily  compromise  the  exist- 
ence of  the  foetus  ;  as  a  case  has  been  published  by  Lhomme  {journal 
de  Veterinaire  du  Midi,  1869),  in  which  a  portion  of  the  foetal  membranes, 
■protruded  beyond  the  vulva,  was   excised  without   interfering  with   the 


i8o  PA  THOLOG  Y  OF  GESTA  TION. 

ordinary  progress  of  gestation  ;  as  when  parturition  occurred  three  months 
afterwards,  a  well-formed  mule  was  born  and  continued  to  live. 

The  chances  of  success  are  greater  as  intervention  takes  place  early, 
and  before  the  abdomen  is  excessively  distented,  the  respiration  not  seri- 
ously affected,  and  debility  not  great. 

The  evacuation  should  be  effected  through  the  vagina,  though  it  has 
been  made  through  a  puncture  in  the  flank.  If  the  membranes  are  in  the 
vagina,  they  may  be  ruptured  by  the  fingers  there  ;  if  not,  and  the  os  is 
sufficiently  dilated  for  the  admission  of  the  hand,  they  may  be  ruptured 
in  the  uterus  ;  if  it  is  closed  it  should  be  gently  dilated,  and  the  envelopes 
punctured,  if  necessary,  by  means  of  a  trocar  and  canula.  As  soon  as 
the  membranes  are  pierced,  a  gush  of  fluid  takes  place,  the  abdomen 
diminishes  in  volume,  the  uterus  becomes  retracted,  and  in  this  retrac- 
tion the  foetus  and  membranes  are  sometimes  expelled.  Should  this 
expulsion  not  take  place  soon,  they  must  be  removed  in  the  ordinary 
way.  Afterwards,  the  animal  is  to  be  carefully  attended  to  and  gener- 
ously fed. 

Paraplegia: 

Paralysis  of  the  posterior  extremities  during  gestation,  is  not  rare  in 
the  Cow,  especially  when  near  parturition,  and  often  even  v/hen  that  act 
has  commenced  ;  it  is  also  witnessed  in  the  Sheep  and  Goat.  Generally, 
however,  it  appears  six,  eight,  ten,  or  twenty  days,  rarely  a  month  or 
six  weeks,  previously,  and  attacks  animals  in  the  most  diverse  hygienic 
conditions  —  those  which  are  well  fed  and  tended,  as  well  as  those 
which  receive  the  opposite  treatment.  As  Saint-Cyr  remarks,  it  is  not 
rare  to  observe,  in  a  cow-shed,  two  or  three  cases  occurring  a  short  dis- 
tance from  each  other,  and  even  in  a  locality  we  may,  in  certain  years, 
meet  with  a  number  of  cases;  then  several  consecutive  years  may  elapse 
without  any  being  noted,  though  it  would  be  a  manifest  exaggeration  to  say 
that  it  was  either  an  epizootic  or  enzootic  malady.  It  must  not  be  con- 
founded with  what  has  been  termed  "  parturient  fever,"  in  which  we  have 
paralysis,  but  from  which  it  differs  greatly,  as  the  symptoms  and  results 
will  show. 

The  paralysis  of  gestation  generally  appears  suddenly  and  without  any 
premonitory  symptoms,  manifesting  itself  with  the  same  intensity  at  the 
outset  as  at  a  later  period  ;  though  in  rare  cases,  the  animal  shows  a 
weakness  and  unsteadiness  of  the  posterior  part  of  the  body  and  hind 
limbs  for  a  short  time  before  it  drops,  and  the  tail  hangs  disjointedly 
and  flaccid.  When  paralysis  has  really  set  in,  the  Cow  is  forced  to 
lie,  but  it  does  not  appear  to  puffer  ;  the  decubitus  is  natural,  the  head 
carried  as  usual,  the  eye  bright  and  clear,,  the  muffle  damp  and  cool, 
and  the  rumination  in  the  majority  of  instances  is  not  suspended  ;  the 
pulse,  respiration,  and  appetite  are  unaltered,  and  sensation  does  not  seem 
to  be  impaired,  even  in  the  hind  limbs — it  may  even  be  exalted.  Consti- 
pation is  frequently  present.  It  is  only  when  the  animal  attempts  to  rise 
that  its  condition  is  evident ;  the  fore  limbs  and  neck  can  be  moved  to 
accomplish  this,  but  the  hinder  extremities  are  powerless. 

Ordinarily,  the  paralysis  persists  until  parturition,  when  it  disappears  ; 
though  Saint-C5T  mentions  an  instance  in  which  a  Cow  became  paralyzed 
twenty-eight  days  before  that  event,  and  lay  on  the  litter  for  two  days 
after  calving,  without  being  able  to  move  its  hind  extremities,  but  which 
arose  spontaneously  on  the  third  day,  and  did  well.     The  same  authority. 


DISEASES  OF  THE  PREGNANT  ANIMAL.  i8i 

however,  states  that  he  has  occasionally  witnessed  the  paralysis  persist 
for  a  longer  time  after  calving,  and  either  cause  death  or  necessitate 
slaughter.  I  have  seen  a  sheep  which  eventually  died  from  the  ante-par- 
turient paralysis. 

The  cause  is  somewhat  obscure,  but  is  supposed  to  be  due  to  compres- 
sion, or  rather  straining,  of  the  nerves  and  vessels  of  the  posterior  extrem- 
ities by  the  heavy  uterus.  In  five  or  six  cases  there  has  been  found  on 
post-mortem  inspection,  infiltration  of  the  dorso-lumbar  and  gluteal  muscles, 
and  discoloration  of  the  muscular  fibres.  The  spinal  canal  has  also  con- 
tained a  large  quantity  @f  serum,  and  the  membranes  of  the  spinal  cord 
are  injected.  From  the  rapidity  with  which  recovery  generally  takes 
place,  it  is  obvious  that  the  lesions  cannot  be  serious. 

Treatment. — In  the  majority  of  cases,  and  especially  before  parturi- 
tion, but  little  treatment  is  necessary.  The  principal  indication  is  to 
avert  or  get  rid  of  constipation  by  means  of  laxatives  and  enemas,  and 
pay  attention  to  the  diet  and  cleanliness,  while  enjoying  quietude.  Should 
the  paralysis  continue  for  any  length  of  time  after  parturition,  then  more 
energetic  treatment  may  be  adopted.  In  these  cases,  the  subcutaneous 
iniection  of  strychnine  is  nearly  always  attended  with  sliccess. 

Artificial  removal  of  the  foetus  is  not  to  be  recommended,  except 
in  very  exceptional  circumstances. 

Amaurosis. 

The  only  instances  of  amaurosis  occurring  in  connection  with  preg- 
nancy, are  two  given  by  Riss  {Recueil  de  Med  Veterinaire^  183 1). 

A  Mare,  nine  years  old  and  in  good  condition,  when  advanced  in  pregnancy  became 
blind.  On  the  eyes  being  examined  by  Riss,  the  humors  and  lens  were  found  to  be 
quite  healthy,  but  amaurosis  was  complete.  A  blister  was  applied  to  each  cheek,  and 
other  treatment  adopted,  but  without  success.  The  day  following-  parturition,  which 
occurred  about  a  month  after,  vision  was  perfectly  restored. 

A  seven-year-old  Mare,  when  near  parturition,  and  which  had  never  exhibited  any 
thing  the  matter  with  its  eyes,  suddenly  became  blind  from  amaurosis.  Remembering 
the  other  case,  Riss  abstained  from  treatment.  The  Mare  foaled  in  thirteen  or  fourteen 
days  after  loss  of  sight  had  been  noted,  and  on  the  third  day  after  this  occurrence  it  was 
able  to  see  as  well  as  ever. 

Cough. 

We  have  mentioned  hydrops  amnii  as  a  cause  of  disturbance  m  the 
respiration,  the  obstacle  to  which  is  often  a  marked  symptom  of  that 
condition.  But  even  without  the  existence  of  this  kind  of  dropsy,  the 
breathing  is  not  unfrequently  impeded  in  pregnant  animals,  and  this 
obstruction  is  sometimes  accompanied  by  a  very  harassing  nervous  cough, 
which,  in  the  larger  animals,  and  particularly  in  the  Mare,  may  lead  to  in- 
jury. For  the  relief  of  this  cough,  Zundel  recommends  the  cyanide  of 
potassium. 

Albuminuria. 

Ihe  existence  of  albuminuria  in  pregnant  women  has  long  been 
^  known,  and  Zundel  gives  it  as  one  of  the  complications  or  accompani- 
ments of  gestation  in  animals  ;  though  he  does  not  look  upon  it  as 
a  pathological  condition.  Saint-Cyr,  on  the  contrary,  thinks  that  this  is 
a  matter  well  deserving  further  investigation  ;  for  as  various  kinds  of 
paralysis — eclampsia,  paraplegia,  amaurosis,  etc.  —  are  probable  conse- 
quences of  albuminuria  in  the  human  female,  there  is  no  reason  why 
they  may  not  be  so  in  animals. 


i82  PATHOLOGY  OF  GESTATION. 

CHAPTER  III. 

Accidents  of  Pregnancy, 

Though  a  distinction  between  the  diseases  and  accidents  of  pregnancy 
cannot  always  be  readily  drawn,  yet  for  convenience  we  follow  Saint-Cyr, 
in  allotting  to  a  separate  chapter  those  conditions  or  diseases  which  may 
be  due  to  accidental  causes,  operating  either  externally  or  internally. 
These  are  prolapsus  of  the  vagifia,  hernia  of  the  utei'us,  rupture  of  the 
uterus,  tnetrorrhagia,  abnormal  retention  of  thefeetus,  and  abortion. 

Ante-Partum  Prolapsus  of  the  Vagina. 

Prolapsus  vagince,  or  inversio  vagitice,  has  only  been  observe^,  so  far  as 
I  can  ascertain,  most  frequently  in  the  Cow  and  Sheep  ;  rarely  in  the 
Mare  or  Bitch.  It  consists  in  the  protrusion  of  the  vagina  by  the  uterus 
and  its  contents  during  pregnancy,  the  tumor  it  forms  appearing  between 
{inversio  vagince.  incompleta),  or  external  to  {iJiversio  vagina  co77ipletd),  the 
labia  of  the  vulva.  It  must  not  be  confounded  with  post-partum  pro- 
lapsus. This  accident  is  peculiar  to  pregnancy,  and  may  occur  in  well- 
shaped  Cows,  but  whose  tissues,  and  especially  those  of  the  genital 
organs,  are  soft  and  relaxed  :  animals  of  a  lymphatic  temperament,  good 
milkers,  with  a  wide  pelvis,  and  which  are  fed  on  an  abundance  of  bulky 
but  innutritions  food.  Keeping  such  Cows  on  a  floor  sloping  too  much 
to  the  rear,  as  well  as  falls,  injuries  of  different  kinds,  distention  of 
the  rumen,  fatigue,  etc.,  are  all  likely  to  lead  to  this  accident  in  such  ani- 
mals, when  pregnant.  It  is  observed,  though  very  rarely,  in  primiparae, 
and  occurs  most  frequentl}''  after  the  third  or  fourth  gestation,  the  period 
of  its  appearance  during  that  state  varying  :  in  certain  Cows  manifesting 
itself  so  early  as  the  fifth  month  (though  this  is  rare),  and  oftenest  at  the 
end  of  the  seventh  or  eighth  month,  and  even  so  late  as  twenty  or  fifteen 
days  before  delivery. 

The  occurrence  of  the  accident  is  made  known  by  the  appearance,  at 
the  vulva,  of  a  circular,  bright-red  tumor,  depressed  in  the  centre,  and  of 
a  variable  but  gradually  increasing  size,  as  gestation  advances,  or  the 
exciting  causes  remain  in  operation — from  the  volume  of  a  fist  to  that  of 
the  head  of  a  child  or  man,  or  even  larger.  At  first  it  is  only  visible 
when  the  animal  is  lying,  and  disappears  when'  it  gets  up  ;  but  when  of 
considerable  volume  it  never  entirely  vanishes  in  the  latter  attitude,  and 
even  when  reduced  by  the  hand  the  vulva  remains  larger  than  usual. 

This  prolapsus,  in  the  majority  of  cases,  does  not  appear  to  cause  the 
slightest  inconvenience  to  the  animal,  and  offers  no  obstacle  to  par- 
turition— indeed,  it  has  been  noted  that  such  Cows  calve  more  easily  than 
others  ;  neither  does  it  predispose  to  chronic  eversion  of  the  vagina,  as 
has  often  been  supposed.  After  calving,  the  vaginal  tumor  disappears 
without  any  treatment  being  required. 

With  some  young,  fidgety  Cows,  however,  when  the  tumor  is  volumin- 
ous, often  recurs,  and  the  animal  is  feeble,  expulsive  efforts  increase  its 
size  and  irritate  it ;  and  thus  give  rise  to  more  or  less  derangement 
of  health,  constituting  a  serious  accident.  Loyer  has  noted  three  deaths 
in  thirty-six  instances  recorded  by  him. 

According  to  Cox  ( Veterinary  journal,  vol.  i.,  p,  267),  Sheep,  when 
heavy  in  lamb,  frequently  evert  a  double  fold  of  the  vaginal  mucous  mem- 


ACCIDENTS  OF  PREGNANCY. 


1 83 


brane.  This  happens  when  they  are  in  a  recumbent  position,  and  it  is  in 
some  animals  of  such  frequent  occurrence  as  to  cause  excoriation  and 
ulceration. 

Treatment.— The  first  thing  to  be  done,  if  the  floor  of  the  stall 
is  lower  behind  than  in  front,  is  to  level  it,  or  even  raise  it  a  little 
behind.  This  may  be  readily  accomplished  by  means  of  the  litter.  The 
diet  may  also  require  attention,  giving  that  which  contains  sufficient 
nutriment  in  small  bulk ;  constipation  should  be  guarded  against  or 
remedied.  This  treatment  will  be  sufficient  in  the  majority  of  cases.  In 
others,  a  bandage,  to  be  hereafter  described,  may  be  required,  and 
especially  if  the  tumor  is  liable  to  become  soiled  and  irritated  when  the 
animal  is  lying. 

In  serious  cases,  when  the  tumor  is  large  and  the  Cow  strains,  and 
spontaneous  reduction  does  not  occur  in  the  standing  position,  the  mass 
must  be  returned.  This  is  readily  enough  accomplished  ;  but  it  some- 
times happens  that  reduction  does  not  prevent  a  continuation  of  the 
straining,  and  even  with  the  bandage  the  everted  vagina  again  appears. 
This  is  due  to  the  mucous  membrane,  which,  not  having  been  properly 
smoothed  down  when  introduced  into  the  pelvic  cavity,  is  ridged,  and 
these  rugae  give  rise  to  an  uncomfortable  sensation,  and  induce  expulsive 
efforts. 

It  is  necessary,  therefore,  in  reducing  the  part,  to  smooth  the  vaginal 
mucous  membrane  by  gentle  pressure  forward  as  far  as  the  cervix  uteri, 
in  order  to  efface  any  folds  which  may  excite  uneasiness.  After  this  the 
bandage  may  be  applied  with  a  view  to  keeping  the  vulva  closed,  until 
its  labia  have  retracted  somewhat.  Wire  sutures  through  these  have  been 
recommended,  but  they  are  very  rarely  required. 

In  very  exceptional  instances,  we  may  have  not  only  complete  prolap- 
sus vaginae,  but  also  partial  protrusion  of  the  uterus  itself.  Then  the 
case  is  very  serious,  owing  to  the  weight  and  bulk  of  the  foetus,  which 
has  to  be  returned  beyond  tli^e  inlet  of  the  pelvis.  Death  is  often  the  re- 
sult of  such  an  accident ;  and  to  prevent  a  fatal  termination,  it  has  been 
suggested  that  artificial  delivery  should  be  effected  without  delay.  Pre- 
mature delivery  has  been  counselled  in  those  cases  in  which  the  Cow 
continues  to  strain  and  evert  the  vagina,  notwithstanding  bandages, 
sutures,  and  other  means,  and  when  grave  consequences  are  likely  to  fol- 
low ;  more  especially  is  this  advice  to  be  adopted  when  pregnancy  has 
reached  the  260th  day,  and  the  calf  is  alive. 

With  Sheep,  according  to  Cox,  it  is  a  common  custom"  to  return  the 
partially  prolapsed  vagina,  and  to  tie  the  wool  across  the  vulva ;  on  other 
occasions  a  truss,  similar  to  that  used  for  cattle,  is  employed.  Both 
methods  frequently  fail,  and  in  these  cases  nothing  answers  so  well  as 
the  ring-shaped  pessary. 

Hernia  of  the  Uterus  (Hysterocele). 

Hernia  of  the  uterus  is  not  uncommon  in  the  domesticated  animals, 
and  has  been  observed  in  the  Mare,  Cow,  Sheep,  Goat,  and  Bitch.  In 
the  latter  animal  the  organ  is  often  displaced  before  conception,  and  the 
foetus  is  developed  in  the  hernia  ;  but  with  the,  larger  creatures  the  empty 
uterus  in  too  far  removed  from  the  abdominal  parietes  to  escape  from  the 
cavnty ;  and  it  is  only  when  its  volume  is  increased  as  gestation  advances, 
that  it  may  form  a  hernia,  should  there  exist  an  accidental  opening  in  the 


1 84  PA  THOL OG  Y  OF  GESTA  TION. 

muscles  which  enclose  the  cavity.  In  the  Bitch  the  hernia  may  be  in- 
guinal ;  in  the  other  animals  it  is  always  accidental  and  ventral,  and  usu- 
ally towards  the  inferior  part  of  the  abdomen,  on  the  right  or  left  side, 
or  in  the  pubic  region. 

Its  ordinary  cause,  when  accidental,  is  due  to  the  natural  or  spontane- 
ous relaxation  of  the  abdominal  aponeuroses  ;  or  to  traumatism,  as  con- 
tusions or  strains,  the  viscus  being  generally  only  covered  by  the  skin. 
It  is  rare  in  young  animals. 

In  the  Cow  it  is  not  at  all  unusual  to  observe  the  hernial  tumor  in  front 
of  the  pubis,  towards  the  attachment  of  the  recti  muscles,  and  near  the 
udder  ;  here  it  may  be  of  a  great  size,  extending  as  low  as  the  hocks, 
pushing  the  mammary  gland  to  one  side,  reaching  as  far  forward  as  the 
floating  ribs,  and  containing,  in  addition,  other  of  the  abdominal  viscera 
than  the  uterus  and  its  contents.  This  tumor  impedes  movement ;  the 
hind  limbs  are  kept  widely  separated,  and  the  animal  is  much  inconve- 
nienced. 

With  the  Bitch,  ventral  hysterocele  has  been  noted  in  two  regions — 
above  the  mammae,  where  it  might  be  mistaken  for  a  scirrhus  tumor  ;  and 
in  one  of  the  labia  of  the  vulva,  beneath  the  skin. 

In  the  larger  animals,  the  foetus  may  sometimes  be  felt  in  the  tumor, 
and  its  movements  may  be  noticed  ;  though,  owing  to  its  being  so  low,  it 
cannot  be  reached  from  the  rectum. 

Very  often,  excepting  the  inconvenience  to  the  female,  hysterocele  does 
not  interfere  with  gestation,  nor  give  rise  to  any  serious  symptoms  ; 
though,  in  some  cases,  it  may  render  parturition  laborious  and  protracted, 
if  not  impossible.  In  other  cases  this  act  may  be  accomplished  without 
difficulty  or  extraneous  aid  ;  Cows  which  have  been  ruptured  from  the 
perineum  to  the  ribs  have  calved  easily  enough ;  and  Leconte  alludes  to 
Mare  which  had  a  uterine  hernia  nearly  as  extensive  as  this,  and  yet 
brought  forth  four  living  foals  in  succession. 

Nevertheless,  it  is  somewhat  of  a  risk  to  attempt  to  breed  from  such 
animals.  When  treating  of  difficult  parturition,  we  shall  have  occasion 
to  return  to  this  subject.  In  the  mean  time,  it  is  only  necessary  to  say 
that  in  order  to  obviate  serious  consequences,  the  hernia  should  be  sup- 
ported by  a  wide  bandage  until  the  uterine  contents  are  expelled.  Should 
circumstances  render  it  necessary,  abortion  may  be  artificially  induced, 
or  hysterotomy  may  be  performed. 

Ante-partum  Rupture  of  the  Uterus. 

Rupture  of  the  uterus  may  happen  before  and  during  parturition,  or  in 
attempts  to  reduce  the  organ  when  inversion  has  occurred  during  that 
act.  This  accident  is  not  very  common  before  gestation  has  terminated, 
and  the  symptoms  by  which  it  can  be  diagnosed  are  not  very  reliable. 
Spontaneous  rupture  of  the  uterus  usually  occurs  at  the  anterior  part  of  the 
organ,  between  the  two  cornua,  or  even  in  the  cornua  themselves  ;  the 
direction  of  the  rupture  generally  depending  on  the  direction  of  the  mus- 
cular fibres — being  sometimes  diagonal,  at  other  times  transversal,  and 
more  rarely  longitudinal.  The  size  of  the  rupture  also  varies  considerably  ; 
though  it  must  be  remembered  that  in  the  dead  animal  ruptures  only  ap- 
pear in  their  original  dimensions  when  the  uterus  had  lost  its  contractility 
before  death,  and  immediately  after  their  production  ;  when  the  organ  has 
contracted  after  the  accident,  the  extent  of  the  laceration  is  much  dimin- 
ished.    The  lips  of  the  wound  are  in  some  cases  thin  and  ragged,  in 


ACCIDENTS  OF  PREGNANCY. 


i8S 


others  swollen  and  inflamed.  The  texture  of  the  uterus  itself,  in  the 
vicinity  of  the  rupture,  may  be  quite  healthy,  or  it  may  be  inflamed,  soft- 
ened, or  gangrenous  ;  while  the  peritoneum  is  normal  or  inflamed.  The 
blood  effused  into  the  abdominal  cavity  may  be  in  large  quantity  or 
scarcely  noticeable,  and  it  may  or  may  not  be  decomposed. 

According  as  the  tissue  of  the  uterus  is  more  or  less  completely  torn, 
the  ruptures  have  been  divided  into  those  which  are  "  complete  "  and 
"incomplete."  In  the  first,  the  cavity  of  the  organ  communicates  freely 
with  that  of  the  abdomen  ;  while  in  the  second,  the  peritoneum,  or  some- 
times a  portion  of  the  muscular  layer,  is  intact. 

Symptoms. — The  symptoms  of  rupture  of  the  uterus  are  not  well  de- 
fined. If  there  has  been  straining,  in  the  majority  of  cases  this  ceases 
altogether  or  diminishes ;  sometimes  blood  or  blood-colored  fluid  flows 
from  the  vagina,  though  this  symptom  is  rare.  The  physiognomy  of  the 
animal  changes  ;  at  the  same  time  it  becomes  restless,  often  the  limbs 
are  cold,  the  pulse  small  or  imperceptible  ;  a  cold  perspiration  covers  the 
body  ;  the  animal  sighs  or  moans,  is  affected  with  dyspncea,  is  greatly 
agitated,  and  intense  debility  sets  in.  The  symptoms  are  violent  and 
marked  as  the  accident  is  sudden  and  severe.  If  the  foetus  has  passed 
into  the  cavity  of  the  abdomen,  it  may  be  felt  there  ;  and  there  may  also 
be  an  alteration  in  the  shape  of  the  abdomen.  Vaginal  exploration 
generally  reveals  alterations  of  a  distinctive  character — sometimes  even 
the  rupture  may  be  detected,  and  the  absence  of  the  foetus  from  the  uterus 
noted.  When  the  rupture  is  small  and  takes  place  gradually,  the  symp- 
toms are  sometimes  little  marked,  and  a  diagnosis  is  more  difficult. 

Results. — Rupture  of  the  uterus  is  sometimes  followed  in  the  gravid 
state  by  fatal  haemorrhage,  peritonitis  (particularly  in  the  Mare),  or  the 
results  described  in  extra-uterine  gestation.  Recovery  may  occur  either 
by  surgical  interference,  or  by  the  aid  of  nature  alone.  When  the  organ 
contracts  the  dimensions  of  the  rupture  are  reduced,  and  tears  in  the 
upper  portions  are  very  much  less  serious  than  those  in  the  lower  surface, 
for  obvious  reasons. 

Saint-Cyr  has  given  an  analysis  of  some  published  cases,  to  which  I 
have  added  others  more  recent. 

1.  In  1808.  Anfri  [Correspondence  sur  les  Animatix  Domestiques,-\^-xr  Fromage  de 
Feugre,  vol.  iii.,  p.  179)  was  called  upon  to  attend  a  Cow  which  had. been  attempting  to 
calve  for  two  days.  When  he  saw  it,  its  efforts  had  ceased,  and  it  was  greatly  pros- 
trated ;  the  hand  introduced  into  the  uterus  could  not  discover  the  foetus.  Death  occur- 
red on  the  night  of  the  third  and  fourth  day,  without  any  thing  having  been  detected 
which  could  have  prevented  delivery.  On  examination  of  the  body,  the  foetal  fluids 
were  found  in  the  abdominal  cavity,  as  well  as  the  foetus  itself.  They  had  escaped  by 
a  large  oblique  rent  in  the  fundus  of  the  organ ;  while  the  left  cornu'was  also  torn  for 
one  half  of  its  length.  The  cause  of  the  mishap  could  not  be  ascertained;  the  animal 
had  been  straining  violently  for  two  days,  and  a  quack  had  attempted  to  deliver  it. 

2.  Vatel  [Journal  Pratique  de  Med.  Vet.,  1827  )  reports  that  a  Cow  in  a  very  bad  state, 
was  sent  to  the  Alfort  School  on  April  25.  It  could  scarcely  walk,  and  there  escaped 
from  the  vulva  glairy,  blood-colored,  odorless  matter  ;  the  condition  of  the  animal  was 
serious.  On  manipulating  the  abdominal  wall,  there  was  felt  a  hard  resisting  body. 
The  Cow  did  not  strain,  and  gradually  became  weaker  until  the  night  of  the  28th,  when 
it  succumbed.  The  abdomen  was  found  to  contain  about  15  litres  of  blood-tinted 
serosity  ;  the  omentum  was  g^t^.\\y  t\\\Qk.&nQ.d.,  and  adhesiojis  were  observed  on  its  visceral 
surface  corresponding  to  the  processes  of  the  placenta  ;  the  peritoneum  showed  traces  of 
intense  inflammation;  while  the' foetus  lay  on  the  floor  of  the  abdomen,  from  which  it 


1 86  PA  THOLOG  Y  OF  GESTA  TION. 

was  only  separated  by  the  omen^tum  and  its  own  membranes,  which  were  not  ruptured. 
Two  large  unaltered  clots  of  blood  were  discovered  between  the  anterior  extremities  of 
the  fcEtal  membranes.  The  uterus  maintained  its  natural  situation,  but  it  was  con- 
tracted, and  rent  from  its  cervix  to  the  middle  of  its  left  cornu.  The  borders  of  the 
rupture  were  red,  swollen,  and  rounded  :  but  the  interior  of  the  organ  did  not  exhibit 
any  trace  of  inflammation. 

The  cause  of  the  accident  was  unknown, 

3.  On  June  8,  1843,  Arnal  {Joiirnal  dcs  Vet.  du  Midi,  1843,  p.  331)  was  summoned  to 
attend  a  Cow  which  had  been  ijl  since  the  previous  evening,  when,  about  half  an  horn- 
before  it  was  noticed  to  be  unwell,  it  had  playfully  jumped  a  wide  ditch,  though  it  was 
advanced  in  pregnancy.  Soon  after  it  voluntarily  returned  to  its  stable,  covered  with 
perspiration.  In  consequence  of  there  being  no  straining,  the  case  was  supposed  to 
be  merely  one  of  "  chill,"  though  the  creature  was  very  ill  indeed-.  Next  day  it  was 
worse ;  the  vulva  was  swollen,  and  there  was  slight  straining.  The  hand  introduced 
into  the  vagina  discovered  the  "  water-bag,"  in  which  the  head  of  a  foetus  could  be 
readily  distinguished.  On  the  membranes  being  ruptured,  only  about  half  a  litre  of 
fluid  escaped ;  the  foetus  was  alive,  and  in  a  vertebro-pubic  position,  the  limbs  being 
doubled  on  the  chest.  These  were  placed  in  a  favorable  direction,  and  by  means  of 
moderate  traction  the  calf  was  born  alive. 

The  Cow  appeared  to  be  much  better,  and  it  was  hoped  that  recovery  would'  ensue  ; 
but  all  at  once  its  condition  became  most  serious,  and  in  spite  of  every  measure  it  per- 
ished on  June  1 1.  When  opened,  the  abdomen  was  found  to  contain  about  ten  litres  of 
sanguinolent  serosity,  and  the  peritoneum  was  much  injected ;  while  the  uterus,  whose 
walls  were  considerably  thickened,  showed  at  its  lower  surface,  near  the  cervix,  a  rup- 
ture four  centimetres  in  circumference,  the  border  of  which  was  red  and  violet  in 
color,  and  greatly  tumefied.  The  uterine  mucous  membrane  was  reddish-brown,  and 
studded  with  ecchymoses.     The  vagina  and  vulva  did  not  offer  any  thing  unusual. 

4.  Presseq  {jfourjial  des  Vet.  dti  Midi,  1849,  P-  35^)  saw  a  Cow  on  March  4,  1846,  which 
the  owner  said  could  not  calve.  There  was  nothing,  however,  to  indicate  that  partu- 
rition was  near  :  the  vulva  was  not  swollen,  the  gluteal  muscles  had  not  sunk,  the  abdo- 
men was  round,  the  flanks  were  full  as  high  as  the  transverse  processes  of  lumbar  ver- 
tebrae ;  and  when  the  hand  was  introduced  with  some  difficulty  into  the  vagina,  the  os 
uteri  was  found  to  be  hermetically  closed.  Presseq  concluded  that  the  animal  was  not 
near  calving,  and  promised  to  see  it  again  next  day.  It  died  during  the  night.  At  the 
autopsy,  the  first  thing  which  attracted  Presseq's  attention,  on  opening  the  abdomen, 
was  a  foetus,  with  its  envelopes,  lying  on  the  walls  of  that  cavity,  and  but  recently  dead, 
as  the  hair  was  intact  and  adherent,  and  the  liquor  amnii  very  limpid.  On  examining 
the  uterus,  he  noticed  only  a  small  perforation  about  four  centimetres  in  diameter,  the 
margin  of  which  was  so  completely  cicatrized,  smooth,  and  even,  as  to  give  it  more  the 
appearance  of  a  natural  than  an  accidental  opening.  The  body  of  the  uterus  was  con- 
tracted, and  had  lost  much  of  its  capacity.  Presseq  learned  that,  two  inonths  pre- 
viously, this  Cow  and  another  had  drawn  a  load  of  barley  to  the  neighboring  market, 
and  in  passing  a  stall  they  took  fright  and  ran  away,  and  were  not  stopped  until  the  cart 
was  upset.  But  the  animal  did  not  appear  to  be  any  the  worse  until  this  illness  set  in. 
The  other  Cow  gave  birth  to  a  fine  calf.  To  this  accident,  two  months  before,  Presseq 
attributed  the  rupture  of  the  uterus,  and  the  escape  of  the  foetus  into  the  alDdominal 
cavity. 

5.  "Boizy  {Recueil  de  Med.  Veterinaire,  1863,  p.  272),  called  to  see  a  Cow  on  February 
8,  1863,  noted  the  following  symptoms  :  general  tremors,  colic,  incessant  pawing,  slight 
tympanitis,  inappetence,  frequent  groans,  and  faeces  very  hard  and  covered  with  mucus. 
He  diagnosed  enteritis,  complicated  with  indigestion.  By  suitable  treatment  the  ani- 
mal appeared  to  recover,  but  on  March  8  it  had  a  relapse ;  the  more  urgent  symptoms 
were  allayed  by  similar  treatment,  but  it  never  quite  recovered,  and  lost  condition.  On 
the  28th  of  the  same  month  this  Cow,  whose  time  for  calving  was  April  4,  evinced  the 
first  signs  of  parturition.  On  the  29th,  Boizy  found  it  straining  must  violently,  and  a 
portion  of  the  foetal  membranes  extruded  from  the  vulva.  Exploring  the  vagina,  no 
calf  could  be  felt,  and  supposing  it  had  been  already  born,  search  was  made  for  it  among 
the  litter  and  in  the  shed,  but  without  success.  Boizy  again  examined  the  vagina  and 
uterus,  and  was  struck  by  a  circumstance  which  he  had  not  before  remarked  :  the  in- 
ternal capacity  of  the  latter  organ  was  not  one  half  what  it  should  have  been  had  de- 
livery occurred  only  a  short  time  previously.  He  began  to  separate  the  maternal  and 
foetal  cotyledons  on  the  lower  surface,  an^  on  I'eaching  the  upper  part,  a  little  to  the 
right,  he  \vas  much  astonished  to  encounter  a  sinuous  ring  the  size  of  a  fist,  directed 
obliquely  forwards  and  from  right  to  left,  and  measuring  about  twenty  centimetres  in 
length  ;  'to  this  the  chorion  was  attached  in  the  closet  fashion,  and  the  membrane  ex- 
tended from  it  in  a  folded  manner,  like  a  half-open  fan.  This  was  the  opening  by  which 
the  foetus  had  passed  into  the  abdominal  cavity.    The  removal  of  the  membranes  was 


ACCIDENTS  OF  PREGNANCY.  187 

given  up  as  useless,  and  the  abdomen  was  examined  externally.  The  "  touch  "  of  the 
right  flank  did  not  reveal  any  thing,  but  that  of  the  left  discovered  a  hard  voluminous 
body,  which  was  surmised  to  be  the  missing  foetus.  The  Caesarean  operation  was  pro- 
posed by  Boizy,  but  the  owner  would  not  allow  it.  The  Cow  died  and  was  buried, 
but  Boizy  had  it  exhumed  three  days  afterwards  ;  though  the  autopsy  was  not  so  satis- 
factory as  he  could  have  desired,  owing  to  this  interval.  He  could  only  note  that 
the  foetus  was  in  the  abdomen,  and  that,  notwithstanding  this  change  of  domicile,  there 
were  indications  that  it  had  continued  to  live  as  long  as  the  Cow ;  it  had  long  frizzled 
hair,  two  incisors  were  apparent,  and  the  horn  of  the  hoofs  was  of  a  greenish  color.  The 
cause  of  the  accident  could  not  be  discovered. 

6.  Dupont  [yournal  des  Vet.  dii  Midi,  1849,  P-  497)  informs  us  that  a  farmer  bought  a 
pregnant  Sheep,  which  soon  after  purchase  showed  signs  of  abortion,  though  the  foetus 
was  not  expelled.  In  two  months,  a  considerable  tumor  formed  a  little  to  the  right  of 
the  umbilicus  ;  this  suppurated,  and  from  the  abscess  the  four  limbs  of  a  foetus,  minus 
the  pasterns,  were  expelled  ;  then  the  wound  cicatrized.  Three  and  a  half  months  later, 
another  tumor  appeared  at  the  same  place,  and  this  likewise  opened,  but  it  only  gave 
exit  to  faeces.  The  Sheep  was  then  given  to  Dupont,  who  kept  it  for  some  time,  then 
had  it  killed  in  order  to  study  the  lesions.  On  opening  the  abdomen,  the  caecum  was 
found  to  be  verj'  much  enlarged,  had  somewhat  the  shape  of  a  horse's  stomach,  and 
was  closely  adherent  to  the  abdominal  muscles  ;  it  offered  four  openings,  the  first  of 
which  was  at  the  middle  of  the  lower  part,  corresponding  to  the  opening  in  the  abdo- 
men, and  from  which  the  faeces  were  passed.  Two  other  openings  were  in  the  intestine 
only,  but  the  fourth  communicated  with  the  right  cornu  of  the  uterus,  which  adhered  in 
the  most  intimate  manner  to  the  caecum.  The  uterus  contained  aL  small  quantity  of 
greyish-colored  foul-smelling  fluid,  in  which  floated  some  small  bones,  chiefly  the  first 
phalanges  of  the  fore  limbs.  The  vagina  was  completely  twisted  from  left  to  right, 
and  Dupont  was  of  opinion  that  this  was  the  cause  of  the  lesions  described.  The 
cause  of-  the  vaginal  torsion,  however,  could  not  be  ascertained. 

7.  Legrain  (Annales  de  Med.  Vet.  de  Bruxelles,  1865,  p.  124)  relates  that  a  laborer 
having  quarrelled  with  his  employer,  revenged  himself  on  a  poor  she-goat  which  was 
pregnant,  by  kicking  it  violently  on  the  belly.  In  consequence  of  this  injury,  the  animal 
lost  its  appetite,  passed  blood  per  vagittam,  was  ill  for  ten  days,  and  then  all  the  phe- 
nomena of  gestation  disappeared ;  the  milk  was  suppressed,  there  were  alternations 
of  appetite  and  inappetence,  and  the  creature  became  terribly  emaciated.  Neverthe- 
less, in  six  months  the  health  was  so  far  re-established  that  oestrum  appeared.  It  was 
put  to  the  male,  though  without  result,  and  it  did  not  again  manifest  "heat."  A  year 
subsequent  to  the  accident,  Legrain  was  asked  to  look  at  it,  as  "  it  had  a  hole  in  front  of 
the  teat."  There,  undoubtedly,  was  a  circular  opening  about  ten  contimetres  in  width, 
through  which  this  veterinarian  extracted  two  incomplete  foetuses  in  process  of  decom- 
position. A  sponge  steeped  in  cold  water  was  introduced  into  the  sac  whence  they  had 
been  withdrawn,  the  wound  was  cleaned  and  dressed  in  the  same  manner  on  the  follow- 
ing days,  and  in  three  weeks  the  animal  had  recovered,  though  the  udder  remained 
atrophied. 

8.  Schmelz  [Annales  de  Med.  Vet.  de  Bruxelles,  1859,  p.  382)  mentions  the  case  of  a 
Cow  which  was  eight  weeks  beyond  the  period  of  calving,  and  was  constantly  lying, 
without  making  any  attempt  to  get  up.  It  was  killed,  when  all  the  viscera  were  dis- 
covered to  be  healthy,  and  a  fully-devdoped  foetus,  surrounded  by  its  membranes,  lay 
in  the  abdomen.  The  uterus  was  completely  detached  at  about  six  centimetres  from 
the  cervix,  and  the  margin  of  the  wound  was  already  cicatrized.  The  foetus,  envelopes, 
and  detached  uterus  exhaled  a  most  offensive  odor,  and  were  putrefied.  There  was  no 
tract  of  liquor  amnii.  The  reason  for  this  rupture  of  the  uterus  could  not  be  discov- 
ered. 

9.  On  May  21,  1874,  Vernant  [Recueil  de  Med,  Veterinaire,  1874,  p.  924)  attended  a 
Cow  eight  years  old,  which  had  arrived  near  the  termination  of  gestation,  and  could 
not  eat,  groaned  constantly,  and  was  tympanitic.  It  lay  on  the  right  side  in  a  natural 
way  ;  the  belly  was  enormously  large  laterally,  but  the  tympanitic  distention  was  on  the 
left ;  loss  of  appetite,  continual  groans  heard  at  some  distance,  eyes  sunk,  pulse  imper- 
ceptible, and  the  skin  and  limbs  hot ;  the  foetus  felt  at  the  lower  part  of  the  abdomen 
on  the  left  side,  but  no  movement  perceived  in  it ;  constriction  of  the  cervix  uteri, 
which,  in  consequence  of  the  tvmpanitis,  was  only  about  four  inches  from  the  vulva ; 
the  animal  could  not  get  up.  Fifteen  days  previously  it  had  been  treated  for  supposed 
indigestion  by  quacks,  but  it  gradually  became  emaciated  and  weak,  and  lost  its  appe- 
tite. A  few  days  before  Vernant  was  called  in,  the  owner  was  astonished  at  the  ap- 
parent, but  gradual,  descent  of  the  foetus  in  the  left  flank,  and  this,  coupled  with  the 
condition,  caused  him  to  think  that  calving  was  about  to  take  place.  Seeing  that  the 
tympanitis  was  producing  serious  effects,  the  rumen  was  punctured  and  a  quantity  of 
gas  escaped ;  the  animal  was  relieved,  but  the  groaning  did  not  cease,  and  the  pulse 


i88  PA THOLOGY  OF  GESTA TION. 

did  not  appear.  Another  exploration  per  vaginam,  proved  that  it  was  impossible  to 
induce  parturition,  as  only  one  finger  could  be  introduced  into  the  os.  Twenty-four 
hours  afterwards,  another  exploration  was  made,  when  Vernant  was  surprised  to  find 
the  OS  so  dilated  that  he  could  feel  some  cotyledons,  which  led  him  to  believe  that  he 
could  effect  delivery.  On  introducing  his  right  arm  deeper,  however,  he  was  aston- 
ished to  discover  it  enveloped  by  the  membranes  only,  without  meeting  with  any  trace 
of  the  foetus  ;  exploration  of  the  horns  did  not  discover  it,  and  it  was  only  by  a  most 
careful  investigation  that  he  satisfied  himself  that  the  membranes  were  displaced,  tense 
as  if  something  was  hanging  to  them,  and  that  there  was  no  liquor  amnii ;  while  the 
cavity  of  the  uterus  itself  would  scarcely  contain  a  man's  head.  Vernant  then  surmised 
that  this  was  a  case  of  extra-uterine  gestation  ;  though  he  was  not  quite  satisfied,  as  the 
presence  and  development  of  the  foetal  membranes  rather  proved  the  contrary.  In 
order  to  solve  the  enigma,  the  inextricable  mesh  of  membranes  was  torn,  and  the  cavity 
of  the  uterus  reached;  then,  at  the  part  which  offered  most  obstacles,  he  contrived  to 
pass  a  finger,  and  then  his  hand,  into  a  diverticulum  or  rent,  through  which  the  mem- 
branes passed.  Following  these,  the  hand  went  into  a  large  cavity  in  the  left  flank, 
where  nothing  could  be  felt.  Turning  over  the  animal  on  the  right  side,  with  external 
assistance  he  managed  to  feel  the  head,  a  fore  limb,  and  then  the  abdomen  of  the  foetuS; 
which  was  in  a  transverse  position — the  head  in  the  left  flank  of  the  Cow,  and  the  belly 
at  the  pelvic  inlet.  He  drew  the  head  and  limb  towards  him,  but  could  not  reach  the 
other  fore  leg  ;  to  do  this  would  have  required  an  arm  four  or  five  feet  long.  Diagnos- 
ing a  rupture  of  the  uterus,  and  seeing  that  the  Cow  was  about  to  succumb,  the 
butcher  was  sent  for.  Next  day  the  carcase  was  examined.  There  was  an  enormous 
male  foetus,  weighing  65  kilogrammes,  and  as  large  as  a  two-months'  old  calf,  with  an 
extraordinary  large  head,  neck,  and  belly,  and  deformed  pelvis ;  in  its  stomach  was 
about  20  litres  of  clear  fluid  like  water,  and  odorless  ;  the  abdomen  contained  a  con- 
siderable quantity  of  sanguinolent  serum,  and  putrefaction  was  commencing  in  the 
viscera.  The  uterus  of  the  Cow  was  remarkably  contracted,  and  at  the  commencement 
of  the  left  horn,  near  the  body  of  the  organ,  the  outer  border  showed  a  somewhat  regu- 
lar rent  more  than  three  inches  long,  with  red  infiltrated  edges.  The  cotyledons  ap- 
peared to  be  healthy,  and  were  everywhere  covered  by  their  placentulae.  The  origin  of 
the  accident  was  ascribed  to  the  large  size  of  the  foetus,  which,  lodged  in  one  of  the 
horns,  deranged  the  digestion,  and  the  walls  of  the  part  becoming  thinner,  at  last  rup- 
tured to  a  slight  extent ;  the  weight  of  the  foetus  gradually  dilated  the  rent,  through 
which  it  slowly  passed,  until  it  fell  into  the  peritoneal  cavity,  carrying  with  it  the  foetal 
membranes,  which  maintained  their  relations  with  the  maternal  cotyledons.  The  uterus 
must  have  retracted  immediately,  and  thus  masked  the  rupture  during  the  exploration. 
The  foetus,  too,  must  have  lived  for  some  time  after  its  change  of  location ;  though  it  is 
not  improbable  that,  in  its  struggles,  it  swallowed  a  large  portion  of  the  liquor  amnii. 

10.  In  the  Veterinarian  (vol.  vii.,  p.  39)  Mr.  King  describes  a  case  of  rupture  of  the 
uterus,  and  the  escape  of  the  foetus  into  the  abdominal  cavity.  The  cause  of  the  rup- 
ture was  supposed  to  be  the  swollen  and  "puffed-up  "  condition  of  the  foetus. 

11.  In  the  same  journal  (vol.  xix.,  p.  624)  Mr.  Cox  states  that  he  visited  a  Cow  in  a 
serious  condition  ;  there  was  a  peculiar  heavy  groaning,  particularly  when  the  animal 
was  lying ;  tympanum  of  the  rumen  and  abdomen ;  the  faeces  were  liquid,  black,  and 
offensive,  and  voided  with  tenesmus  ;  mouth  cold,  and  rigors  ;  mucous  membranes  pal- 
lid. The  animal  died,  and  when  opened  the  calf  was  found  among  the  intestines,  the 
uterus  ruptured,  and  the  peritoneum  inflamed.  It  was  within  five  weeks  of  calving ; 
the  foetus  was  healthy  and  well  developed,  and  appeared  to  have  been  alive  up  to  the 
time  of  the  rupture.  No  cause  could  be  discovered  for  the  accident.  The  same  veter- 
inarian alludes  to  a  similar  accident  occurring  in  a  Mare,  through  unusual  exertion  in 
draught  when  within  a  month  of  foaling.  She  died  in  twelve  hours  from  internal  haem- 
orrhage. 

12.  M.-AC%\\X\six?i^  (Veterinary  yotcrnal,  1876,  p.  249)  was  requested  to  visit  a  two- 
year-old  Cow  in  the  seventh  month  of  pregnancy,  which  was  very  uneasy,  and  showing 
slight  calving  pains,  He  found  immense  distention  of  the  abdomen,  with  a  slight  but 
thick  reddish-brown  discharge  from  the  vagina.  From  the  symptoms,  it  was  supposed 
that  a  dead  calf  was  about  to  be  expelled,  and  a  vaginal  examination  was  accordingly 
made.  '  The  os  was  slightly  dilated,  and  a  portion  of  the  foetal  membranes  as  large  as 
the  fist  lay  in  the  vaginal  canal ;  on  rupturing  and  removing  this,  it  was  discovered  to 
be  part  of  the  chorion  with  two  placentulae  attached.  Very  little  fluid  escaped,  and  the 
*•'  pains  "  were  scarcely  at  all  present.  The  os  only  admitted  three  fingers,  and  it  could 
not  be  dilated  ;  one  finger  pushed  through  it  came  in  contact  with  a  foetus.  Explora- 
tion of  the  cervix  afterwards  did  not  produce  any  straining,  and  the  os  remained  rigid. 
The  case  being  deemed  hopeless,  the  animal  was  killed.  When  the  abdominal  cavity 
was  laid  open,  an  extraordinary  quantity  of  a  nearly  transparent  and  slightly  yellow- 
colored  fluid  escaped.    There  was  an  immense  rupture  in  the  fundus  of  the  uterus,  to- 


k 


A  CCIDENTS*  OF  PREGNANC  Y.  1 89 

wards  the  left  cornu.  One  foetus  had  escaped  from  the  uterus  altogether,  and  was 
found,  destitute  of  membranes,  in  the  right  hypochondriac  :  another  fcEtus  was  yet  in 
the  uterus — towards  the  right  cornu,  and  part  of  the  intact  amnion  enveloping  it  pro- 
truded through  the  rupture.  The  two  foetuses  did  not  appear  to  have  been  long  dead, 
as  there  was  no  putrid  smell  about  them  or  the  membranes.  The  walls  of  the  uterus 
were  apparently  healthy  ;  the  external  surface  of  the  liver  and  intestines  was  bleached, 
and  near  where  the  disengaged  foetus  lay  the  peritoneum  was  blanched.  Macgillivray 
was  of  opinion  that  hydrops  uteri  must  have  existed  for  a  .considerable  time,  as  the 
animal  had  been  large-bellied  and  uneasy  for  some  days ;  though  three  or  four  days 
before  he  was  calle^  in,  it  was  supposed  that  she  had  sustained  an  injury  from  another 
Cow,  and  that  then  or  afterwards  the  rupture  had  occurred. 

Saint-Cyr  refers  to  what  the  Italian  veterinarians  designate  as  semi- 
mobile  uterus,  and  which  he  believes  to  be  allied  to  rupture.  This  is  a 
condition  in  which  the  uterus  has  been  completely  divided  across,  either 
at  the  body  or  the  cornua,  and  remains  floating  in  the  abdominal  cavity, 
being  only  suspended  by  the  broad  ligaments.  The  most  singular  fact 
connected  with  these  cases  is,  that  although  the  uterus  is  torn  in  this 
manner,  its  contents — the  fcetus  and  membranes — do  not  escape  ;  the 
section  cicatrizes,  and  the  organ  appears  as  a  large  kystoid  tumor. 
ErcoLini,  Veterinary  Professor  at  the  Bologna  University,  has  met  with 
four  instances  of  this  extraordinary  accident,  the  pathological  specimens 
being  deposited  in  the  museum  of  that  institution.  Their  history  and 
description  are  as 'follows  : 

1.  The  uterus  of  a  Cow  which  contained  in  one  of  the  cornua  a  foetus  beyond  its 
term,  and  in  the  other  horn  such  a  great  quantity  of  mucus  that,  so  far  as  volume  is 
concerned,  it  would  be  difficult  to  say  which  cornu  was  the  largest.  This  uterus  is 
completely  divided  at  the  cervix  and  floats  in  the  abdominal  cavity,  being  attached  only 
by  the  broad  ligaments,  which  are  thin  and  distended.  The  detached  portion  of  the 
uterus  has  a  globular  form,  and  its  perfectly  smooth  surface  is  everywhere  covered  by 
peritoneum  ;  where  the  separation  has  taken  place,  the  organ  is  closed  by  the  cicatri- 
cial union  of  the  border  of  the  rupture.  The  mucous  membrane  in  the  left  cornu  of 
this  portion  is  loose,  and  shows  numerous  radiating  cicatrizes ;  the  foetus  in  the  right 
cornu  is  indurated,  and  appears  to  have  lived  beyond  the  ordinary  period  of  gestation, 
to  judge  by  the  hoofs,  as  well  as  the  teeth,  which  are  cut.  The  nose  did  not  corre- 
spond to  the  opening  of  the  cornu,  as  the  head  was*  doubled  on  the  left  side  of  the  neck. 
The  vertex  and  occiput  were  turned  upwards,  and  closed  a  vast  circular  opening  result- 
ing from  the  destruction  of  the  partition  separating  the  two  cornua.  The  head  ad- 
hered to  the  entire  border  of  this  opening — unequal  and  ragged  as  it  must  have  been ; 
and  all  that  portion  which  projects  into  the  left  cornu  presents  a  large  tonstcre,  where 
not  only  is  the  skin  absent,  but  even  the  periosteum  itself.  Lying  flat  on  one  of  its 
sides  and  curled  up,  the  limbs  twined  towards  the  head,  and  the  muffle  placed  between 
the  thighs,  the  fcetus  represents  a  kind  of  great  discoid  bod}-.  .^ 

2.  Cornu  of  the  uterus  of  a  pregnant  Cow,  containing  a  completely  developed  foetus, 
markedly  indurated.  This  cornu,  perhaps  ruptured  during  parturition,  is  detached,  and 
hangs  almost  free  in  the  abdomen ;  while  the  rupture  has  cicatrized,  and  there  is  formed 
a  large  kyst,  everywhere  closed,  and  containing  the  foetus.  The  walls  of  the  uterus  are 
for  the  most  part  fibrous,  and  the  foetal  envelopes  coriaceous.  Like  the  preceding  case, 
this  specimen  was  found  in  a  Cow  which  had  been  slaughtered  by  the  butchery  the  cornu 
fell  on  the  ground,  after  some  few  fibrous  bands  which  attached  it  to  the  sub-lumbar 
region  had  been  cut  through. 

3.  The  uterus  of  a  Sheep  arrived  at  the  termination  of  pregnancy ;  the  organ  has 
been  torn  in  the  vicinity  of  the  vagina,  and  remains  free  in  the  abdominal  cavity.  In 
this  instance,  also,  the  uterus  forms  a  completely  closed  kyst,  which  contains  a  very 
much  indurated  lamb.  In  detaching  this  organ,  an  irregular  cicatrix  is  seen,  which  leads 
to  the  supposition  that  the  accident  was  due  to  torsion  of  the  cervix. 

4.  Posterior  portion  of  the  body  of  a  Guinea-pig,  which  shows  the  right  horn  of  the 
uterus  detached  and  cicatrized  where  separation  has  occurred.  This  horn,  whicli  was 
half  free,  was  filled  with  fluid  blood ;  the  distention  caused  by  the  blood  has  been  so 
great,  that  the  horn  is  ruptured  in  the  middle  and  the  foetus  must  have  died  from  haem- 
orrhage. J 


190 


PATHOLOGY  OF  GESTATION. 


With  regard  to  these  curious  and  very  interesting  cases,  Saint-Cyr  is 
of  opinion  that,  to  allow  the  foetus  to  remain  in  the  detacJied  portion  of 
the  uterus,  the  separation  must  have  taken  place  slowly  and  gradually,  and 
that  cicatrization  must  have  been  going  on  in  the  portion  already  separated 
— the  work  of  union  and  disunion  being  simultaneous. 

Treatment. — When  it  is  possible  to  diagnose  rupture  of  the  uterus,  the 
indications  are  obvious  :  extract  the  foetus  as  promptly  and  easily  as 
possible,  and  if  need  be  by  gastro-hysterotomy.  We  shall  refer  to  the 
treatment  of  these  cases  when  describing  this  accident  as  a  consequence 
of  parturition. 

Metrorrhagia. 

Accidental  haemorrhage  from  the  uterus  during  pregnancy,  appears  to 
be  rare  in  animals,  judging  from  the  paucity  of  instances  recorded. 
Carsten  Harms  {Lehrbuch  der  thierdrztlichen  Gcburtshillfe,  p.  60)  has  ob- 
served this  accident  in  cattle ;  it  was  accompanied  by  a  small  discharge 
of  blood  from  the  vagina,  particularly  during  micturition,  and  resulted  in 
the  death  of  the  foetus.  Other  observers  have  not  noticed  this  discharge ; 
the  blood  always,  remaining  in  the  uterus,  where  it  has  been  sometimes 
found,  as  a  clotted  mass,  to  the  amount  of  more  than  four  gallons.  In 
the  majority  of  cases  it  would  seem  to  be  occasioned  by  a  spontaneous 
separation— more  or  less  extensive — of  the  placental  capillaries  from  the 
uterine  surface.  Zundel  has  seen  it  occur  in  an  animal  which  showed 
signs  of  oestrum  while  pregnant.  The  following  cases  may,  to  some  extent, 
illustrate  this  accidental  uterine  haemorrhage. 

Egli  was  called  to  see  a  Cow  which  staggered  about  in  walking,  and  did  not  eat.  He 
found  it  lying,  and  had  great  difficulty  in  getting  it  up ;  when  it  kept  alternately  lifting  the 
hind  legs.  The  pulse  was  slow  and  very  weak,  and  the  heart's  beats  were  loud.  There 
were  no  other  symptoms.  It  was  bled,  but  during  the  operation  it  staggered  and  trembled; 
the  bleeding  was  stopped.  It  then  lay  down  without  appearing  to  suffer,  and  was  dead  in  a 
few  minutes.  At  the  autopsy  the  uterus  was  observed  to  be  considerably  distended  and 
of  a  violet  color,  and  an  enormous  quantity  of  blood  was  effused  between  the  muscular 
and  serous  layers,  so  that  the  wall  of  the  organ  was  about  six  inches  thick ;  there  was  no 
extravasation,  either  in  the  abdomen  or  the  cavity  of  the  uterus.  No  cause  was  ascribed 
for  the  accident. 

Ziindel  {yotirital  de  Med.  Vet  de  Lyon,  1861)  describes  the  case  of  a  Mare  which  sud- 
denly presented  the  followi!ig  symptoms  during  pregnancy:  Anxious  countenance, 
drooping  head,  rigidity  of  the  loins,  staggering  gait  and  lameness  of  the  left  hind  leg,  as 
if  from  a  sprain  ;  the  respirations  36  per  minute,  and  pulse  60  and  small.  Treatment 
was  of  no  avail ;  prostration  gradually  set  in,  the  animal  appeared  extremely  anxious, 
soon  it  could  net  stand,  and  when  it  fell,  death  ensued  almost  immediately  without  much 
agony.  There  were  never  anv  symptoms  of  colic  or  discharge  of  blood  per  vulvain.  On 
examination,  a  five  months'  old  foetus  was  discovered  iii  the  right  cornu,  and  the  placenta 
was  detached  nearly  throughout.  The  left  horn  was  the  seat  of  sub-acute  inflammation, 
and  its  volume  exceeded  that  of  the  right ;  an  enormous  blood-clot,  measuring  about 
four  gallons,  occupied  this  horn  and  the  body  of  the  uterus.  The  blood-vessels  were 
nearly  empty.  Zundel  asks  whether  the  lameness,  which  had  already  been  noted  as  a 
symptom  of  metrorrhagia  by  some  German  authorities,  may  not  be  explained  by  the 
arrangement  of  the  lumbar  plexus,  which  sends  nerves  to  the  limbs  and  the  generative 
organs. 

In  a  pregnant  Mare,  Schmidt  [Antiales  de  Med.  Vet.  de  Bruxellei,  1862)  witnessed 
the  following  symptoms  :  Sudden  inappetence  ;  head  low  and  "  beneath  the  manger;  " 
reeling  gait ;  extreme  feebleness,  and  hind  limbs  widely  separated  ;  looking  first  towards 
one  flank,  then  the  other ;  pulse  iic,  regular  but  sinking;  heart's  beats  quite  audible, 
and  venous  pulsation  in  neck  ;  mucous  membranes  very  pale,  and  the  body  temperature 
low.  Dark-colored  blood  flowed  in  a  passive  manner  from  the  uterus.  The  Mare  died 
on  the  same  day,  and  an  autopsy  revealed  all  the  organs,  except  the  uterus,  almost  blood- 


A  CCI DENTS  OF  PREGNANCY.  1 9 1 

less  ;  that  viscus  was  found  to  be  considerably  distended  with  blood — nearly  two  pails- 
ful — which  was  partly  coagulated.  It  contained,  in  addition,  a  seven  months'  foetus  sur- 
rounded by  the  liquor  amnii,  and  entirely  separated  from  the  uterine  walls. 

When  there  is  no  escape  of  blood  externally,  the  diagnosis  of  this  acci- 
dent is  most  difficult ;  but  when  the  haemorrhage  is  apparent,  then  arti- 
ficial delivery  should  be  attempted,  and  the  same  treatment  adopted  as 
iox  post-partwn  haemorrhage  {which  see).  • 

Abnormal  Retention  of  the  Fcctus. 

It  was  remarked,  when  speaking  of  the  normal  period  of  gestation,  that 
this  varied  within  considerable  limits,  and  that  the  fcetus  might  remain  in 
the  uterus  for  a  comparatively  long  period  beyond  the  ordinary  time,  with- 
out any  serious  inconvenience  to  itself  or  its  bearer.  But  when,  from  any 
special'  cause,  delivery  cannot  take  place,  then  very  grave  results  may, 
indeed  nearly  always,  follow. 

Cases  of  abnormal  retention  of  the  fcetus  were  observed  in  the  last  cen- 
tury by  Boutrolle  {Le  Parfait  Bouvier,  1776),*  Gervy  {Instructions  Vet- 
erinaire,  vol.  iv.,  p.  256),  and  Huzard,  senior  and  junior ;  the  latter 
exhibited  to  the  Society  of  the  Faculty  of  Medicine  of  Paris,  in  18 15,  the 
uterus  of  a  Sheep  containing  a  fcetus  which  had  been  there  for  three  years. 
Since  that  period  the  literature  of  the  subject  has  become  very  extensive, 
nearly  forty  instances  being  recorded  in  English  veterinary  journals  alone. 
All  the  domesticated  animals  are  exposed  to  this  abnormal  retention  of 
the  foetus,  but  the  Cow  far  more  than  any  other  creature  :  the  frequency 
in  this  animal  being  as  twelve  to  one  in  the  Mare,  and  ten  to  one  in  the 
Sheep. 

Symptoms  and  Terminations. — The  symptoms  at  first  are,  of  course, 
those  of  pregnancy,  until  the  period  of  normal  parturition,  or  even  during 
pregnancy  when  abortion  is  about  to  take  place.  At  this  period  we  have 
nearly  all  the  signs  of  parturition  :  enlarged  mammae,  swollen  vulva,  pen- 
dulous abdomen,  restlessness  and  anxiety.  Then  straining  begins,  but 
the  OS  uteri  remains  closed,  and  no  fcetus  appears.  This  condition  may 
persist  for  only  a  brief  period,  and  be  so  little  marked  as  to  pass  unob- 
served in  some  cases  ;  in  others  it  may  continue  for  two,  three,  or  four 
days,  the  expulsive  efforts  gradually  diminishing  in  force  and  frequency 
until  they  altogether  disappear.  The  animal  then  regains  its  ordinary 
state,  and,  if  a  Cow,  the  secretion  of  milk  goes  on  as  if  there  was  nothing 
the  matter.  Health  may  never  be  impaired  from  this  cause,  and  the 
condition  of  the  animal  may  not  be  suspected  until,  if  a  Cow  or  a  Sheep, 
it  has  been  fattened  and  slaughtered  by  the  butcher  for  food,  when  the 
foetus  is  discovered.  It  has  been  observed  that  oestrum  does  not  appear 
in  such  animals,  as  a  rule.  The  exceptions  are  rare  ;  but  Rossignol 
mentions  a  Cow  which  retained  its  foetus  for  twenty-seven  months,  but 
which  yet  gave  an  abundance  of  milk,  often  exhibited  oestrum,  and  went 
to  the  bull,  and  was  at  last  killed  because  it  became  too  fat ! 

*  Boutroile  writes  :  "  There  are  Cows  which  are  not  '  open,'  that  is  to  say,  which  have  not  sufficient 
passage  for  the  calf,  which  remains  in  the  Cow  and  becomes  dried-up  hke  a  ball.  The  Cow  does  not  die 
for  all  this,  if  it  is  well  cared  for  ;  but  many  perish  when,  instead  of  drying-up,  the  foetus  becomes  a  mass 
of  corruption.  The  Cow  which  carries  its  dried-up  calf  in  the  uterus  does  not  seek  the  Bull.  ...  It 
is  necessary  to  take  care  of  these  Cows  for  ten  months  or  a  year,  and  to  feed  them  well,  especially  when 
the  calf  dries,  for  they  eat  little  and  become  extremely  emaciated  for  fifteen  days.  In  about  ten  months  or 
earlier,  if  there  is  any  herbage,  these  kind  of  Cows  are  put  out  to  pasture,  and  they  fatten  like  others  ;  the 
butchers  find  the  calf  dried  up  in  the  calf-bag." 


192  PA  THOLOG  Y  OF  GESTA  TION. 

In  other  instances,  after  the  ordinary  period  of  gestation  has  been 
exceeded  by  several  months,  signs  of  parturition  are  again  manifested, 
and  delivery  may  then  be  safely  accomplished,  either  without  aid,  which 
is  rare,  or  by  careful  manipulation  ;  the  young  animal  may  even  be  born 
alive  if  too  long  a  period  has  not  intervened  since  the  normal  time  of  deliv- 
ery.* Parturition  in  these  cases  is  generally  difficult ;  and  the  favorable 
termination  of  such  a  copdition  is  due  to  the  membranes  of  the  fcetus  re- 
maining intact,  and  the  os  sufficiently  contracted  and  close  to  exclude  the 
atmosphere.  Even  under  these  circumstances,  as  Saint-Cyr  points  out, 
the  retention  of  the  foetus  may  not  have  so  fortunate  an  ending.  Very 
often,  after  fruitless  straining,  the  animal  continues  unwell  ;  it  has  little  or 
no  appetite,  languishes,  becomes  feeble  :  hectic  fever  appears  ;  it  falls 
into  a  state  of  marasmus,  and  dies  after  a  more  or  less  prolonged  period 
of  misery. 

When,  at  the  usual  time  of  parturition,  the  straining  of  the  animal  has 
ruptured  the  fcetal  membranes,  and  the  liquor  amnii  escapes,  air  at  the 
same  time  obtaining  access  to  the  uterine  cavity,  the  case  is  in  nearly 
every  instance  very  serious.  The  foetus  soon  perishes  and  begins  to 
putrefy,  and  in  a  short  time  the  decomposing  mass  causes  inflammation 
of  the  uterus  (metritis),  accompanied  by  frequent  and  exceedingly  severe 
straining  ;  low  fever  supervenes  ;  a  foul-smelling  putrescent  fluid  escapes 
from  the  vagina,  and  the  creature  finally  succumbs  to  metritis  and  putrid 
infection.  In  other  instances  the  termination  is  not  so  rapid.  The  ani- 
mal remains  unhealthy  ;  the  secretion  of  milk  is  suspended  ;  horribly 
fetid  discharges  are  passed  per  vaginam,  containing  pus,  broken-up 
decomposed  tissues,  and  even  bones  of  the  fcetus ;  these  discharges  are 
increased  by  the  straining  which  sometimes  takes  place  at  intervals.  In 
the  mean  time,  the  creature  loses  condition,  emaciation  becomes  extreme, 
and  death  ensues  from  debility  and  marasmus. 

With  the  Cow  we  may,  nevertheless,  have  a  vaginal  discharge,  due'  to 
the  presence  of  a  putrefying  foetus,  and  foe  a  long  time,  without  any  such 
serious  result.  Figuier,  quoted  by  Saint-Cyr,  removed  from  the  uterus  of 
a  Cow  the  entire  skeleton  of  a  foetus  which  had  been  there  for  more  than 
five  years,  without  giving  rise  to  any  other  symptoms  than  a  very  disgust- 
ing intermittent  vaginal  discharge.  The  animal  quite  recovered. 
Thierry  reports  the  abortion  of  a  Cow  at  the  fifth  month  of  gestation, 
and  the  retention  of  the  putrefied  foetus  for  more  than  three  months 
afterwards,  without  any  harm  ensuing  ;  Gervy  also  removed  the  head  of 
a  fcetus  which  had  lain  in  the  uterus  of  a  Cow  for  eighteen  months,  with- 
out the  animal  suffering  much  inconvenience  during  that  time.  In  the 
Veterinarian  (vol.  ix.,  p.  454)  there  is  an  instance  of  a  Cow  carrying 
a  decomposing  calf  for  two  years  with  impunity  ;  and  another  (vol.  xxix., 
p.  577)  for  ten  months. 

It  is  not  the  same  with  the  Mare,  as  death  has  been  the  usual  termina- 
tion \  but  it  would  appear  that  retention  of  the  foetus  is  very  unusual 
indeed  in  this  animal,  the  best  recorded  instances  being  one  by  Hamon, 

*  In  the  Newcastle  Journal  for  January  i8,  1840,  there  is  the  description  of  a  calf  which  was  born  on 
the  365th  day  (fifty-two  weeks  and  cue  day).  It  was  alive  when  dropped,  but  died  soon  after.  It  was  of 
great  size,  though  bom  without  assistance  ;  it  was  a  male. 

Strange  to  relate,  in  the  Verierinarian  for  1850  (p.  148),  a  Mr.  Tatam,  of  Homcastle,  records  a  case  of 
abnormal  gestation  in  a  Cow  in  his  locality,  in  which  not  only  was  the  period  the  same  (fifty-two  weeks  and 
a  day),  but  the  calf  was  a  male,  as  extraordinary  in  size,  and  excited  a  similar  degree  of  wonder  as  the 
above  !     Mr.  Tatam  saw  the  calf :  had  he  seen  the  other  one  ?  . 

I  have  some  instances  of  300  days' gestation,  the  calves  being  born  alive. 

In  the  Mare,  prolonged  gestation  is  not  so  frequent,  though  it  sometimes  occurs,  the  foetus  being  retained 
a  month,  or  even  a  little  longer,  without  prejudice  to  the  foal's  existence. 


ACCIDENTS  OF  PREGNANCY.  193 

in  which  death  took  place  after  seventeen  months'  pregnancy;  and 
another  by  Hammond,  when  the  same  result  followed  after  twenty-two 
months. 

The  period  during  which  a  foetus  may  be  retained  in  the  uterus  varies 
from  a  few  months  to  five  years. 

We  have  mentioned  that  in  these  cases  of  retention,  the  foetus  may  live 
for  a  certain  time,  provided  the  membranes  are  not  ruptured  when  the 
symptoms  of  parturition  first  manifest  themselves  ;  it  may  even  continue 
to  develop,  as  is  evidenced  by  its  size,  its  bony  framework,  hoofs,  teeth, 
etc.,  which  often  cause  it  to  look  like  an  animal  which  has  been  born  for 
two,  four,  or  six  months.  But  in  other  cases,  there  can  scarcely  be  a 
doubt  that  the  foetus  perishes  when  the  first  ineffectual  expulsive  efforts 
are  made  by  the  mother,  or  even  at  a  period  anterior  to  the  ordinary 
occurrence  of  parturition  ;  as  is  proved  by  the  absence  of  hair,  and  the 
small  size  and  weight  of  the  creature  ;  while,  again,  it  may  live  for  some 
hours  after  rupture  of  the  membranes,  provided  it  can  breathe,  or  the 
placental  connections  are  intact. 

In  all  cases,  as  a  rule,  if  the  air  does  not  obtain  access  to  the  uterine 
cavity,  putrefaction  does  not  ensue  ;  and  when  the  uterus  is  examined 
after  death,  it  is  found  to  be  closely  contracted  on  its  contents,  its 
mucous  membrane  healthy  or  slightly  ecchymosed  here  and  there,  with 
the  cotyledons  pale,  wasted,  and  separated  from  the  placentulae.  Some- 
times between  the  inner  surface  of  the  uterus  and  the  chorion  there  is  a 
gelatinous  mass,  which  covers  the  foetus  and  conceals  the  placental 
cotyledons,  these  being  decayed,  spongy,  and  sometimes  completely 
destroyed.  The  liquor  amnii  has  also  been  absorbed  ;  so  that  the  mem- 
branes are  in  close  contact  with  the  foetus,  and  may  even  have  become 
adherent  to  it  in  places.  The  foetus  itself  is  dessicated  by  absorption,  and 
its  skin  is  hard  and  dry  as  if  tanned,  or  it  is  wrinkled  and  shrivelled  ;  while 
the  flesh,  if  any  remains,  is  either  perfectly  white,  or  pale  and  faded- 
looking  in  color,  and  emits  a  kind  of  rancid  odor.  Other  organs  are 
pale  and  bloodless,  and  more  or  less  undergoing  fatty  degeneration.  When 
the  retention  has  continued  for  a  long  time,  all  the  soft  textures  may  dis- 
appear, and  nothing  remain  but  the  bones ;  in  other  instances  the  foetus 
and  its  membranes  become  the  seat  of  calcareous  infiltration,  and  con- 
stitute what  has  been  termed  a  lithopcedian. 

It  is  sometimes  extraordinary  how  perfectly  a  foetus  is  protected  from 
decay  in  the  uterus.  For  instance,  in  the  Veterinary  journal  (July,  1876), 
Mr.  Taylor  mentions  one  which  had  been  retained  for  seven  months 
beyond  the  normal  period  ;  and  yet  with  the  exception  of  absorption 
of  the  eyes,  it  did  not  present  indications  of  having  passed  more  than 
a  few  days  in  excess  of  the  usual  term  in  the  uterus. 

When  the  envelopes  have  been  ruptiired,  however,  and  the  liquor  amnii 
has  escaped,  w^e  have  a  different  pathological  condition.  Then,  through 
the  partially  dilated  os  the  air  has  been  admitted,  and  if  immediately 
before  this  the  foetus  was  alive,  it  may  then  die  and  rapidly  submit  to  the 
putrefactive  process,  its  soft  parts  decomposing  and  macerating  and  form- 
ing a  most  foul-smelling  mass  ;  so  that  when  the  uterus  is  opened,  we 
discover  a  grey  or  greyish-rd^l  fluid  emitting  a  most  disgusting  odor,  and 
containing  portions  of  matter  resembling  adipocere,  and  perhaps  bones 
which  may  yet  be  covered  by  soft  parts  and  held  together  by  ligaments, 
or  entirely  disunited  and  decaying,  The  uterus  itself  shows  evidence,  in 
the  majority  of  cases,  of  chronic  metritis ;  sometimes  abscesses  have  been 

13 


194  PA  THOL  OG  V  OF  GESTA  TION. 

formed  in  its  texture,  or  it  has  become  adherent  to  other  organs — as  the 
intestine,  or  tissues — as  the  abdominal  walls,  with  which  it  has  established 
fistulous  communications,  and  through  which  portions  or  the  whole  of 
the  fcetus  may  be  passed. 

Causes. — Various  causes  have  been  assigned  for  the  retention  of  the 
foetus,  several  of  which  are  no  doubt  quite  sufficient  to  offer  an  obstacle 
to  normal  parturition.  Among  these  causes  may  be  cited  :  a  diminution 
or  loss  of  contractile  power  in  the  uterus  itself  to  expel  its  contents,  and 
the  absence  of  assistance  when  attempts  are  made  ;  adhesions  of  an  un- 
usual character  between  the  uterus  and.  placenta  ;  malposition  of  the 
foetus  ;  displacement  of  the  uterus  ;  deformed  pelvis  ;  fibrous  induration 
or  spasmodic  contraction  of  the  cervix  uteri ;  torsion  of  the  uterus,  or 
adhesion  of  its  ligaments,  etc. 

The  following  cases  are  given  as  examples. 

Mr.  Cartwright  ( Veterinarian,  vol.  x.,  p.  243)  refers  to  a  Cow  that  was  at  full  time  of 
calving  in  May,  and  showed  signs  of  parturition,  the  udder  being  of  great  size,  and  two 
of  the  feet  of  the  fcetus  being  seen  in  the  vagina.  As  the  animal  could  not  be"  assisted 
just  then,  a  day  or  two  was  allowed  to  elapse,  when  exhibiting  no  signs  of  uneasiness 
a  further  interval  ensued.  But  no  indication  of  calving  was  again  noticed,  the  Cow 
only  moaning  for  a  few  days.  Four  or  five  days  afterwards  she  was  milked,  though 
the  yield  was  scanty  at  first,  and  only  became  moderately  plentiful  at  a  later  period. 
It  was  sold  in  October,  though  it  had  not  appeared  to  be  quite  well  for  some  time  after 
the  proper  period  of  calving  had  passed,  and  there  was  no  oestrum.  At  the  first  the 
abdomen  was  very  large,  and  then  gradually  subsided.  The  calf  could  be  felt  all  the 
time. 

The  same  excellent  obsers^er  relates  ( Veterinarian,  vol.  xi.,  p.  16)  that  a  farmer,  at 
shearing  time,  discovered  that  one  of  his  Sheep,  a  fine  four-year-old  Cheshire  Ewe,  had 
not  lambed,  and  that  the  foetus  was  "coming  out  at  the  bottom  of  the  belly."  Mr. 
Cartwright's  examination  revealed  the  existence  of  an  opening  at  the  umbilicus,  sufficient 
to  admit  two  or  three  fingers,  from  which  hung  a  little  hair,  and  matter  oozed.  The 
fcetus  could  be  distinctly  felt  at  the  lower  part  of  the  abciomen,  and  seemed  hard. 
Many  pieces  of  the  hair  and  skin,  also  one  fore  leg  as  high  as  the  shoulder,  and  a  por- 
tion of  another  limb,  were  removed.  No  more  could  then  be  got  through.  The  wound 
gradually  closed,  and  the  animal  improved  in  condition  until  about  six  months  after- 
wards, when,  being  exposed  to  much  wet  weather,  it  began  to  decline,  and  it  was 
deemed  advisable  to  send  it  to  the  butcher.  The  abdominal  wall  in  the  region  of  the 
wound  was  thickened,  and  portions  of  bones  projected  from  and  pressed  around  the 
orifice,  which  was  the  width  of  a  finger.  The  vagina  and  os  uteri  were  pervious  and 
natural ;  but  in  front  of  the  cervix  the  uterus,  for  a  foot  in  length,  was  no  thicker  than  a 
thin  pipe  stem,  and  very  similar  in  appearance  and  structure  to  one  of  the  ureters  ;  it 
would  only  admit  a  probe.  Then  it  became  wider  and  more  muscular,  and  divided  into 
two  passages,  in  which  were  contained  a  few  small  bones.  From  this  part  the  body  of 
the  uterus  expanded  to  half  the  size  of  a  man's  head  (the  Iwo  short  cavities  opening 
into  it),  and  was  attached  anteriorly  to  the  diaphragm,  and  laterally  to  the  abdomen, 
for  several  inches  around  in  every  direction ;  it  contained  the  remains  of  a  fine  foetus, 
now  reduced  in  a  great  measure  merely  4;o  bones  and  a  little  putrid  matter.  The  sac 
thus  formed  by  a  part  of  the  uterus  was,  inside,  in  an  apparently  diseased  state,  being 
necessarily  of  a  darkish  color  in  consequence  of  the  uterus  firmly  clasping  the  bones, 
and  becoming  injured  by  their  rough  projections,  as  it  was  completely  wedged  full. 
There  were  attachments  formed  on  its  peritoneal  layer  with  the  small  intestines  and 
thin  mesentery,  but  they  were  sound.  The  Ewe  should  have  lambed  two  years  pre- 
viously, at  which  time  it  showed  uneasiness.  The  owner  thought  it  would  have  done 
so  had  it  been  assisted. 

M.  Caillier  [Reaieil  de  Med.  Veterinaire,  1847.  p!  690)  was  called  to  attend  a  seven- 
year-old  Mare,  which  had  been  put  to  a  stallion  Ass.  The  animal's  abdomen  was  very 
large  and  pendulous,  there  was  loss  of  appetite,  the  surface  of  the  body  was  cold  and 
skin  unhealthy,  membranes  pallid,  frequent  yawnings,  often  looking  back  at  flank, 
head  continually  agitated,  sinking  of  the  hind  "quarters,  and  unsteady  gait.  The  foetus 
appeared  to  be  dead.  The  Mare  had  been  ill  for  two  days,  though  it  had  not  been  ex- 
posed to  any  thing  likely  to  cause  abortion ;  its  period  of  gestation  had  expired  and 


ACCIDENTS  OF  PREGNANCY.  19. 

the  movements  of  the  foetus  had  been  lately  observed.  On  the  previous  evening  the 
usual  signs  of  approaching  parturition  were  noted ;  there  were  expulsive  efforts,  a 
discharge  of  glairy  matter,  considerable  dilatation  of  the  vulva,  filling  of  the  udder, 
and  sinking  of  the  abdomen.  An  exploration /(?r  ra?-/«-'zw  discovered  the  cervix  uteri 
to  be  rigid  and  the  os  completely  closed,  which  gave  rise  to  a  suspicion  of  the  existence 
of  scirrhus.  Three  days  afterwards  glairy  discharges  had  been  passed,  but  the  udder 
and  abdomen  appeared  to  be  diminished  in  size.  Another  examination  proved  that 
the  index  finger  could  not  be  introduced  into  the  uterus,  but  was  opposed  by  a  hard 
tumor.  The  owner  not  assenting  to  an  operation  for  the  relief  of  the  Mare,  affairs  were 
left  to  take  their  course  ;  for  two  months  there  was  no  amendment;  then  the  animal 
was  put  to  pasture,  when  improvement  began,  and  on  the  return  of  the  season  it  was  put 
six  times  to  a  Horse.  Ten  days  afterwards  it  died.  Examined  immediately  after  death, 
the  uterus  was  fouiid  to  be  a  hard  voluminous  mass,  which,  when  opened,  was  discovered 
to  contain  the  body  of  a  well-formed-mule  in  a  perfect  state  of  preserv'ation,  the  hair 
evenbeing  quite  firm.  The  nose  was  fixed  in  the  os,  and  it  had  become  elongated  and 
the  nasal  cavities  obliterated.  There  was  nothing  unusual  about  the  uterus  itself  or 
the  membranes,  except  at  the  cervix,  the  texture  of  which  was  yellow,  swollen,  and 
scirrhus,  and  so  hard  that  it  was  with  difficulty  cut.  The  Mare  had  gone  twenty-three 
months  with  foal,  and  the  retention  was  due  to  the  diseased  condition  of  the  cervix 
uteri. 

At  the  Obstetrical  Society  of  Edinburgh,  in  1872,  the  mummified  foetus  of  a  Cow  was 
exhibited ;  it  had  been  expelled,  without  any  effort,  two  years  and  three  and  a  half 
months  after  insemination.  In  July,  1S65,  this  Cow,  which  was  of  a  celebrated  breed, 
was  put  to  the  Bull ;  but  in  December  it  was  attacked  with  the  rinderpest,  when  no 
doubt  the  foetus  died,  though  the  mother  recovered.  There  were  no  signs  of  labor 
when  the  foetus  perished,  nor  yet  at  the  ordinary  period  of  parturition.  The  animal 
was  fedior  the  butcher,  and  on  October  iS,  1867,  in  the  course  of  the  extreme  fattening 
which  it  underwent,  the  almost  forgotten  pregnancy  was  brought  to  recollection  by  the 
expulsion,  probably  due  to  the  accumulation  of  fat  in  the  omentum  and  elsewhere,  of 
the  lithopaedian. 

In  the  Veterinarian  (vol.  xli.,  p.  88)  Mr.  Wilson  describes  a  case  of  what  he  desig- 
nates "retention  of  a  foetus"  in  a  Cow,  which  was  evidently  some  time  beyond  the 
usual  period  of  parturition.  On  being  killed  and  opened,  all  the  viscera  of  the  pelvis 
and  posterior  part  of  the  abdomen  were  observed  to  be  bound  up  en  masse  by  more  or 
less  thin,  transparent,  and  loose  tissue.  Removing  this,  the  left  tibia,  fibula,  and  patella 
of  a  foetus  were  found  within  a  double  of  the  intestine.  The  bones  were  fullyformed, 
but  black,  and  matted  with  short  hair.  The  intestine  of  the  Cow  presented  no  morbid 
appearances,  but  the  contents  were  liquid  at  that  part  only.  The  animal  had  been 
artacked  with  transient  diarrhoea  three  days  previously.  The  body  of  the  uterus  was 
affected  with  anasarca,  and  in  the  cavity  of  the  organ  was  another  lot  of  bones  of  the 
same  appearance  as  the  others.  The  cotyledons  were  entirely  absorbed,  and  the  tex- 
ture of  the  walls  was  like  basil  leather.  There  were  three  distinct  tubular  passages 
between  the  fundus  of  the  organ  and  the  colon,  the  largest  of  which  was  not  less  than 
three  inches  in  diameter,  and  through  this  the  bones  in  the  intestine  must  have  passed. 
The  Fallopian  tubes  appeared  to  constitute  two  of  these  ducts.  The  cervix  uteri  was 
cartilaginous,  and  no  os  could  be  found. 

A  very  interesting  case  is  recorded  in  the  Veterinarian  (vol.  xlii.,  p.  391)  of  a  Cow 
which  had  aborted  towards  Christmas,  186S,  and  until  the  following  May  had  been  in 
thriving  condition  ;  when  in  that  month  it  began  to  lose  appetite,  and  commenced  to  strain. 
Then  the  vagina  becamediscolored,  and  a  peculiar  offensive  discharge  flowed  from  it. 
On  examination /fr  rectum  nothing  could  be  discovered,  but  on  exploring  the  generative 
organs  it  was  found  that  the  os  uteri  would  admit  the  index  finger,  and  that  the  dis- 
charge, which  was  faecal  in  character,  was  proceeding  from  the  uterus  ;  hence  it  was 
surmised  that  the  irritation  and  straining  at  the  commencement  of  the  animal's  illness, 
might  be  accounted  for  by  the  large  quantity  of  faeculent  matter  escaping  by  the  vagina. 
The  diagnosis  was  that  a  communication  existed  between  the  uterus  and  bowels,  prob- 
ably as  the  result  of  abscess.  The  Cow  was  destroyed,  and  on  cutting  down  on  what 
appeared  to  be  an  enlarged  portion  of  intestines,  some  of  the  bones  of  a  calf  were  come 
upon  ;  it  was  also  noted  that  several  communications  existed  between  the  uterus  and 
bowels.  The  uterus  appeared  to  possess  three,  instead  of  two,  cornua  ;  and  in  one  of 
these,  and  partly  covered  by  a  thick  layer  of  the  mucous  membrane,  several  bones  of  a 
foetus,  including  some  belonging  to  the  head,  were  found.  An  adhesion  existed  on  the 
outer  side  of  the  cavity  containing  the  foetal  remains,  and  the  peritoneal  surface  of  the 
intestines.  The  continuous  pressure  of  the  sacculated  bones  had  led  to  the  production 
of  fistulous  openings  into  the  bowels,  through  which,  apparently,  several  of  the  bones 
had  ultimately  passed  into  the  intestinal  canal.  This  Cow  may  have  been  pregnant  with 
twins,  and  only  one  had  been  aborted. 


196  PA  THOLOG V  OF  GESTA  TIOJV. 

Treatment. — The  treatment  of  fcetal  retention  must  greatly  depend 
upon  circumstances.  Wlien  the  owner  of  an  animal  that  has  reached 
the  termination  of  gestation  and  begins  to  be  in  labor,  perceives  that  the 
efforts  are  weak  and  irregular,  and  not  sustained,  so  that  birth  does  not 
take  place  after  twenty-four,  thirty-six,  forty-eight  hours,  and  even  when 
the  S3^mptoms  of  colic  are  slight  and  the  condition  of  the  creature  other- 
wise satisfactory,  the  attendance  of  the  veterinary  surgeon  should  not  be 
delayed.  The  latter  will  inform  himself  as  to  the  history  of  the  case,  and 
also  its  present  condition  by  careful  external  examination  and  internal 
exploration.  By  the  latter  he  will  ascertain,  in  all  probability,  the  charac- 
ter of  the  obstacle  to  parturition,  and  be  in  a  position  to  decide  whether 
delay  is  necessary,  or  if  he  is  to  promote  immediate  delivery.  In  some 
instances  it  will  be  difficult  to  arrive  at  a  decision.  Some  practitioners 
of  note  recommend  abstention  from  interference,  and  the  adoption  of 
expectant  treatment,  so  long  as  the  os  is  not  sufficiently  dilated  or  the 
foetal  membranes  are  not  ruptured  ;  and  they  insist  on  this  course,  even 
when  there  is  a  material  obstacle  present — such  as  torsion  of  the  uterus 
or  degeneration  of  the  cervix — which  renders  spontaneous  or  natural 
delivery  impossible. 

This  treatment  is  based  on  the  relative  innocuousness  of  the  foetus  in 
the  uterus,  even  for  a  very  long  period,  so  long  as  the  liquor  amnii  has 
not  escaped  and  the  air  has  not  penetrated.  This  course  is  no  doubt 
most  judicious  in  some  cases,  and  is  followed  by  successful  results.  All 
that  has  to  be  done  is  to  keep  the  animal  very  quiet,  in  a  darkened  place 
if  possible,  and  to  administer  opium  or  chloral  in  full  doses,  both  in 
draught  and  enema  if  need  be. 

But  Saint-Cyr  is  of  opinion  that  in  the  majority  of  cases,  if  not  in  all,  it 
is  mor^  preferable  to  resort  to  active  measures.  The  expectant  method, 
he  says,  was  all  very  well  when  art  found  itself  disarmed  in  the  face  of 
certain  accidents,  such  as  torsion  of  the  cervix,  which  rendered  spontane- 
ous delivery  impossible  ;  but  it  cannot  be  urgently  insisted  upon  now, 
when  we  are  in  possession  of  methods  which  enable  us  to  overcome  these 
accidents.  Therefore  he  thinks  that,  as  a  rule,  it  is  the  duty  of  the  obstet- 
rist  to  terminate  as  soon  as  possible  the  act  of  parturition,  when  it  has 
once  cpmmenced.  In  compliance  with  this  advice,  the  veterinarian,  after 
informing  himself  as  to  the  nature  of  the  obstacle  opposed  to  delivery, 
should  act  according  to  the  rules  applicable  to  each  particular  case — 
rules  which  will  be  alluded  to  hereafter. 

When  the  membranes  are  ruptured,  then  delay  may  be  out  of  the 
question,  and  intervention  might  require  to  be  prompt^  if  serious  conse- 
quences are  to  be  averted.  Attempts  to  effect  speedy  delivery  should  be 
resorted  to  at  once,  in  the  majority  of  cases,  if  not  in  all.  Nevertheless, 
even  here  we  find  excellent  practitioners  recommending  abstention,  at  least 
for  some  hours,  according  to  circumstances.  For  instance,  Dupont,  of  Bor- 
deaux (Arc/lives  Veterinaires,  June,  1876),  a  good  authority,  does  not  at  all 
agree  with  the  generally  received  opinion  that  death  of  the  foetus  must 
necessarily  immediately  follow  rupture  of  the  membranes,  as  he  has 
met  with  many  cases  in  which  it  has  lived  for  a  long  interval — twenty- 
four  to  thirty-six  hours — after  the  escape  of  the  liquor  amnii ;  and  he 
does  not  hesitate  to  affirm  that  respiration  commences  with,  and  is  con- 
tinued after,  the  evacuation  of  this  fluid,  especially  if  the  young  creature 
is  in  a  natural  position — the  fore-limbs  and  nose  in  the  os.  He  will  not  say 
so  much  for  all  the  positions  of  the  foetus,  though  he  has  effected  delivery 


ACCIDENTS  OF  PREGNANCY.  197 

in  them  fifteen  to  twenty  hours  after  escape  of  the  liquor,  and  the  crea- 
ture has  respired  and  lived.  He  thinks  that  the  popular  opinion  is  due  to 
the  fact,  that  the  attention  of  the  obstetrist  is  solely  directed  to  preserving 
the  life  of  the  mother,  and  that  the  foetus  is  killed  through  the  violent 
compression  it  sustains  in  a  narrow  pelvis,  from  the  powerful  contractions 
of  the  uterus,  without  the  intervention  of  other  causes. 

When  some  time — days,  for  instance — has  elapsed  since  this  stage 
in  parturition  was  reached,  and  labor  has  completely  subsided,  the  case 
is  difficult,  and  it  will  again  depend  upon  circumstances  whether  expec- 
tant or  active  treatment  shall  be  adopted.  An  exploration  should 
certainly  be  made,  and  if  it  can  be  ascertained  that  the  membranes  are 
not  ruptured,  while  there  is  no  straining  and  the  condition  of  the  animal 
is  satisfactory,  then  it  will  be  advisable  to  wait  until  indications  of  labor 
are  once  more  manifested.  If  the  state  of  the  animal  is  not  so  favorable, 
and  delivery  is  decided  upon  ;  should  the  os  be  impermeable,  or  not 
sufficiently  dilated  to  allow  the  passage  of  the  foetus,  then  it  must  be 
opened  either  by  careful  manipulation,  uterine  douches,  the  uterine 
dilating  bag,  or  other  modes  which  will  be  alluded  to  when  treating  of 
dystokia. 

When  a  long  period  has  intervened,  and  the  general  and  local  disturb- 
ance in,  the  animal  necessitates  active  interference  on  the  part  of  the 
veterinary  obstetrist,  then  of  course  the  first  and  most  urgent  indication 
is  to  remove  the  cause — the  putrefying  foetus — from  the  uterus.  When 
the  OS  is  not  sufficiently  open  to  admit  the  hand  and  the  withdrawal  of 
the  foetus,  then  the  case  is  one  of  difficult  labor,  complicated  by  the 
death  of  the  foetus  and  its  state  of  decomposition.  If  the  os  should 
chance  to  be  contracted,  it  must  either  be  dilated  by  the  means  we  have 
named,  or  if  these  do  not  succeed  (though  they  often  do),  then  the  cervix 
must  be  incised.  In  very  exceptional  cases,  gastro-hysterotomy  has  to 
be  performed  if  the  foetus  or  its  remains  are  to  be  got  rid  of  ;  and  in 
some  instances,  owing  to  the  emphysematous  condition  of  the  foetus,  its 
shape  or  size,  or  the  deformity  of  the  genital  passages  of  the  mother, 
embryotomy  is  called  for. 

When  the  uterus  is  emptied  of  all  the  matters,  solid  and  fluid,  it  con- 
tains, it  may  be  thoroughly  cleansed  by  repeated  injections  or  washings 
with  tepid  water,  and  finally  with  some  anti-putrescent  fluid — weak  solu- 
tions of  chloral,  or  carbolic  or  salicylic  acids.  General  treatment  may 
also  be  necessary,  and  this  must  be  regulated  according  to  the  indications. 
In  all  the  manipulative  operations  subsequent  to  delivery,  it  will  generally 
be  found  that  care  and  patience,  and,  above  all  things,  an  absence  of 
undue  haste,  are  commendable,  and  particularly  with  regard  to  the 
removal  of  the  membranes,  especially  in  primiparae.  The  danger  of 
septic  infection  may  be  largely  averted  by  intravaginal  emollient  douches, 
and  serious  consequences  may  often  be  avoided  by  abstaining  from  pre- 
mature and  violent  interference. 

When  portions  of  the  foetus  are  expelled  through  fistulous  openings, 
even  then  surgical  interference  might  be  successfully  invoked. 

ABORTION. 

When  pregnancy  is  interrupted  by  the  expulsion  of  the  ovum,  or  of  the 
foetus  at  a  stage  when  this  has  not  attained  sufficient  development  to  live 
external  to  its  parent,  abortion  {partus  immaturiis)  is  said  to  occur.     But 


198  PATHOLOGY  OF  GESTATION, 

when  the  foetus  is  expelled  before  the  ordinary  period  for  parturition,  yet 
with  all  its  organs  sufficiently  perfected  to  enable  it  to  exist  for  at  least 
some  time  in  the  external  world,  this  is  designated //'^/^^////'^  birth  (^partus 
prcEinaturtis).  In  the  first  instance,  the  young  creature  is  either  dead  when 
expelled  from  the  uterus,  or  dies  immediately  afterwards  ;  and  in  the  second 
it  may  be  weakly  and  immature,  and  succumb  after  a  variable  period  ;  or 
it  may  continue  to  live  and  thrive.  In  practice,  there  is  no  accurately 
defined  limit  between  abortion  and  premature  birth,  and  especially  when 
the  latter  has  been  brought  about  by  some  of  the  causes  which  produce 
the  former. 

Abortion  may  be  said  to  take  place  in  solipeds,  when  the  foetus 
is  expelled  forty  days  before  the  normal  period  ;  in  the  bovine  species, 
thirty-five  days  ;  in  the  Sheep  and  Goat,  twenty  days  ;  in  the  Pig,  fifteen 
days  ;  and  with  the  Bitch  and  Cat,  seven  days.  Saint-Cyr  says  that  it 
may  be  acknowledged  that  abortion  has  taken  place,  when  the  foetus  is 
expelled  in  the  Mare  before  the  300th  day  of  gestation,  in  the  Cow  before 
the  200th,  in  the  Sheep  before  the  140th,  and  in  the  Pig  before  the  looth 
day. 

There  is  not  the  same  tendency  or  readiness  in  all  the  domesticated 
animals  to  abort.  The  Bitch  and  Cat  rarely  do  so,  even  after  serious 
injuries  ;  and  the  Pig  retains  its  foetuses  almost  as  tenaciously  \  but  the 
Sheep  and  Goat  are  rather  liable  to  this  accident.  The  Cow  and  Mare, 
but  more  especially  the  former,  most  frequently  lose  their  foetus.  In 
what  proportion  abortions  occur  is  not  ascertainable  from  any  document- 
ary evidence.  For  the  Cow,  Baumeister  and  Rueff  state  that  in  France, 
in  a  dairy  containing  Durham  Cows,  and  numbering  100  pregnancies, 
there  were  17  abortions  ;  and  at  Hohenheim,  from  a  register  kept  for 
thirty  years,  it  appears  that  one-fifth  of  the  Cows  aborted.  Among  5864 
Sheep  of  various  breeds  at  the  same  establishment,  there  were  only  26 
abortions,  or  o'433  per  cent. 

Abortion  may  occur  at  any  period  of  gestation  within  the  limits  above 
named,  though  it  is  much  more  frequent  during  the  first  than  the  second 
half  of  pregnancy,  and  especially  with  the  Mare.  When  this  accident 
occurs  at  a  very  early  stage,  it  may  produce  no  appreciable  disturbance 
of  health  in  the  female,  iind  the  ovum  escapes  intact,  and  often  unper- 
ceived.  The  accident  is  more  serious  when  it  happens  at  a  late  period  ; 
as  it  then  not  only  causes  the  loss  of  the  young  animal,  but  may  compro- 
mise the  existence  or  value  of  the  mother. 

Abortion  may  be  either  sporadic  or  eiizootic  or  epizootic.  When  cases 
occur  here  and  there  over  a  wide  extent  of  country,  without  any  relation- 
ship as  to  causation,  they  are  sporadic  or  accidental  abortions ;  and 
though  they  must  be  reckoned  as  losses,  yet  they  rarely  attract  much 
attention  from  the  damage  they  inflict,  and  because  of  their  isolated,  and 
by  no  means  unusual,  occurrence.  But  when,  on  the  contrary,  the 
pregnant  animals — say  Cows,  Ewes,  or  Mares — on  a  farm,  in  a  village,  or 
over  a  large  district  or  country,  miscarry  in  large  numbers,  and  the  mishap 
is  evidently  due  to  the  same  cause  or  causes,  then  it  is  indeed  a  grave 
misfortune,  as  it  entails  serious  damage — present  and  prospective — to  the 
interests  of  agriculture.  This  is  enzootic  or  epizootic  abortion  :  an  occur- 
rence far  from  uncommon,  and  the  etiology  of  which  has  attracted  the 
attention  of  the  most  distinguished  European  veterinarians  for  many 
years. 


ACCIDENTS  OF  PREGNANCY.  199 

Sporadic  Abortion. 

Causes. — The  causes  of  sporadic  abortion  are  very  numerous ;  they 
may  act  eitlier  directly  or  indirectly,  and  produce  their  effects  in  an  evi- 
dent or  an  obscure  manner.     They  may  be  ranged  as  extertial  ox  internal. 

I.  External  Causes. — Atmospherical  influences,  bad  weather,  or  irreg- 
ular seasons,  have  been  cited  as  causing  abortion.  There  can  be  no 
doubt  whatever  that  cold,  and  especially  when  suddenly  applied  to  the 
skin,  may  produce  this  result,  and  hence  it  is  that  the  abrupt  setting  in  of 
cold  weather  is  often  marked  by  miscarriages  among  animals  exposed  to 
it.  Many  observers  have  noted  that  the  continued  and  severe  cold  of 
winter  is  far  less  frequently  productive  of  abortions  than  when  one  cold 
wet,  or  frosty  night  in  autumn  succeeds  a  fine  warm  day.  Cold  rain  is 
sometimes  very  damaging  in  this  respect. 

With  regard  to  food  and  ingesta  in  general,  there  can  be  no  doubt  that 
here  we  often  have  an  undoubted  cause.  Food  of  bad  quality,  indiges- 
tible, or  containing  injurious  ingredients,  is  well  known  to  be  dangerous. 
After  unfavorable  seasons,  when  forage  has  not  been  well  dried  and 
made,  abortions  are  far  from  uncommon.  Indigestible  food,  or  that 
which  has  a  tendency  to  collect  or  ferment  in  the  stomach,  may,  by 
exerting  pressure  on  the  uterus,  produce  this  accident.*  On  the  other 
hand,  too  great  an  abundance  of  easily-digested  and  stimulating  food,  by 
inducing  plethora,  and  consequent  congestion  of  the  uterus  and  looseni-ng 
of  the  placentas,  has  been  set  down  as  another  cause.  Frozen  food  or 
water,  when  taken  in  immoderate  quantity,  and  especially  if  the  digestive 
organs  are  nearly  empty,  as  well  as  forage  or  herbage  covered  with  snow 
or  frost,  are  also  injurious  in  this  respect  to  all  the  larger  animals  when 
pregnant,  and  abortion  often  follows  immediately-t  Filthy  putrid  water 
has  also  very  frequently  a  pernicious  influ^ince  on  gestation.  Some  plants-— 
such  as  the  horse-tails  {Equisetacce),  sedges  {Cyperacece).,  etc. — and  the 
leaves  of  beet-root,  readily  induce  abortion,  according  to  several  autlior- 
ities.  Rue,  savin,  ergot  of  rye,  and  other  ecbolics  will,  of  course,  cause 
expulsion  of  the  foetus  more  or  less  readily  ;  and  toxical  substances,  such 
as  cantharides,  which  act  upon  the  uterus,  will  do  the  same.  Purgatives, 
especially  those  of  a  drastic  kind,  are  a  fertile  cause  ;  and  opium,  digitalis, 
and  some  other  drugs  have  to  be  administered  with  caution.  Food  or 
herbage  altered  by  the  presence  of  cryptogamic  vegetation,  has  long  been 

*  Delwart  hns  given  a  good  illustration  of  this.  '*  For  t\yenty  years  all  the  Cows  in  a  herd  of  thirty 
aborted  each  year,  and  if  by  chance  one  calf  reached  its  term,  it  was  so  puny  and  deformed  that  it  died  in  a 
few  days  after  birth.  The  cause  of  these  abortions  appeared  to  me  to  lie  in  the  too  large  quantity  of  grains 
and  balls  of  cereals  with  which  the  animals  were  fad  ;  the  rumen  and  second  compartment  of  the  stomach 
formed  a  compact  mass  which  weighed  on  the  foetus,  prevented  its  development,  and  ended  by  killing  it. 
These  Cows  were  put  under  our  care,  and  submitted  to  a  different  kind  of  alimentation  ;  roots  replaced 
the  innutritions  food  previously  given,  and  which  gave  rise  to  permanent  indigestion.  This  regime  was 
seconded  by  the  administration  of  a  decoction  of  linseed,  five  or  six  bucketfuls  \\\  the  day,  and  a  draught  of 
a  pound  of  sodium  sulphate  to  each  Cow.  .  .  .  Success  was  complete  ;  the  destructive  scourge  entirely 
disappeared,  and  twentj'-eight  healthy  calves  were  born  at  the  proper  time." 

t  Saint-Cyr  mentions  that  Gelle  has  witnessed  nearly  one-fifth  of  a  flock  of  Sheep  abort  immediately 
after  drinking  from  a  pond,  the  ice  on  which  had  to  be  broken  to  water  them.  Audoy  reports  an  exactly 
similar  occurrence  ;  and  Delorme,  who  has  also  observed  analogous  accidents,  adds  that  they  are  most 
likely  to  happen  when  the  Sheep  have  been  deprived  of  water  for  several  days.  Huvellier  mentions  a  rich 
grazier  of  Merlerault  who  owned  ten  brood  Mares,  one  half  of  which  aborted  every  year,  because  they 
were  sent  three  times  a  day  to  drink  cold  water.  Often,  after  quenching  their  thirst,  they  trembled,  were 
seized  with  colic,  and  aborted.  The  regime  was  changed  ;  the  Mares  received  water  at  morning  and  mid- 
day in  the  stable,  a  handful  of  bran  being  put  in  the  water  ;  and  only  in  the  evening  were  they  allowed  to 
be  watered  outside,  after  the  stable-doors  had  been  opened  for  an  hour.  The  abortions  ceased.  Flandrin 
relates  similar  accidents  occurring  to  the  Mares  belonging  to  the  Prince  of  Conde,  and  from  the  same 


2  oo  PA  THOL  OG  Y  OF  GESTA  TION. 

known  to  cause  abortion.  Ergotized  grasses  and  grains  have  often  pro- 
duced wide-spread  losses  from  this  accident.* 

Excessive  muscular  exertion  and  unusual  travelling,  and  especially  if 
there  is  a  predisposition  to  abortion,  is  very  likely  to  produce  it  ;  if  the 
exertion  is  sudden  and  severe,  or  even  moderate,  but  coming  after  a 
long  period  of  rest,  it  is  all  the  more  certain.  Contusions  to  the  abdo- 
men by  kicks  or  falls,  or  squeezing  through  a  narrow  doorway  or  passage, 
railway  or  steamboat  travelling,  blows  and  shocks,  keeping  the  animals 
in  stalls  with  very  inclined  floors,  are  all  so  many  causes.  A  case  came 
under  my  observation  recently,  of  a  little  Bitch,  extremely  fat,  which 
aborted  at  a  late  period  of  gestation,  through  frequently  ascending  and 
descending  a  steep  staircase. 

Access  of  the  male  not  unfrequently  produces  a  miscarriage  ;  and 
exploration  per  vagtJiam  by  the  expert,  has  also  been  blamed,  as  well  as 
surgical  operations  performed  on  pregnant  animals — bleeding,  for  in- 
stance, or  throwing  an  animal  down  to  be  operated  upon.f 

Carrying  a  rider,  in  the  case  of  the  Mare,  and  especially  if  spurs  are 
used,  is  attended  with  much  risk. 

Excitement,  fear,t  sudden  surprise,  or  anger,  are  also  causes.  Heavy 
thunder  has  sometimes  been  serious  in  this  way  ;  and  the  fear  produced 
by  Dogs  leads  sometimes  to  heavy  losses  among  Sheep — foxhounds  run- 
ning near  or  among  pregnant  Cattle  or  Sheep  often  cause  considerable 
damage,  especially  among  nervous  animals. 

Certain  odors  are  said  to  cause  abortion,  and  contagion  is  supposed  to 
play  an  active  part. 

2.  Internal  Causes. — Badly-fed  and  neglected  animals  sometimes  mis- 
carry, but  not  nearly  so  frequently,  perhaps,  as  those  in  the  opposite  con- 
dition and  extremely  fat.  It  is  generally  admitted  that  with  some 
animals  there  is  a  special  predisposition  to  abort,  and  that  a  very  trifling 
cause,  and  sometimes  no  appreciable  cause  at  all,  will  induce  this  acci- 
dent ;  while  other  animals  never  lose  their  foetus,  though  exposed  to  the 
influence  of  apparently  most  powerful  causes.  This  predisposition  is  not 
manifest  externally,  and  sometimes  it  disappears  as  age  advances. 

A  more  constant  and  potent  cause,  however,  is  to  be  found  in  the 
presence  of  grave  diseases,  and  especially  those  which  aifect  the  system 
generally,  producing  more  or  less  derangement  of  all  the  functions.  The 
various  serious  epizootic  maladies,  enteritis,  and  all  those  abdominal 
disorders  which  give  rise  to  restlessness,  tympanitis,  cough,  and  those 
diseases  which  induce  cough — as  bronchitis,  pneumonia,  asthma,  etc. — 
pleurisy  and  other  affections  and  injuries  accompanied  by  great  pain  ; 

*  The  Veterinary  Journal  (vol.  i.,  p.  422)  alludes  to  an  occurrence  of  this  kind  in  New  Zealand  in  1875 
It  appears  that  this  accident  was  comparatively  rare  in  that  colony  until  the  introduction  of  rye-grass  on  the 
pastures,  after  which  it  was  common,  and  a  cause  of  great  loss  when  the  rye  became  ergotized.  The  same 
journal  (vol.  ii-,  p.  5;)  contains  an  account  of  serious  abortions  among  Mares  in  Germany,  due  to  rust 
{Trichobasis  riibigo)  ov\.  the  straw  on  which  they  were  fed.  In  Animal  Plag'ues  (London,  1871)  many 
interesting  notices  are  given  of  similar  occurrences. 

Haselbach  reports  that  in  a  cow-shed  where  maize  infested  with  its  parasitic  iungxis  (l/slilaj^o  mdidis) 
was  given  to  the  cattle,  eleven  aborted  within  eight  days.  The  food  was  changed  at  once,  and  the  other 
Cows  escaped  the  accident.  A  certain  quantity  was  administered  to  two  pregnant  Bitches,  and  they  both 
expelled  their  young. 

t  Professor  Bouley  performed  the  operation  of  castration  on  three  pregnant  Cows  ;  they  aborted  in  two 
days  after,  and  one  died.  Nevertheless,  Chanel  has  seen  a  castrator  operate  on  a  Sow  about  two  months 
pregnant.  Three  foetuses,  the  size  of  the  middle  finger,  were  removed  with  the  portion  of  cornu  in  which 
they  were  contained.  The  poor  beast  lost  much  blood,  and  was  very  ill  for  six  or  seven  days  ;  yet  in  more 
than  two  months  afterwards  it  brought  forth  five  young  pigs,  which  it  suckled. 

J  The  Cat  rarely  aborts,  and  instances  are  on  record  in  which  they  have  fallen  from  a  considerable  height 
without  this  accident  occurring.  Nevertheless,  they  are  liable  to  miscarry,  and  a  friend  who  lives  near 
Chatham  had  a  favorite  Cat  heavy  in  kitten,  that  aborted  immediately  after  being  pursued  by  a  strange 
Dog,  which,  however,  did  not  seiie  it.    The  accident  in  this  case  was  evidently  due  to  fear. 


ACCIDENTS  OF  PREGNANCY.  201 

as  well  as  nervous  or  convulsive  derangements — such  as  tetanus,  epilepsy, 
vertigo,  etc.,  are  all  set  down  as  causes.  Disease  of  the  uterus  will,  of 
course,  be  very  likely  to  lead  to  the  premature  expulsion  of  the  ovum  or 
foetus.  Metritis,  abnormal  conditions  of  its  mucous  membrane,  as  well 
as  new  formations — such  as  fibroid  and  carcinoma,  and  other  alterations 
by  which  the  enlargement  of  the  organ  is  hindered — as  enormous  tumors 
in  the  abdomen,  ovarian  dropsy,  etc. — will  predispose  to  or  excite  abor- 
tion, as  will  also  every  condition  which  leads  to  hyperaemia  of  the  viscus. 

Abortion  has  not  unfrequently  been  ascribed  to  some  defector  other 
influence  in  the  male,  though  in  what  these  consist  has  not  been  ex- 
plicitly stated  ;  unless  they  are  to  be  found  in  the  debility  arising  from 
too  frequent  usage,  or  other  causes  related  to  the  animal's  state  of  health. 
There  is  strong  and  abundant  evidence  that  a  male  enfeebled  by  too 
much  use,  is  very  likely  to  be  a  cause  of  abortion  in  the  females  to  which 
he  has  been  put.  This  accident  has  also  been  said  to  occur  frequently 
when  the  male  was  larger  and  more  powerful  than  the  female.  Various 
injuries  and  diseases  of  the  foetus  or  its  envelopes,  may  lead  to  the  same 
result.  External  violence  may  not  only  injure  the  uterus  itself,  so  as  to 
produce  abortion,  but  the  foetus  even  may  sustain  damage.  Cauvet,  cited 
by  Saint-Cyr,  has  remarked  in  a  case  of  miscarriage  in  a  Mare  brought 
about  by  kicks  on  the  abdomen,  that  the  foetal  membranes  exhibited 
at  the  corresponding  point  an  enormous  ecchymosis,  and  behind  the 
shoulder  of  the  foetus,  which  was  in  relation  to  this  extravasation,  was  a 
large  brown-colored  exudation.  Another  observer  has  witnessed  an  ad- 
hesion between  the  skin  on  the  cranium  of  a  foetus  and  the  foetal  mem- 
branes, as  well  as  depression  of  the  cranial  bones — all  evidently  due  to 
external  violence. 

In  acute  febrile  diseases  of  the  mother,  the  foetus  may  perish  from  the 
abnormal  accumulation  of  heat ;  or  chronic  or  acute  anaemia  in  the  female 
may  prove  fatal  to  the  foetus,  by  causing  asphyxia  in  it. 

Certain  virulent  disorders  affecting  the  female  may  likewise  cause  the 
death  and  expulsion  of  the  young  creature  iti  utero.  The  foetus  of  a  Cow 
affected  with  contagious  pleuro-pneumonia,  has  been  found  with  its  lungs 
affected  in  a  similar  manner ;  *  and  to  prove  that  the  transmission  of 
these  diseases  can  be  effected  in  this  way.  Sheep  which  were  in  the 
uterus  when  their  dam  was  affected  with  variola  (sheep-pox)  were  found 
to  resist  inoculation  with  the  virus  of  that  very  malignant  malady. 
Hydrocephalus,  ascitis,  anasarca,  and  chlorosis,  may  also  lead  to  the 
death  of  the  foetus,  which  in  nearly  every  case  is  not  only  the  most  fre- 
quent predisposing  cause  of  abortion,  but  is  almost  a  certain  determining 
cause  of  its  expulsion.  Hydramnios,  and  other  morbid  conditions  of 
the  foetal  membranes,  or  faulty  formation  or  relations  between  the 
placenta?,  are  other  causes  ;  as  well  as  congenital  malformations  of  the 
foetus,  malposition,  or  exaggerated  volume.  The  presence  of  several 
foetuses  often  leads  to  abortion  in  uniparous  animals. 

Symptoms. — The  symptomatology  of  abortion  is  extremely  varied; 
being  in  some  cases  so  trifling  that,  as  already  said,  the  accident  may  be 
unperceived,  so  far  as  the  female  is  concerned  \  while  in  others  the  sym- 

*  Barrier  describes  an  abortion  epizobty  among  Cows,  in  which  nearly  all  the  calves  were  expelled  alive 
at  the  fifth  to  the  seventh  month,  but  died  within  eight  days  afterwards.  The  principal  symptoms  were  a 
more  or  less  loud  rale,  the  discharge  of  rusty-colored  mucus  from  the  nostrils,  and  constant  loud  bellow- 
ings.  At  the  autopsies  the  "  lungs  were  tumefied,  red,  and  fleshy,  and  the  brgnchia  filled  with  the  saffron- 
tinted  fluid  that  flowed  from  the  nostrils." 


202  PA  THOLOG  Y  OF  GESTA  TION. 

toms  indicate  a  very  serious  condition.  This  usually  depends  on  the 
period  of  gestation  at  which  the  accident  occurs. 

Generally,  abortion  takes  place  without  any  premonitory  indications, 
and  the  animal  may  be  as  well  and  lively  as  usual  up  to  the  moment  when 
the  foetus  is  expelled  ;  and  the  expulsion  itself  is  so  sudden,  so  prompt, 
and  accomplished  with  so  little  visible  effort  or  disturbance,  that*  the  acci- 
dent in  most  cases  receives  very  little,  if  any  notice.  It  often  occurs 
during  the  night,  and  wonder  is  often  expressed  at  finding  in  the  morning 
the  aborted  foetus,  generally  contained  in  its  intact  envelopes,  lying  behind 
an  animal  which,  on  the  previous  evening,  looked  perfectly  well,  and  even 
now  is  so  cheerful  and  unaltered,  and  its  functions  so  unimpaired,  that  it 
can  scarcely  be  believed  that  it  has  been  the  subject  of  such  a  mishap. 
Even  the  sentiment  of  maternity,  which  is  so  strongly  developed  in  ani- 
mals, as  Saint-Cyr  justly  remarks,  is  not  awakened  in  favot  of  the  expelled 
foetus,  and  the  mother  shows  the  utmost  indifference  to  it,  even  treading 
on  it  as  if  it  were  in  no  way  related  to  her. 

When  this  simple  abortion  has  taken  place  during  the  day,  it  has  been 
noted  that  the  flanks  fall  in  a  little,  the  abdomen  descends,  the  vulva  and 
vagina  slightly  dilate,  and  there  escapes  from  them  a  glutinous,  sometimes 
sanguinolent,  fluid,  with  which  the  foetus  is  passed  almost  without  effort. 
We  have  said  that  the  ovum  or  foetus  is  generally  expelled  in  its  intact 
membranes  ;  this  more  frequently  happens  at  an  early  stage  of  pregnancy. 
Sometimes,  however,  the  amnion  ruptures  at  the  commencement  of  the 
abortion,  and  the  embryo  or  foetus  escapes  with  a  small  quantity  of  liquor 
amnii,  the  envelopes  being  rejected  soon  after,  or  in  some  instances  they 
may  be  retained  in  the  uterus,  and  thus  constitute  a  source  of  danger,  the 
animal  not  making  any  effort  to  get  rid  of  them.  This  complicated  abor- 
tion occurs  more  frequently  at  the  later  stages  of  pregnancy,  and  more 
resembles  normal  birth  than  j-/w//(?  abortion,  which  is  more  often  witnessed 
in  the  first  half  of  gestation.  Nevertheless,  we  have  the  latter  happen  so 
late  sometimes  as  the  seventh  or  eighth  month  in  the  larger  animals.  It 
is  observed  more  particularly  in  those  which  are  debilitated  from  any 
cause  ;  but,  at  the  same  time,  animals  which  appear  in  the  very  best 
health  are  often  the  victims  of  simple  abortion. 

So  little  disturbance  does  this  kind  of  abortion  cause,  that  the  animal 
can  be  treated  in  every  way  as  if  nothing  had  happened  ;  though  it  is 
more  judicious  to  give  it  a  little  extra  care  for  some  hours  at  least. 

In  what  has  been  termed  laborious,  difficult,  or  complicated  abortion, 
which  is  often  due  to  external  causes,  such  as  injuries,  the  precursory 
symptoms  are  generally  well  marked,  and  vary  somewhat  according  as 
the  foetus  may  be  dead  or  alive.  The  animal  suddenly  appears  dull  and 
peculiarly  dejected  \  or  it  is  restless,  uneasy,  and  continually  moving 
about ;  if  pregnancy  is  advanced  and  the  foetus  is  alive  and  strong,  its 
movements  are,  on  watching  the  abdomen  attentively,  perceived  to  be 
frequent,  violent,  and  disordered,  but  they  soon  become  feeble  and  un- 
frequent,  and  cease  altogether  when  the  foetus  has  succumbed.  The 
appetite  is  lost,  a  plaintive  neigh  in  the  Mare,  moan  in  the  Cow,  or  bleat 
in  the  Sheep,  is  emitted  every  now  and  again  ;  the  pulse  is  quick,  small, 
and  hard  as  in  haemorrhage  ;  progression  is  difficult  and  unsteady  ;  the 
physiognomy  is  anxious,  and  respiration  hurried.  When  the  foetus  is 
alive  there  is  perhaps  less  prostration  ;  and,  more  particularly  with  the 
Mare,  there  appears  to  be  much  abdominal  pain.  The  animal  often  looks 
anxiously  towards  the  flanks,  paws  with  its  fore  feet  and  stamps  with  its 


ACCIDENTS  OF  PREGNANCY.  ^  203 

hind  ones,  moves  from  side  to  side,  perspires  at  the  flank,  breast,  and 
elsewhere,  lies  down  and  gets  up  again,  whisks  the  tail  incessantly,  and 
exhibits  every  indication  of  increasing  restlessness.  At  the  ^ame  time 
the  abdomen  loses  its  round  shape,  and  drops  ;  if  the  animal  is  in  milk, 
the  mammae  become  soft  and  diminish  in  size  more  or  less  rapidly,  while 
the  secretion  diminishes  ;  but  if  it  is  not  yielding  milk,  then,  on  the  con- 
trary, they  enlarge  and  become  turgid  -,  the  vulva  is  tumefied,  and  from  it 
escapes  a  tenacious  mucus,  serous,  or  sero-sanguinolent,  and,  if  the  foetus 
is  dead,  more  or  less  foetid  fluid,  according  to  circumstances.  Then 
follow  symptoms  analogous  to  those  which  characterize  normal  parturition : 
the  uterus  begins  to  contract,  and  the  expiratory  muscles  act  simultane- 
ously with  it  \  the  expulsive  efforts,  or  "  labor  pains,"  acting  more  or 
less  energetically  and  continuously,  according  to  the  suddenness  of  the 
abortion  and  the  strength  and  health  of  the  animal.  The  first  result  of 
this  straining  is  the  evacuation  of  the  bladder  and  rectum  ;  the  next  is 
the  dilatation  of  the  os  uteri  and  protrusion  of  the  membranes  into  the 
vagina,  then  through  the  vulva,  where  they  appear  externally  as  the 
"  wateT-bag  ;"  this  may  rupture  and  the  liquor  amnii  escape,  and  the  pains 
becoming  more  powerful,  the  foetus  is  at  last  expelled  either  nude  or 
covered  by  the  membranes.  This  act  occupies  a  variable  period — from 
a  few  to  many  hours,  according  to  the  strength  of  the  animal  ;  and  it  may 
even  require  human  intervention  to  bring  it  to  a  successful  termination. 
In  other  instances,  however,  the  foetus  is  not  expelled  immediately  after 
it  is  dead,  but  after  many  of  the  premonitory  symptoms  just  described 
have  been  manifested  j  with  the  cessation  of  the  movements  in  the  foetus 
the  animal  regains  its  ordinary  tranquillity,  appetite,  and  liveliness,  and 
all  the  symptoms  disappear  for  one  or  more  days,  when  they  again  set  in, 
and  the  foetus  may  be  rejected  without  any  apparent  effort,  or  after  much 
straining. 

And  in  some  cases  of  what  might  be  termed  "  violent "  or  *'  acute 
abortion,"  when  it  suddenly  sets  in,  and  nothing  being  prepared  for  its 
being  carried  to  a  successful  termination,  neither  on  the  part  of  the  foetus 
nor  of  the  mother,  the  latter  is  exhausted  hy  ineffectual  efforts,  and  soon 
passes  into  a  critical  condition. 

Abortion  differs  from  normal  parturition  chiefly  in  the  state  of  the 
cervix  uteri.  Towards  the  termination  of  pregnancy,  this  part  of  the. 
uterus  becomes  gradually  shortened  and  softer  ;  but  in  abortion  we  do  not 
have  these  progressive  changes  which  are  so  favorable  to  the  passage  of 
the  foetus  from  the  uterine  cavity  outwards  ;  the  cervix  is  long  and  rigid 
as  in  the  non-pregnant  condition,  and  its  dilatation  is  therefore  slower, 
more  difficult,  and  more  incomplete  than  when  gestation  has  reached  its 
termination  \  and  especially  as  the  muscular  fibres  of  the  uterus  have  not 
acquired  either  their  full  development  or  contractile  force.  To  counter- 
balance this,  there  is  the  small  size  of  the  foetus,  which  does  not  require 
so  much  space  for  its  passage  as  if  it  were  full  grown;  so  that  the  diffi- 
culty in  removing  it  is  less  on  this  account,  though  the  other  difficulties 
the  obstetrist  has  so  often  to  encounter  in  parturition  may  all  be  present. 

Results. — Abortion  is  always  a  serious  accident,  if  only  from  the  loss 
of  the  foetus.  It  is  frequently  complicated  by  haemorrhage,  which  may 
primarily  have  been  the  cause  of  uterine  action  3  it  may  also  result  in 
rupture  of  the  organ,  from  the  efforts  the  animal  makes  to  overcome  the 
resistance  offered  by  the  cervix  \  indeed,  we  may  have  the  usual  compli- 


2  04  PA  THOL OG  Y  OF  GESTA  TION. 

cations  that  attend  parturition.  But  in  many  cases  the  complications  are 
few  and  trifling,  the  animals  scarcely  experiencing  any  inconvenience,  and 
retaining  ^^11  their  useful  qualities  unimpaired.  When  the  accident  occurs 
in  the  Cow  at  an  early  period — before  the  fifth  month — the  secretion  of 
milk  is  generally  interrupted,  often  for  a  year,  as  the  mammas  have  not 
had  time  to  experience  the  reflex  or  sympathetic  influence  which  stimu- 
lates them  into  activity  ;  when,  however,  it  takes  place  in  the  last  half  of 
.pregnancy  the  secretion  may  be  established,  though  the  yield  is  usually 
diminished,  and  the  glands  do  not  furnish  their  ordinary  quantity  until 
the  next  pregnancy. 

Abortion  may  produce  prolapsus  of  the  uterus  and  vagina,  and  some- 
times even  of  the  rectum.  At  an  early  period  of  gestation,  as  we  have 
mentioned,  when  the  foetal  and  uterine  attachments  are  not  very  close,  the 
ovum  or  foetus  may  be  expelled  with  the  whole  of  the  membranes  ;  but  as 
the  process  has  advanced,  this  result  is  less  probable,  and  particularly 
with  the  Cow.  The  membranes  are  frequently  retained,  wholly  or  par- 
tially, when  the  foetus  comes  away  ;  and  owing  to  the  condition  of  the 
cervix  and  its  rapid  contraction,  they  are  included  in  the  uterine  cavity 
and  constitute  what  is  termed  *'  retention  of  the  placenta  :  "  often  a  serious 
complication  of  abortion  in  the  Cow  after  the  first  third  of  pregnancy,  the 
membranes  decomposing  and  giving  rise  to  putrid  infection  and  other 
alarming  pathological  conditions. 

In  the  simplest  cases,  oestrum  appears  in  the  Cow  in  from  one  to  two 
weeks  after  the  miscarriage,  as  after  parturition,  and  conception  may  occur 
then  ;  but  not  unfrequently  impregnation  does  not  take  place  until  after 
several  returns  of  this  condition,  and  often  a  whole  year  elapses.  In 
other  instances,  oestrum  does  not  appear  until  the  full  interval  of  regular 
pregnancy  has  elapsed,  and  then  the  animal  conceives  almost  as  readily 
as  before  the  mishap.  Another  very  common  result  is  a  more  marked 
disturbance  in  the  generative  functions,  in  which  there  is  a  tendency  to 
abortion  after  every  conception  ;  and  with  other  animals  there  remains 
an  excitability  of  the  generative  organs,  which  is  manifested  by  an  almost 
persistent  state  of  oestrum,  giving  rise  to  nymphomania,  and  accompanied 
by  sterility. 

Pathological  Anatomy. — The  lesions  occasioned  by  abortion  are 
varied,  according  to  circumstances.  In  the  majority  of  cases,  and  espe- 
cially when  pregnancy  has  been  well  advanced,  the  maternal  organs  are  in 
a  similar  condition  to  that  observed  after  normal  parturition.  The  os  is 
dilated  or  closed,  but  in  general  the  cervix  is  a  little  softer  than  in  the 
unimpregnated  state.  The  uterus  is  more  or  less  contracted  on  itself  and 
looks  congested,  its  vessels  being  voluminous,  varicose,  and  filled  with 
blood  ;  its  cavity  contains  a  certain  quantity  of  blood-colored  mucus, 
and  often  all  the  characteristic  indications  of  placental  retention  and 
decomposition  ;  its  mucous  membrane  is  red  and  thickened,  and  there 
may  be  traces  of  inflammation  in  it  and  the  cotyledons,  as  well  as  evidence 
of  the  cause  which  profluced  the  accident,  if  due  to  injury. 

The  appearance  of  the, foetus  varies  also,  according  to  the  period  at 
which  it  is  expelled,  the  cause  or  causes  which  led  to  its  expulsion  or 
death,  as  well  as  the  period  of  its  decease.  At  page  107  we  have  enu- 
merated every  thing  known  that  is  likely  to  lead  to  a  knowledge  of  its  age. 
Whether  it  is  expelled  or  is  found  in  the  uterus  on  examining  the  carcase 
of  an  animal  that  has  died  or  been  destroyed,  the  body  of  the  foetus  may 


ACCIDENTS  OF  PREGNANCY.  205 

be  in  a  more  or  less  perfect  state  of  preservation.  If  it  has  perished  re- 
centl}'-,  it  is  little  if  at  all  altered  ;  its  skin  is  firm,  white,  elastic,  and  even  ; 
and  its  flesh  white,  rather  firm,  and  odorless.  But  when  death  has  taken 
place  some  days  previously,  and  the  air  has  had  access  to  the  uterine  cav- 
ity, then  there  are  indications  of  putrefaction — all  the  more  marked  as 
the  interval  is  prolonged  since  death  occurred.  The  foetus  is  swollen  and 
emphysematous,  and  exhales  a  putrescent  odor,  while. the  hairs,  and  even 
the  hoofs,  are  easily  removed.  When  the  air  has  not  entered  the' uterus, 
the  foetus  may  present  a  withered,  wrinkled,  mummified  appearance. 

Saint-Cyr  draws  attention  to  a  fact  which  we  have  already  alluded  to  on 
several  occasions,  but  which  is  worth  alluding  to  again.  It  is  that,  as  a 
general  rule,  the  death  of  a  foetus  brings  about  its  expulsion  in  a  short 
time  ;  and  not  its  own  expulsion  alone,  but  also,  in  multiparous  animals,  that 
of  all  the  uterus  may  contain.  This  rule,  however,  is  far  from  being  absolute. 
We  have  already  seen  that  a  dead  fcetus  may  be  retained  for  a  very  long 
time  ;  and  at  the  autopsy  of  such  multiparous  creatures  as  the  Bitch,  Cat, 
and  Sow,  which  have  died  or  been  killed  while  pregnant,  it  is  not  rare  to 
find,  between  two  perfectly  healthy  and  well-developed  foetuses,  one  which 
had  been  arrested  in  its  growth,  and  has  evidently  been  dead  for  a  long 
time,  and  yet  its  presence  has  occasioned  no  disturbance.  Besides, 
Bitches  and  Sows,  and  even  the  uniparous  Mare  and  Cow,  at  the  usual 
period  of  parturition  will  bring  forth,  along  with  well-developed  and  living 
young,  one  or  more  dead  foetuses  whose  general  appearance  testifies  that 
they  have  ceased  to  live  for  a  long  time.  These  facts  prove  that  the 
diseased  condition,  or  even  the  death,  of  one  or  more  of  the  foetuses  in  an 
animal  does  not  always  prevent  gestation  from  following  its  regular  course. 

Diagnosis. — The  diagnosis  of  abortion,  easy  in  some  cases,  is  in  others 
difficult  and  complicated  ;  and  as  an  error  in  distinguishing  this  accident 
may  result  in  serious  consequences  to  the  veterinary  obstetrist,  no  less 
than  to  the  animals  confided  to  his  care,  as  Saint-Cyr  properly  remarks, 
it  is  well  that  it  should  receive  attention.  This  excellent  authority  judi- 
ciously presents  the  problem  in  three  different  aspects  :  i.  Prognosticate 
a  possible,  but  not  yet  imminent  abortion  ;  2.  Distinguish  an  abortion 
taking  place  from  other  accidents  or  diseases  with  which  it  might  be  con- 
founded ;  3.   Recognize  that  an  abortion  has  taken  place. 

I.  Prognosticate  an  Abortion. — Suppose  the  owner  of  a  pregnant  animal 
asks  such  a  question  as,  *'  Will  this  creature  carry  its  young  the  full  time  V 
this  must  be  answered  by  another  question,  "  What  leads  you  to  think  it 
will  not  ?"  For  there  can  be  no  doubt  that,  as  has  been  already  asserted, 
there  is  a  special  predisposition  in  certain  animals  to  abort  from  the  most 
trifling  cause,  and  indeed  without  any  evident  cause  at  all  ;  and  yet  they 
offer  no  visible  indication  of  this  tendency.  In  this  aspect  of  the  ques- 
tion, it  is  always  judicious  to  remember  certain  maxims,  the  most  important 
of  which  is  that  relating  to  several  previous  miscarriages,  before  giving  an 
opinion  as  to  the  probability  of  such  an  accident ;  and  this  opinion  should 
be  based  on  exact  knowledge  of  the  cause  capable  of  compromising  the 
issue  of  pregnancy  to  which  the  animal  has  4Deen  or  is  then  exposed. 
The  inquiry  should  be  as  complete  as  possible,  and  then  an  opinion  ought 
to  be  carefully  given  ;  as  many  of  the  causes  of  abortion  are  so  very  imper- 
fectly known,  and  so  many  circumstances  may  modify  the  predicted 
result,  that  in  the  majority  of  cases  it  is  only  permissible  to  hazard  pre- 
sumptions which,  after  all,  are  more  or  less  uncertain. 


2  o6  PA  THOL  OG  Y  OF  GESTA  TION. 

2.  Recognize  an  Actual  Abortioti. — Here  we  have  to  distinguish  an 
abortion  in  process  of  accomplishment;  and  at  first  sight  nothing  would 
appear  more  easy,  and,  in  fact,  nothing  is  so  easy  if  time  be  allowed  until 
all  the  characteristic  symptoms  attending  the  expulsion  of  the  foetus  are 
plainly  developed.  Biit  when  the  obstetrist  is  consulted  at  the  com- 
mencement— during  the  premonitory  period,  it  may  be  very  embarrassing 
to  give  a  decided  opinion.  In  many  cases,  indeed,  impending  abortion 
is  only  announced — even  for  some  days — by  such  vague  signs  as  an 
indefinable  malaise^  a  peculiar  dulness,  inappetence,  laziness,  perhaps  a 
little  fever,  with  pawing  now  and  again,  agitation  of  the  tail,  and  symp- 
toms which  might  be  taken  for  those  of  slight  colic.  Saint-Cyr  has 
known  many  good  practitioners  deceived  by  these  signs,  and  who  have 
diagnosed  either  indigestion,  gastro-enteritis,  or  some  other  malady  which 
disappeared — after  the  expulsion  of  the  foetus !  Such  a  mistake  is 
unfortunate  for  the  reputation  of  the  veterinarian,  as  well  as  for  the  owner 
of  the  animal,  whose  interests  suffer;  as  if  a  miscarriage  had  been  diag- 
nosed in  proper  time  it  might  have  been  prevented,  and  pregnancy 
allowed  to  run  its  normal  course. 

To  prevent  such  an  error,  it  is  well  to  know  that  a  mistake  is  possible ; 
so  that  if  called  in  to  attend  an  animal  offering  some  of  the  above- 
enumerated  symptoms,  the  first  inquiry  should  be  as  to  whether  it  is 
pregnant ;  then  the  external  organs  of  generation — the  vulva  and 
mammae — ought  to  be  examined  with  the  greatest  care,  and  the  actual 
symptoms  thoughtfully  analyzed.  This  being  done,  it  will  often  be  found 
that  this  is  a  case  of  threatened  abortion  ;  and  that,  when  taken  in  time, 
the  accident  can  be  averted  by  rational  treatment. 

3.  Recognize  that  an  Abortion  has  taken  place. — It  may  happen  that 
information  is  required  as  to  whether  abortion  has  occurred  in  an  animal ; 
though  this  information  is  far  less  likely  to  be  sought  from  the  veterina- 
rian than  the  human  obstetrist.  In  the  absence  of  the  foetus  or  its  envel- 
opes, such  a  question  is  not  easily  answered  with  regard  to  animals  ;  and 
the  difficulty  is  increased  if  the  foetus  is  developed,  and  a  long  interval 
has  elapsed  since  the  presumed  date  of  the  suspected  abortion.  Saint- 
Cyr  is  of  opinion  that,  as  a  rule,  it  is  impossible  after  fifteen  days  to 
assert  with  absolute  certainty  that  such  an  accident  has  occurred,  the 
generative  organs  having  at  that  date  resumed  their  ordinary  physiologi- 
cal condition.  For  it  is  only  by  an  early  inspection  of  these  that  we  can 
enlighten  ourselves  as  to  what  may  have  taken  place.  In  this  inspection 
is  included  that  of  the  mammce  ,  which  are  always  a  little  tumid,  hard, 
and  painful,  and  often  yield  a  small  quantity  of  milk  after  a  recent 
abortion  ;  the  tail,  the  hair  of  which  is  soiled  and  matted  by  blood, 
mucus,  and  the  liquor  amnii ;  the  vulva,  which  is  swollen  and  dilated,  and 
the  mucous  membrane  of  which  often  presents,  in  addition  to  its  uniform 
and  more  or  less  deep-red  color,  ecchymoses  due  to  the  rubbing  or 
bruising  it  experiences  during  the  passage  of  the  foetus.  On  careful 
vaginal  exploration,  if  the  cervix  is  found  to  be  softer  than  usual  and  the 
OS  partially  open,  and,  better  still,  if  the  hand  can  be  introduced  without 
much  difficulty  into  the  uterine  cavity,  and  a  quantity  of  sanguinolent  or 
sanious  fluid,  or  remains  of  membranes  is  discovered  in  it,  it  may  be 
concluded  that  a  foetus  has  been  recently  expelled. 

Treatment. — The  treatment  is  preventive  ?ix\d  remedial.  With  regard 
to  preventive  treatment,  this  must  mainly  depend  upon  a  knowledge  of 
the  causes  which  produce  abortion — which  we  have  seen  are  numerous, 


A  CCIDENTS  OF  PREGNA NCY.  207 

and.  care  in  avoiding  or  modifying  these.  This  pertains  to  the  chapter 
on  the  hygiene  of  pregnancy  (p.  153).  With  regard  to  animals  wiiich 
have  a  predisposition  to  abortion  they  should  not,  if  possible,  be  bred 
from.  Should  it  be  desired  to  breed  from  them,  if  they  arebovines,  they 
must  not  be  put  frequently  to  the  male,  and  certainly  not  before  eighteen 
months  or  two  years  have  elapsed  since  the  last  miscarriage.  If  the 
accident  has  been  due  to  irritation  of  the  generative  organs,  then  these 
should  receive  appropriate  treatment.  When  pregnancy  has  again  oc- 
curred, every  precaution  should  be  observed  to  continue  it  to  a  success- 
ful termination,  by  avoiding  or  removing  those  causes  which  previously 
induced  the  accident,  and  attending  to  the  general  health — combating  ple- 
thora on  the  one  hand,  or  anaemia  on  the  other  ;  guarding  against  constipa- 
tion by  administering  mild  laxatives,  and  against  irritation,  whether 
general  or  uterine,  by  doses  of  chloral  of  opium  given  by  mouth  or  by 
rectum  ;  and  allowing  only  gentle  exercise  towards  the  end  of  gestation. 

Wlien  abortion  appears  to  be  imminent,  active  intervention  generally 
becomes  necessary  in  order  to  avert  it ;  and  therefore  it  must  be  accu- 
rately diagnosed.  We  have  already  alluded  to  the  symptoms  and  means 
by  which  this  accident  may  be  distinguished.  If  the  veterinarian  is 
fortunately  called  upon  in  good  time,  and  he  is  able  to  assure  himself 
that  the  foetus  is  still  alive,  that  the  membranes  are  not  ruptured,  and 
labor  pains  have  been  few  and  not  severe,  the  accident  may  be  checked 
or  prevented  by  the  administration  of  narcotics,  and  keeping  the  animal 
in  the  most  perfect  quiet  possible  —  alone  in  a  darkened  place,  with 
doors  and  windows  closed,  if  convenient.  The  narcotic  may  be  opium 
(in  the  form  of  tincture  if  desirable),  chloral  hydrate,  or  chloroform. 
Saint-Cyr  recommends  laudanum  (one  or  two  and  a  half  drachms  for 
large  animals)  administered  every  half-hour  or  hour,  in  very  small 
enemata  (not  more  than  a  wineglassful  at  once),  which  he  thinks 
preferable  to  draughts,  but  which  may,  nevertheless,  be  employed 
concurrently.  Zundel  prefers  chloroform,  which,  he  asserts,  has  yielded 
extraordinary  results  in  his  hands  in  these  cases,  by  suddenly  arresting 
the  straining.  He  gives  it  in  doses  of  about  three  drachms  to  the  Cow, 
in  the  form  of  draught  in  oil  or  mucilage,  repeating  them  every  hour. 
Carsten  Harms  recommends  camphor,  or  camphor  and  opium,  and  Rueff 
assafoetida. 

The  abdomen  should  be  gently  rubbed  for  some  time,  and  the  stall 
well  littered  ;  and  if  the  animal  will  eat  and  drink,  easily-digested  food 
in  small  quantity,  and  gruel,  may  be  given  until  all  danger  has  passed — 
generally  for  one  or  two  days — -when  it  may  be  gradually  put  upon  ordi- 
nary diet,  and  allowed  to  resume  its  usual  occupation. 

When  abortion  is  inevitable — indicated  by  rupture  of  the  water-bag 
and  escape  of  the  waters — and  there  is  no  means  of  preventing  the 
expulsion  of  the  foetus — the  object  must  then  be  to  favor  the  latter  in 
some  cases  as  speedily  as  possible,  and  remove  the  membranes,  should 
there  be  any  likelihood  of  their  being  retained  in  the  uterus.  In  the 
majority  of  cases,  active  intervention  is  of  little  value  here,  and  is  only  to 
be  recommended  when  the  labor  is  tedious,  and  the  animal  is  becoming 
exhausted  by  fruitless  straining,  or  when  the  labor  is  altogether  suspend- 
ed after  rupture  of  the  membranes.  Then,  having  emptied  the  rectum, 
the  oiled  hand  is  to  be  cautiously  introduced  into  the  vagina,  and  if  the 
OS  is  contracted  or  not  sufficiently  open,  it  must  be  gently  dilated  by  the 
index  and  other  fingers,  until  the  interior  of  the  uterus  can  be  reached, 


2o8  PA  THOL OG  Y  OF  GESTA  TION. 

)jvhen  the  foetus  is  to  be  seized  and  removed  in  the  usual  way ;  should  it 
be  in  a  wrong  position,  or  should  there  be  any  obstacle  to  its  egress,  then 
we  must  proceed  according  to  the  directions  given  for  overcoming  such 
obstacles  when  they  occur  at  the  normal  period  of  parturition.  In  abor- 
tion or  premature  labor,  however,  the  foetus  being  smaller,  the  difficulties 
are  less. 

If  it  should  happen  that  the  sphincter  of  the  cervix  is  contracted,  and 
shows  no  sign  of  yielding  to  gentle  manipulation,  then  after  a  sufficient 
time  has  been  allowed  measures  should  be  adopted  to  relax  it.  Bel- 
ladonna ointment  (one  part  to  four  of  lard),  introduced  into  the  vagina 
and  applied  around  the  cervix  by  the  hand  or  any  suitable  instrument, 
may  be  used  with  advantage.  Mr.  Cox,  of  Ashbourne,  also  recommends 
rugs  dipped  in  hot  water  and  applied  over  the  pelvic  region.  Injections 
of  mucilaginous  fluids  or  glycerine  into  the  vagina,  may  be  resorted  to 
if  the  passage  has  become  dry  after  the  escape  of  the  amniotic  fluid  ; 
and,  internally,  extract  of  belladonna,  chloral,  or  aether  or  alcoholic 
draughts  should  be  administered,  particularly  if  the  animal  is  exhausted  ; 
when  gruel,  beef-tea,  milk,  or  other  strengthening  fluids  may  likewise  be 
required.  The  ergot  of  rye  is  of  little  value  in  these  cases  occurring  in 
the  larger  animals,  and  its  use  is  rarely  to  be  prescribed. 

If  the  membranes  come  away  with  the  foetus,  there  is  little  more  to  be 
done  ;  but  in  the  contrary  case,  which  is  by  no  means  unfrequent  in 
abortion  or  premature  birth,  the  membranes  are  strongly  adherent  to  the 
uterine  placentae,  and  their  retention,  particularly  in  cattle,  is  often  trouble- 
some. Some  practitioners  in  these  instances  prefer  to  remove  them  im- 
mediately and  mechanically  by  the  hand,  carefully  separating  the  placen- 
tulae  one  after  another  ;  and  though  this  is  easily  enough  done  so  long  as 
the  OS  is  dilated,  which  it  usually  is  for  three  days  after  delivery,  yet 
others  are  content  with  some  simple  precautions,  and  then  prefer  to  wait. 
When  they  find  the  membranes  firmly  adherent,  and  their  separation 
from  the  uterus  likely  to  be  attended  with  inconvenience,  they  only 
partially  detach  them,  then  collect  and  twist  them  into  a  rope-like  form, 
and  leave  this  mass  in  the  vagina  ;  so  that  should  the  cervix  contract,  it 
may  not  be  imprisoned  in  the  uterus.  Others  tie  them  together  with  a 
piece  of  tape,  which  is  allowed  to  hang  out  of  the  vagina.  In  a  short 
time  the  placenta  has  become  loosened,  and  can  then  be  wholly  removed. 
A  few  experienced  obstetrists  rely  on  internal  medication  for  the  sep- 
aration of  the  foetal  placenta.  Zundel,  for  instance,  has  long  and  suc- 
cessfully administered  powdered  laurel  berries  in  an  infusion  of  fennel, 
giving  I  ^  ounces  three  times  a  day,  with  an  ounce  of  sodium  bicarbonate 
in  half  a  pint  of  fennel  infusion.  The  membranes  always  come  away  on 
the  second  or  third  day,  particularly  if  plenty  of  mucilaginous  fluid  has 
been  given  in  the  interval.  Rychner  employs  a  decoction  of  the  meal  of 
linseed-cake  in  doses  of  about  twelve  pints  a  day,  when  this  result  ensues 
about  the  ninth  day. 

An  animal  which  has  aborted  requires  attention  after  the  delivery  of 
the  foetus.  It  should  be  kept  clean,  fed  on  gruel  and  easily-digested 
food,  though  not  in  excess,  kept  from  draughts  of  air,  particularly  in  cold 
weather,  and  otherwise  nursed  for  some  days.  The  complications  which 
sometimes  accompany  this  accident  will  be  alluded  to  hereafter,  as  they 
are  usually  those  of  ordinary  parturition.  The  animal  should  not  be 
allowed  to  become  impregnated  at  the  next  oestrum,  nor  yet  perhaps  at 
the  succeeding  period. 


ACCIDENTS  OF  PREGNANCY.  209 

Relaxation  of  the  genital  passages  in  the  Bitch  generally  follows  im- 
mersion in  a  warm  ba'th  (112°  to  .114°  Fahr.)  for  a  few  minutes  ;  it  must 
not  be  prolonged  after  the  respiration  becomes  hurried  or  the  animal 
looks  distressed  j  and  the  creature  should  be  well  dried  and  kept  com 
fortable. 

Epizootic,  Epizootic,  or  Infections  Abortiofi. 

What  has  been  named  epizootic  or  enzootic  abortion,  but  which  we  have 
designated  "  infectious,"  differs  in  its  etiology  and  some  other  features 
from  abortion  occurring  in  isolated  or  sporadic  cases,  but  more  partic- 
ularly from  its  attacking  all,  or  nearly  all,  the  pregnant  cattle  (for  it  is 
more  particularly  observed  in  Cows,  seldom  in  Sheep,  and  more  rarely 
among  Mares)  on  a  farm  or  pasture,  in  a  village,  over  a  wide  district,  or 
even  throughout  an  entire  country,  for  perhaps  a  succession  of  years — thus 
constituting  itself  a  veritable  scourge  to  agriculture  ;  and  more  especially 
as  it  only  too  frequently  defies  all  precautions  to  prevent  its  occurrence, 
and  eludes  the  most  careful  search  for  its  exciting  cause. 

Epizootics  of  abortion  have  been  recorded  from  the  earliest  times  ;  * 
but  it  was  only  towards  the  end  of  the  last  .century,  when  Flandrin,  Bar- 
rier, Pele,  and  other  French  veterinary  authorities  undertook  their  inves- 
tigation, that  we  discover  the  damage  they  inflicted.  The  observers  in 
this  century  are  very  numerous,  but  space  forbids  our  alluding  to  them  ; 
it  may  be  sufficient  to  state  that  Continental  authorities  are  agreed  as  to 
the  destructiveness  of  this  accident  or  disease,  as  well  as  to  the  obscurity 
which  attends  its  development.  For  instance,  Heuze  mentions  that  in 
the  Nievre  (France)  in  1869,  the  loss  to  certain  agriculturists  amounted 
to  30,  40,  and  even  50,000  francs  ;  in  South  Germany,  in  1851-52,  accord- 
ing to  Rueff,  it  was  very  serious  ;  Zundel  mentions  that  it  is  frequent  in 
North  Germany  ;  and,  according  to  Harms,  it  is  very  prevalent  in  Han- 
over. 

Causes. — If  we  attempt  to  study  the  causes  which  have  been  alleged 
as  operating  in  the  production  of  epizootic  abortion,  we  are  baffled  among 
conflicting  statements  and  opinions.  Many  authorities  hav^e  adduced 
those  causes  which  have  been  already  enumerated  as  producing  sporadic 
or  accidental  abortion ;  while  others  hav^e  taken  into  consideration  those 
influences  which  may  give  rise  to  the  accident,  as  well  as  those  which 
may  propagate  the  disorder.  Among  the  latter  is  Zundel,  who  has  made 
a  conscientious  study  of  this  important  subject,  and  throws  considerable 
light  upon  it. 

With  regard  to  general  causes,  it  is  remarked  that  the  disease  is  most 
frequent,  enzootic,  in  wet  years,  as  it  was  in  South  Germany  in  1852, 
when  inundations  were  common  (Rueff),  and  in  Haute-Saone  frequently 
(Trelut),  and  in  other  countries,  when  it  is  probably  due  to  anaemia,  as 
well  as  to  forage  damaged  by  moisture,  ergotized,  or  otherwise  altered. 
This  adynamic  condition  of  animals,  brought  about  by  the  weather  and 
food,  is,  in  the  opinion  of  Zundel,  particularly  favorable  for  the  multi- 
plication pf  microphytes,  micrococci,  and  bacteria  in  the  genito-urinary 
mucous  membrane,  and  these  have  been  spoken  of  as  the  principal  local 

*  Those  occurring  up  to  a.d.  800  are  described  in  Animal Plagnei.  We  need  only  allude  in  this  place 
to  the  human  "Abortus  epidemicus"  of  b.c.  278  ;  to  that  observed  in  Germany  in  1777,  in  which  Cows 
and  Pigs  were  involved  ;  and  that  at  Chalons  in  1784,  in  which  nearly  all  the  Cows  and  Mares  aborted. 

14 


2 1 o  PA  THOLOG  Y  OF  GESTA  TION. 

cause  of  this  kind  of  abortion.  He  also  adds  that  it  is  possible  that,  • 
among  the  fungus  or  parasitic  elements  which  infest  forage  in  wet  sea- 
sons, there  may  be  some  which  act,  like  the  ergot  of  rye,  directly  on  the 
uterus.  But  in  addition  to  the  influence  of  seasons,  there  is  also  an 
influence  of  locality — the  disease  fixes  itself  in  particular  places  and 
spares  others.  For  instance,  Heuze  remarks  that  in  the  department  of 
the  Nievre,  France,  abortions  are  very  few  in  the  arrondissement  of 
Clamecy,  while  in  other  arrondissements  there  is  scarcely  a  calf. 

With  regard  to  local  conditions  or  causes,  it  is  certain  that  the  regime 
to  which  animals  are  subjected  cannot  be  abduced  as  in  operation ;  for 
the  abortions  occur  under  every  kind  of  regime,  and  as  frequently  with 
poor  as  with  lean  stock,  and  irrespective  of  age,  breed,  or  constitution. 

So  long  ago  as  the  end  of  the  last  century,  contagion  or  infection  was 
believed  to  play  the  principal,  if  not  the  sole  part ;  for  it  was  observed 
that  when  a  Cow  aborted  in  a  place  where  other  pregnant  Cows  were 
kept,  these  would  abort  in  succession  until  all,  or  nearly  all,  had  mis- 
carried. Not  only  this,  but  it  has  often  happened  that  a  newly-purchased 
Cow-in-calf  has  been  introduced  into  a  farm  where  the  Cows  had  always 
calved  favorably  at  the  proper  time  ;  and  when  the  stranger  has  aborted, 
first  one,  then  another,  then  a  third,  and  so  on,  of  the  others  have 
experienced  the  same  misfortune,  and  the  malady  has  persisted  in  the 
place  for  consecutive  years.  It  is  not  always  the  pregnant  Cows  next  to 
the  one  which  has  aborted  that  are  first  seized,  but  rather  animals  some 
distance  from  it. 

Again,  when  pregnant  Cows  which  were  living  in  a  place  where  the 
disease  had  not  existed,  have  been  introduced  into  a  stable  where  it  pre- 
vails, those  that  are  at  the  end  of  gestation  calve  regularly  and  normally 
soon  after  arrival  ;  while  if  they  are  a  certain  time  in  the  infected  stable 
before  this  period  is  reached,  they  abort  like  the  others. 

So  that  the  presence  of  an  infecting  element,  if  not  absolutely  proved, 
is  at  least  admissible,  after  the  very  numerous  observations  of  the  most 
competent  veterinarians — especially  of  Darreau,  Cruzel,  Felizet,  Bouley, 
and  Lafosse  in  France  ;  and  Rueff,  Haubner,  Franck,  and  Roloff  in 
Germany.  The  insalubrity  and  bad  hygiene  of  cowsheds  and  stables 
appear  to  have  no  influence  in  the  pathogenesis  of  the  accident,  as  it 
appears  quite  as  severely  and  readily  in  those  which  are  well  ventilated 
and  cleansed  as  those  in  the  opposite  conditions  ;  in  fact,  nothing  can 
explain  the  occurrence  of  enzootic  abortion  except  the  presence  of  a 
contagtujn  or  a  miasmatic  infection. 

The  existence  of  a  contagium  would  appear  to  be  proved  by  the  result 
of  an  experiment  performed  by  Franck,  of  the  Munich  Veterinary  School. 
It  has  been  established  by  microscopical  investigation,  that  on  the  lining 
membrane  of  the  vagina  and  that  of  the  vulva,  there  is  constantly 
found,  as  on  the  buccal  mucous  membrane,  a  minute  fungus  mixed  with 
the  mucus,  in  every  respect  similar  to  the  Leptothrix  buccalis,  which, 
according  to  Hallier,  is  only  an  allotropic  condition  of  the  ordinary 
moulds,  such  as  the  Penicillium  glaucmn  or  Aspergillus — being,  in  fact, 
a  kind  of  bacterium.  Towards  the  period  of  parturition,  these  bodies 
become  extraordinarily  abundant,  and  they  appear  to  concur  in  !^  decom- 
position of  the  foetal  membranes  and  their  expulsion  ;  when  the  mem- 
branes are  retained  and  putrefy  in  the  uterus,  they  are  extremely 
numerous,  as  are  the  micrococci.  Franck  has  sho^n  that,  by  smearing 
the  vaginal   canal  of  a  pregnant   animal   to   a  certain   depth  with  the 


A  CCIDENTS  OF  PREGNA  NCY.  211 

matter  from  the  expelled  membranes  of  one  which  has  been  delivered, 
abortion  can  be  induced. 

So  that,  says  Zundel,  it  is  sufficient  to  introduce  into  the  vagina 
micrococci  or  bacteria,  which  multiply  there,  and,  penetrating  to  the 
uterus,  commence  their  work  of  decomposition,  of  which  abortion  is  the 
consequence.' 

Roloff  has  also  ascertained  that  abortion  is  due  to  something  which 
finds  admission  to  the  uterus  by  the  vagina  ;  that  a  certain  amount  of 
.  redness  and  tumefaction  of  the  lining  membrane  of  the  latter  always 
precedes  this  accident ;  and  that  this  viruliferous  or  miasmatic  matter  is 
found  on  the  articles  soiled  by  the  delivery  of  a  Cow  which  has  aborted, 
as  well  as  in  the  drains  of  the  stable,  on  the  litter,  etc. 

It  has  been  remarked  that,  in  general,  the  foetal  membranes  are  liable 
to  be  retained  in  Cows  which  abort,  and  that  when  not  removed 
artificially,  they  only  come  away  when  decomposition  sets  in.  The 
influence  of  these  putrefying  membranes  has  been  noted  by  several 
veterinarians — Pele,  Barrier,  Cruzel,  Bouley,  Rychner,  Haubner,  and 
others — who  imagined  that  the  putrescent  emanations  infected  the 
economy  of  the  animals  breathing  them  ;  but  Zundel  thinks  it  more 
probable  that  direct  infection  takes  place  by  the  genital  mucous  mem- 
brane. In  support  of  this  opinion,  he  quotes  the  observations  of  Roloff, 
who  asserts  that  he  always  saw  the  disease  or  accident  developed  in 
stables  where  the  distance  between  the  mangers  and  drains  was.small,  or 
where  the  drains  did  not  have  sufficient  fall,  whereby  the  hind  quarters  of 
the  cattle  were  readily  soiled  by  the  excreta  in  them. 

Without,  then,  going  further  into  the  question,  and  without  taking  into 
consideration  other  agencies  which  may  cause  extensive  abortion — such 
as  ergotized  grasses — it  may  be  concluded  that  this  kind  of  miscarriage 
is  transmissible  through  the  medium  of  some  infectious  or  virulent 
principle,  which  is  really  specific  in  its  nature  :  for  it  is  not  necessarily 
allied  to  putrefaction  of  the  foetal  membranes  ;  and  it  always  produces 
the  same  effect — abortion — without  any  other  apparent  efficient  cause 
being  in  opertion. 

Symptoms. — It  is  rare  that  this  kind  of  abortion  occurs  before  the 
third  or  fourth  month  of  gestation ;  more  frequently  it  is  at  the  fifth, 
sixth,  or  seventh  month,  or  even  later.  There  are  no  premonitory  symp- 
toms, except  perhaps  a  trifling  uneasiness  for  a  few  hours  previously, 
with  sinking  of  the  flanks  and  descent  of  the  abdomen  ;  the  animal 
generally  looks  well  and  hearty,  and  yields  its  supply  of  milk  as  usual  ; 
and  soon  after  the  foetus  is  expelled,  apparently  without  any  effort  or 
inconvenience,  and  along  with  its  membranes,  if  these  are  not  ruptured, 
with  or  without  them  when  they  are.  It  is  rare,  however,  that  the  rup- 
tured membranes  are  rejected  immediately  after  the  foetus  ;  as  a  rule 
they  are  nearly  always  retained,  particularly  when  gestation  is  advanced  ; 
and  they  putrefy  in  the  uterus,  being  got  rid  of  only  in  shreds  at 
intervals.  Then  the  animal  loses  its  appetite  and  condition,  goes  off  its 
milk,  and  sometimes  perishes,  as  a  consequence  of  this  placental  re- 
striction. If  it  recovers,  oestrum  appears  unnaturally  often,  though  con- 
ception is  unfrequent  and  sterility  common  ;  and  on  the  other  hand, 
there  are  some  animals  which  expel  the  membranes  quickly,  conceive 
•soon  after,  but  agaii*  abort  as  readily — perhaps  three  times  in  the 
course  of  a  year. 


212  PA  THOL  OG  Y  OF  GESTA  TION. 

The  foetus  is  usually  dead,  though  when  it  is  expelled  (in  the  Cow) 
after  the  fifth  month  it  may  be  alive ;  but  it  is  weakly  and  soon  dies, 
even  when  born  near  the  termination  of  pregnancy.  Barrier  mentions 
that  these  calves  make  a  rattling  noise  when  breathing,  accompanied  by 
the  discharge  of  a  rusty-colored  mucilaginous  fluid  from  the  nostrils  ; 
that  they  bellow  continually,  and  are  always  emaciated  and  flabby,  the 
gums  and  palate  being  pale,  and  the  umbilical  vessels  livid  and  withered- 
looking.  The  dyspnoea  and  great  weakness  evinced  by  them  shows  that 
they  are  not  properly  organized.  Those  which  are  dead  when  expelled 
exhibit  indications  of  having  ceased  to  live  a  short  time  previously. 

As  has  been  stated,  all  the  animals  on  a  pasture  or  in  a  shed  where 
the  disease  prevails,  do  not  abort  at  the  same  time,  but  at  intervals. 
When  one  aborts,  another — its  neighbor  perhaps — appears  to  prepare  for 
the  event,  which  occurs  in  about  eight  days ;  then  some  days  after  this  it 
is  the  turn  of  another,  and  so  on  until  two-thirds,  or  perhaps  even  all,  of 
the  pregnant  Cows  beyond  three  months'  gestation  have  miscarried. 

It  has  also  been  mentioned  that  it  is  only  after  being  some  time  in 
sheds  in  which  the  disease  is  present,  that  newly-purchased  pregnant 
Cows  are  attacked  ;  those  which  have  passed  their  eighth  month  and  near 
calving  escaping  abortion. 

Darreau  alludes  to  instances  in  which  a  pregnant  Cow,  leaving  a  shed 
in  which  abortions  prevailed,  and  transferred  to  another  where  the  acci- 
dent had  aiot  been  seen,  would  remain  all  right  for  some  time,  then  sud- 
denly miscarry,  and  in  the  course  of  fifteen  days  other  abortions  would 
occur  in  this  shed,  testifying  to  the  danger  of  keeping  pregnant  Cows  in 
contact  with  or  in  proximity  to  those  which  have  miscarried  in  this  way. 
It  has  also  been  stated  that  an  animal  which  miscarries  has  always  a  ten- 
dency to  do  so  again.  But  it  has  been  observed  that  if  cows  are  well  fed, 
the  period  of  gestation  after  each  abortion  is  often  longer;  so  that  if  a 
Cow  aborts  the  first  time  at  six  months,  it  will  do  so  again  at  the  seventh 
month,  and  the  third  time  a  little  before  the  ninth  month,  reaching  its  full 
period  in  three  pregnancies. 

Treatment. — If  the  malady  is  suspected  to  be  due  to  any  one  partic- 
ular cause,  or  if  there  exist  predisposing  causes,  then  the  indications  for 
the  prevention  or  cure  of  the  diseased  condition  are  obvious.  The  atonic 
state  which  seems  to  favor  the  occurrence  of  infectious  abortion  in  or  after 
certain  rainy  seasons,  should  be  remedied  by  good  food  and  tonics — and 
especially  preparations  of  iron.  Tonics  are  particularly  serviceable  when 
abortion  is  due  to  ergotized  food  ;  though  Zundel  recommends  the  inter- 
nal administration  of  carbolic  acid. 

If,  however,  we  admit  the  most  common  and  efficient  cause  to  be  infec- 
tion— that  abortion  is  due  to  the  presence  of  an  agent  transmissible  from 
an  affected  animal,  or  something  that  has  belonged  to  it,  to  another  in 
health — then  the  first  and  fundamental  indication  is  to  remove  or  isolate 
the  source  of  the  mischief. 

When,  therefore,  abortion  occurs,  and  there  is  reason  to  believe  that 
this  accident  is  in  its  nature  infectious,  the  foetus  and  all  pertaining  to  it 
should  be  removed  as  promptly  and  completely  as  possible  from  the  shed 
or  place  in  which  the  animal  is  located.  The  Cow  itself  should  also  be 
removed,  and  kept  altogether  isolated,  or  at  least  away  from  all  other 
pregnant  cattle,  with  a  special  attendant  employe^!  to  look  after  it ;  this, 
attendant  should  not  go  near  the  unaffected  cattle,  and  the  excreta  from 
the  cow  should  also  be  carefully  kept  out  of  their  way. 


A  CCI DENTS  OF  PREGNA  NCY.  213 

The  shed  from  which  the  cow  has  been  moved,  and  which  contains 
other  pregnant  cattle,  ought  to  be  immediately  cleared  of  all  manure  and 
other  matters  of  an  objectionable  kind,  the  drains  and  the  floor — partic- 
ularly that  of  the  stall  which  had  been  occupied  by  the  Cow — being  thor- 
oughly swilled  with  water,  and  sprinkled  with  some  good  disinfectant ;  a 
good  layer  of  straw  may  then  be  laid  down,  and  the  cattle  replaced. 

The  shed  should  be  kept  clean  and  well  ventilated  for  a  number  of  days, 
and  the  drains  well  flushed  and  disinfected. 

The  animal  which  has  aborted  must  also  be  at  once  attended  to.  If  the 
membranes  have  not  been  discharged — which  is  most  frequently  the  case 
— they  should  be  removed  as  early  as  possible,  and  not  allowed  to  pu- 
trefy ;  their  removal  should  be  affected  by  the  hand,  and  a  weak  solu- 
tion of  carbolic  acid,  permanganate  of  potass,  or  salicylic  acid  ought  to 
be  injected  into  the  vagina  and  uterus.  The  membranes  themselves 
should  be  destroyed  or  buried,  and  the  Cow  should  not  be  allowed  to  go 
near  others  which  are  pregnant  so  long  as  there  is  any  discharge /^r  viil- 
vam  :  for  safety,  the  period  of  isolation  should  extend  to  from  eight  to 
fifteen  days.  The  animal  may  require  good  nursing  in  the  mean  time  ; 
and  it  should  not  be  put  to  the  male  until  every  trace  of  irritation  in  the 
generative  organs  has  disappeared. 

When  Cows  show  any  symptoms  of  impending  abortion,  they  ought  to 
be  promptly  removed  from  the  vicinity  of  others  which  are  in  calf. 

When  this  accident  continues  in  a  stable  or  shed,  Saint-Cyr  thinks  it 
necessary  to  recommend  disposal  of  all  the  Cows  therein,  and  before  in- 
troducing others  into  it,  to  thoroughly  cleanse  and  disinfect  it  by  removing 
all  excreta  ;  renewing  the  soil  or  flooring,  washing  and  scraping  the  man- 
gers, racks,  and  walls  and  wood-work,  making  more  air-apertures  if  neces- 
sary, and  leaving  it  empty,  with  the  doors  and  windows  open,  for  a  month 
or  six  weeks. 

Should  epizootic  abortion  be  traced  to  the  food — ergotized  or  other- 
wise damaged  fodder,  of  course  the  use  of  this  must,  if  possible,  be  pro- 
hibited, and  a  change  resorted  to.  If  the  pasture  grasses  are  ergotized, 
then  the  pregnant  animals  must  be  removed  from  them,  and  placed  in 
more  favorable  conditions  with  regard  to  food.  Ergotized  or  mouldy  dry 
forage  may  be  rendered  safe  for  consumption  by  scalding  it  with  boiling 
water  or  steam,  or  pickling  it  in  salt. 

Whenever  or  wherever  the  accident  occurs — whether  at  pasture,  straw- 
yard,  or  in  shed — it  must  not  be  forgotten  that  the  greatest  po^ible  care 
should  be  taken  to  isolate  the  animal,  if  it  is  with  other  pregnant  creatures 
of  the  same  species,  and  to  bury  every  thing — foetus,  membranes,  etc.,  as 
well  as  to  destroy  all  traces  of  discharges  from  the  patient. 


214  '  NORMAL  PARTURITION, 

BOOK  IV. 

NORMAL   PARTURITION. 

Normal,  natural,  physiological  or  spontaneous  parturition  or  birth,  is  the 
expulsion  of  the  foetus  at  term  from  the  uterus,  through  the  maternal  pas- 
sages, by  natural  forces,  and  when  it  is  sufficiently  developed  to  live  ex- 
ternal to  its  parent.  This  act  is  designated  "  foaling"  when  occurring  in 
the  Mare,  "calving"  in  the  Cow,  "lambing"  in  the  Sheep,  "pupping" 
in  the  Bitch,  etc.  It  receives  the  designation  of  "normal,"  "natural," 
etc.,  when  it  is  accomplished  in  a  manner  favorable  to  the  parent  and 
offspring  without  extraneous  assistance,  and  by  natural  forces  alone  ; 
and  "abnormal,"  "pathological,"  or  "difficult,"  when  it  cannot  be 
so  accomplished,  and  when  the  aid  of  man  is  required  to  relieve  the 
parent  and  release  the  progeny.  Though  eminently  a  physiological  act, 
it  is  nevertheless  one  of  the  most  difficult ;  the  interval  between  normal 
and  pathological  parturition  is  sometimes  extremely  brief,  the  one  being 
often  transformed  into  the  other  in  a  remarkably  short  time.  It  is  also 
said  to  be  "  premature  "  when  it  occurs  before  the  usual  period,  and  the 
young  creature  is  born  in  a  viable  condition  ;  while  it  is  "  prolonged  " 
birth  when  pregnancy  extends  beyond  the  ordinary  term.  We  have 
already  spoked  of  these  terms,  and  alluded  to  their  diversity  ;  and  we 
have  only  now  to  note  that  these  variations  do  not  appear  to  have  any 
influence  on  the  physiological  act  of  parturition. 


CHAPTER  I. 

Physiology  of  Parturition. 

The  act  of  parturition,  notwithstanding  its  special  object,  is  distinguished 
from  all  other  physiological  acts  or  functions  by  certain  peculiarities  ;  for 
while  the  latter  are  normally  accomplished  without  disturbing  in  any  way 
the  well-being  of  the  individual,  parturition,  on  the  contrary,  even  when 
natural,  is  accompanied  by  pain,  general  disturbance  and  uneasiness,  and 
violent  efforts.  And  during  birth  nature  does  not  appear  to  obey  those 
immutable  laws  so  strictly  as  in  the  accomplishment  of  the  other  physio- 
logical acts,  but  makes  frequent  and  wide  deviations  ;  though  these  do 
not  often  compromise  the  final  result.  We  never  find  two  births  exactly 
alike,  but  each  offers  something  peculiar  when  attentively  observed.  We 
need  only  refer  to  the  duration  of  the  act  as  a  whole,  as  well  as  to  each 
of  its  periods  or  stages.  Sometimes  it  only  occupies  a  few  minutes,  in 
other  instances  days  are  required  to  complete  it ;  in  some  cases  the  first 
stage  is  long  and  the  second  short,  and  in  others  it  is  the  reverse.  The 
labor  pains,  or  contractions,  present  as  notable  differences  with  regard 
to  intensity,  duration,  and  frequency,  as  well  as  in  the  pain  they  cause 
and  the  influence  they  exercise  on  the  other  parts  of  the  body ;  while  the 
amount  of  allantoid  or  amniotic  fluid  is  as  variable,  though  no  ill  effects 
may  result  from  this.  And,  finally,  the  foetus  may  present  itself  for  expul- 
sion in  a  variety  of  positions,  which,  though  they  may  not  impede  birth, 
yet  prove  that  parturition  is  an  extremely  variable  act. 


PHYSIOLOGY  OF  PARTURITION. 


SECTION    I. — CAUSES   OF   PARTURITION. 


215 


Though  parturition  only  occurs,  at  the  end  of  pregnancy,  nevertheless 
this  act  is  being  prepared  for  from  an  early  period  in  the  development  of 
the  ovum,  as  we  have  shown  when  speaking  of  the  anatomy  and  physiol- 
ogy of  the  generative  organs.  During  the  evolution  and  development  of 
the  ovum,  the  uterus  increases  in  a  corresponding  manner,  and  its  mus- 
cular layer  is  proportionately  augmented.  When,  towards  the  termination 
of  gestation,  the  ovum  has  reached  maturity,  and  the  organs  necessary  for 
the  independent  existence  of  the  foetus  are  completely  developed,  certain 
alterations  occur,  both  in  the  uterus  and  the  foetal  connections  with  it, 
which  bring  about  the  expulsion  of  the  young  creature. 

These  alterations  would  appear  to  consist  in  a  gradually  increasing 
fatty  degeneration  of  the  decidua,  by  which  the  organic  connection  that 
had  existed  between  the  peripheral  portions  of  the  ovum  and  the  uterus 
is  gradually  destroyed,  by  a  regressive  process  in  the  cells  lying  between 
them  ;  while  the  blood  which  was  sent  to  the  organ  is  now  diverted 
towards  the  mammae,  for  the  secretion  of  milk.  The  exchange  of  mate- 
rials between  the  uterus  and  foetus  is  lessened,  and  the  latter  becomes  like 
a  foreign  body  in  the  cavity  of  the  former.  At  all  the  places  where  the 
cell  degeneration  has  reached  a  certain  stage,  the  terminations  of  the 
nerves  are  irritated.  But  to  obtain  a  reflex  action,  and  consequent  con- 
traction of  the  uterine  muscles,  as  Schroeder  observes,  a  certain  amount 
of  continuous  irritation  is  necessary.  This  sum  once  obtained,  a  reflex 
action  takes  place  in  the  form  gf  a  contraction,  which,  however,  is  slight 
at  the  beginning.  Then  a  pause  follows,  until  the  sum  of  the  irritation  is 
again  sufficient  to  cause,  a  contraction.  By  the  increase  in  intensity  of 
the  contractions,  the  uterine  wall  is  removed  from  the  envelopes,  and  this 
separation  becomes  a  new  source  of  irritation  to  the  uterine  nerve-fibres. 
The  reflex  action,  in  the  form  of  labor-pains,  becomes  more  and  more 
powerful,  until  these  follow  at  last  in  rapid  succession  and  complete  the 
expulsion  of  the  ovum.  This  irritability  of  the  uterine  nerves  progres- 
sively increases  with  the  advance  of  pregnancy,  and  explains  the  regular 
setting  in  of  labor,  as  well  as  the  not  unfrequent  retardation  of  the  pains 
in  cases  where  the  separation  of  the  membranes  has  been  premature. 

The  sympathetic  nerve  is  in  all  probability  that  which  is  most  concerned 
in  the  uterine  contractions,  as  it  is  the  motor  nerve  of  the  organ ;  and  its 
influence  is  called  forth  by  the  irritation  just  mentioned  as  being  pro- 
duced on  the  terminations  of  the  nerves  on  the  inner  surface  of  the  uterus 
by  reflex  action,  the  irritation  being  transformed  into  involuntary  motor 
activity.     It  is  surmised  that  the  sacral  nerves  are  merely  inhibitory. 

SECTION    II. THE    EXPELLING    POWERS. 

The  expulsive  force  by  v/hich  parturition  is  effected  resides  in  the  un- 
striped  muscular  fibres  of  the  uterus,  which  cause  the  organ  to  contract  in 
a  rhythmical  and  somewhat  peristaltic  manner,  the  contractions  of  the 
abdominal  muscles  and  diaphragm  being  merely  auxiliary.  These  con- 
tractions of  the  uterus  may  take  place  although  the  organ  does  not  con- 
tain a  foetus,  and  have  been  noted  in  extra-uterine  pregnancy,  when  they 
probably  occur  through  sympathy.  They  have  been  observed  in  the  false 
gestation  of  the  Bitch  which  has  not  really  conceived,  but  whose  mammae 
enlarge,  and  which  makes  its  bed  and  exhibits  other  indications  of  ap- 
proaching labor;  us  well  as  in  pregnancies  prolonged  beyond  their  ordi- 
narv  limit. 


,^^  - 


2i6  NORMAL  PARTURITION. 

As  the  uterine  contractions  which  lead  to  expulsion  are  usually  ac- 
companied by  a  painful  sensation  (duQ  to  the  pressure  exercised  on  the 
terminations  of  the  nerves  within  the  muscular  fibres),  they  are  in  com- 
mon parlance  designated  "labor  pains"  {dolores  ad partuni)\  while  the 
resistance  they  have  to  overcome  is  centred  in  the  foetus  and  its  envel- 
opes, as  well  as  in  the  passages  these  have  to  traverse  in  order  to  reach 
the  external  world. 

Expulsion  is  not  effected  by  one  contraction,  but  by  a  series  of  con- 
tractions ;  between  each  of  these  there  is  an  interval  of  apparent  repose, 
during  which  the  organ  seems  to  be  gathering  strength  for  a  new  effort. 
As  in  almost  all  unstriped  muscular  fibres,  the  reflex  action  following  upon 
an  irritation  is  slow  and  gradual,  and,  according  to  the  degree  of  irritation, 
of  varying  intensity  and  duration.  ;  At  the  commencement,  corresponding 
to  the  slight  irritation,  the  contraction  is  feeble  and  short,  and  the  time 
required  to  obtain  the  necessary  sum  of  the  persistent  irritation  for  a  new 
reflex  action  as  comparatively  long ;  through  the  uterine  walls  are  not 
relaxed  on  their  contents,  but  are  maintained  in  a  certain  state  of  con- 
traction by  the  tonicity  of  their  muscles. 

When  the  pains  are  regular,  there  is  also  a  certain  gradation  in  each 
individual  contraction.  Feeble  at  its  commencement,  it  gradually  increases, 
the  uterus  becoming  harder  until  the  maximum  of  contraction  has  been 
reached  ;  this  persists  for  some  time,  and  then  as  gradually  subsides. 

As  parturition  progresses,  and  the  separation  between  the  uterus  and 
foetus  increases,  the  irritation  becomes  stronger,  and  the  intervals  between 
the  contractions  shorter,  while  these  latter  augment  progressively  in  inten- 
sity and  duration.  The  necessity  for  these  intermissions,  particularly  in 
the  early  stage  of  parturition,  is  obvious.  They  allow  the  animal  time  to 
recover,  to  some  extent,  from  the  exhaustion  they  occasion,  and  permit 
the  genital  passages  to  become  gradually  prepared  for  the  exit  of  the 
foetus  through  them  ;  while  the  latter  can  also  recover  from  the  inconveni- 
ence it  may  suffer  from  the  interruption  between  it  and  the  uterus  during 
the  pain,  and  especially  towards  the  termination  of  the  act. 

During  each  regular  pain  the  whole  of  the  uterus  contracts,  though  the 
fundus  does  so  most  energetically  ;  and  the  longitudinal  fibres  of  the  organ 
are  more  particularly  brought  into  play  at  the  initial  and  middle  stage  of 
parturition.  The  cornua  likewise  contract,  are  twisted  on  themselves 
anteriorly,  are  shortened  through  the  action  of  the  longitudinal  fibres,  and 
are  brought  nearer  the  body  of  the  uterus,  which  is  also  shortened  ;  and  as 
this  shortening  is  always  taking  place  in  the  direction  of  the  cervix,  it  is 
here  that  the  sum  total  of  the  expelling  force  is  centred  ;  and  it  is  this 
force,  commencing  to  operate  at  the  fundus  of  the  organ,  and  exerted  on  the 
incompressible  liquor  amnii,  which  gradually  opens  the  os  for  the  extrusion 
of  the  fcetus.  The  latter,  with  its  envelopes,  first  acts  as  a  stimulus  to 
the  uterus,  but  they  soon  begin  to  play  quite  a  mechanical  part  in  the  di- 
lation of  the  already  greatly  shortened  cervix.  The  latter  becomes  thin- 
ner as  the  contractions  force  the  bag  of  waters  against  it;  so  that  the  os 
is  gradually  widened,  and  the  cervix  becomes  a  part  of  the  uterine  cavity. 
As  soon  as  the  os  is  slightly  opened,  the  bag  of  waters  enters  it  and  acts 
as  a  mechanical  dilator  ;  then  the  lower  parts  of  the  fore  limbs,  succeeded 
by  the  head  of  the  foetus,  are  introduced,  and  from  their  combined  shape 
act  like  a  wedge,  until,  by  the  eccentric  pressure,  the  chest  is  passed  in, 
and  the  cervix  being  drawn  over  the  presenting  parts,  the  os  is  of  the 
same  diameter  as  the  vagina,  which  then,  with  the  uterus,  constitutes  one 


PH YSrOL OG  Y  OF  PAR TURITION.  2 1 7 

common  cavity.  Every  part  of  the  cervix  being  acted  on  by  the  longitu- 
dinal fibres,  the  aperture  of  the  os  is  perfectly  circular  at  this  stage  ;  as  is 
observed  in  the  Cow  and  Goat  when  the  uterus  is  pushed  back,  and  its 
orifice  is  visible  at  the  vulva.  Irregularity  in  the  contractions,  however, 
and  particularly  when  they  are  rendered  so  from  a  transverse  position  of 
the  fcetus,  delays  the  dilatation,  which  is  otherwise  rapid  according  to  the 
force  and  frequency  of  these  contractions.  At  first  the  dilatation  occurs 
very  slowly,  especially  in  primiparse  ;  when  the  foetus  presents  by  the 
croup,  or  when  the  body  of  the  uterus  inclines  too  much  downwards, 
causing  the  cervix  to  bend  up  towards  the  sacrum,  it  is  also  very  tardy. 
As  soon,  however,  as  the  mechanical  action  of  the  water-bag  and  fcetus 
come  into  operation,  it  makes  rapid  progress  in  natural  parturition. 

If  the  uterus  of  animals  usually  uniparous  contains  two  foetuses,  the 
two  cornua  are  about  the  same  size,  each  having  a  foetus  in  the  same 
position  as  if  there  was  only  one  in  the  uterine  cavity.  In  general,  the 
two  foetuses  present  anteriorly  ;  although  it  sometimes  happens  that  the 
second,  or  the  first,  or  even  both,  present  posteriorly  ;  not  unfrequently 
the  second  makes  a  malpresentation.  When  there  are  twins,  parturition 
is  more  difficult  and  slower  than  when  there  is  only  one  :  possibly  because 
the  great  distention  of  the  uterus  diminishes  its  contractile  power,  an- 
other feature  in  twin  pregnancies  is  that  parturition  often  occurs  before 
the  ordinary  time  ;  and  even  when  this  has  been  reached,  one  or  both 
foetuses  are  smaller  and  weaker  than  when  there  is  only  a  single  fcetus. 

When  twin  parturition  sets  in,  the  uterine  contractions  commence 
almost  simultaneously  in  both  cornua,  which  are  much  less  apart  than  in 
the  non-pregnant  state  ;  but  as  the  two  foetuses  cannot  be  born  together, 
that  which  is  most  advanced  is  delivered  first,  the  other,  which  is  behind 
it,  mechanically  aiding  in  its  expulsion.  In  the  Mare,  the  interval 
between  the  birth  of  twins  is  rarely  more  than  ten  minutes  ;  with  the 
Cow  it  may  be  one  or  two  hours  ;  and  with  the  Ewe  half  an  hour.  When 
the  position  of  the  second  foetus  is  favorable,  it  is  usually  expelled  more 
rapidly  and  easily  than  the  first ;  and  when  they  are  of  a  different  size, 
the  largest  is  ordinarily  born  before  the  other.  W^hen  the  number  of 
foetuses  is  greater,  they  are  also  expelled  successively  at  intervals  of  some 
hours. 

In  cases  of  superfoetation,  if  such  an  occurrence  can  take  place  in 
animals  other  than  in  those  the  cornua  of  whose  uterus  opens  into  the 
vagina,  the  uterine  contractions  must  be  limited  to  the  cornu  containing 
the  fcetus  whose  period  for  birth  has  arrived  ;  otherwise,  the  other  foetus 
would  be  expelled  at  the  same  time,  and  there  would  then  be  a  birth  and 
an  abortion. 

With  the  small  multiparous  animals,  in  which  the  foetuses  are  expelled 
one  after  the  other,  it  may  be  admitted  that  each  fraction  of  the  uterus 
corresponding  to  a  fcetus  contracts  in  its  turn — at  first  the  segment  of  one 
of  the  cornua  nearest  the  cervix,  then  the  next  segment,  and  so  on  until 
the  one  in  proximity  to  the  ovary  is  reached,  so  as  to  get  rid  of  all  succes- 
sively :  one  cornu  expelling  a  foetus  alternately  with  the  other  ;  the  uterine 
contractions,  although  general,  being  most  energetic  at  the  portions  in- 
termediate to  the  foetuses. 

The  uterine  contractions-are  very  powerful,  as  any  one  can  testify  who 
has  had  occasion  to  introduce  his  hand  into  the  uterus  during  parturition  ; 
and  the^r  force  is  not  always  related  to  the  general  physical  power  of  the 
animal ;  though  they  are  always  more  energetic  in  the  Mare  than  the  Cow, 


2i8  NORMAL  PARTURITION. 

as  well  as  more  continuous.  Not  unfrequently  they  are  more  powerful  in 
weak-looking  animals  than  in  those  which  are  robust  and  vigorous ;  and 
their  energy  depends  evidently  upon  the  development  of  the  muscular 
structure  of  the  uterus,  and  the  potency  of  the  sympathetic  ganglia  which 
stimulates  it.  Their  energy  and  frequency  also  often  depend  upon  the 
duration  of  the  pains,  and  the  existence  of  mechanical  obstacles  to  the 
birth  of  the  foetus. 

After  the  complete  dilatation  of  the  os,  the  third  stage  of  delivery 
begins,  and  the  manner  in  which  the  uterus  contracts  is  modified.  The 
resistance  is  no  longer  at  the  cervix,  but  in  the  uterus  itself,  being  due  to 
the  presence  of  the  foetus  ;  and  now  the  circular  as  well  as  the  longitudi- 
nal fibres  come  into  action  simultaneously,  in  order  to  diminish  the 
uterine  cavity  and  quite  expel  its  contents.  In  this  they  are  greatly  aided 
by  the  abdominal  muscles  and  the  diaphragm,  which  until  now  could 
assist  but  little  ;  though  the  participation  of  these  does  not  appear  to  be 
absolutely  indispensable,  for  birth  may  take  place  without  it.  Neverthe- 
less, it  is  a  fact  that  in  diminishing  the  abdominal  cavity,  and  pressing 
on  its  contents,  these  muscles  concur  in  pushing  the  foetus  in  the  direc- 
tion in  which  least  resistance  is  offered — towards  the  pelvic  cavity  ;  and 
as  their  contractions  are  effective,  so  do  those  of  the  uterus,  which  are 
coincident  with  them,  become  increased  in  power  and  frequency.  The 
animal  "strains,"  as  in  defecation  or  micturition,  but  with  all  its  force; 
and  these  throes,  which  are  involuntary  to  a  great  extent,  and  in  which 
nearly  all  the  muscles  of  the  trunk  share,  soon  bring  the  act  to  a  termi- 
nation. 

The  foetus  itself  has  been  sometimes  regarded  as  the  chief  agent  in 
parturition,  from  the  fact  that  this  act  is  Jonger  and  more  difficult  when 
the  creature  is  dead,  and  that  it  has  been  expelled  after  the  mother  has 
ceased  to  live.  But  it  must  be  remembered  that  the  movements  of  the 
foetus  are  very  trifling,  and  of  little  importance  when  compared  with  the 
resistance  to  be  overcome  at  birth  ;  so  that  the  young  creature  must 
remain  almost,  if  not  quite  passive  during  the  act.  And  if  this  act  is 
tardily  accomplished- when  the  foetus  is  dead,  the  delay  maybe  due  to  the 
absence  of  stimulation  or  irritation  in  the  organ,  to  the  uterus  not  having 
a  fixed  point  to  act  upon,  or  perhaps  even  to  a  local  septosis  or  paralysis 
from  the  decomposition  of  the  foetus. 

With  regard  to  expulsion  of  the  foetus  after  the  death  of  the  mother,  it 
must  also  be  remembered  that  all  the  organs  do  not  cease  to  live  at  once, 
and  that  many  continue  to  contract  for  some  time  after  the  mother's 
heart  has  ceased  to  pulsate.  Leroux  has  felt  this  organ  contracting  a 
quarter  of  an  hour  after  death,  and  after  gastro-hysterotomy  on  the  dead 
human  body  it  has  been  seen  to  contract  as  in  the  living  woman  ;  Haller 
has  witnessed  the  contraction  of  the  cornua  of  the  Cat's  uterus,  even 
when  the  organ  was  detached  from  the  body;  and  Colin  states  that  he 
has  observed  the  uterus  of  Sheep  to  contract  for  forty  and  fifty  minutes 
after  death. 

As  we  have  said,  the  resistance  which  the  expelling  forces  have  to 
overcome  is  constituted  by  the  foetus  and  its  membranes,  and  the  genital 
passages — the  os  uteri,  vagina,  vulva,  as  well  as  the  pelvis  and  soft  parts 
covering  and  lining  it.  The  foetus  participates  in  the  resistance  by  its 
volume,  its  form,  its  manner  of  presentation,  its  position,  the  conforma- 
tion and  texture  of  the  tissues  which  unite  it  to  the  mother,  etc.  ;  while 
the  genital  passages  offer  resistance  from  their  form,  width,  extensibility, 


PHYSIOLOGY  OF  PARTURITION. 


219 


and  softness.     The  faeces  accumulated  in  the  rectum,  or  urine  in  the  blad-'' 
der,  sometimes  increase  the  resistance  to  be  overcome. 

In  order  that  birth  may  be  possible,  the  expelling  force  must  be  greater 
than  the  resistance,  and  it  is  upon  the  relation  between  these  that  the 
manner  in  which  the  foetus  is  expelled  will  more  particularly  depend,  as 
well  as  the  difficulty  attending  its  expulsion  and  the  time  required  for  the 
act  of  parturition. 

We  have  only  now  to  allude  to  the  influence  of  the  expelling  force  on 
the  fcetal  membranes.  We  have  seen  that  these,  which  we  may  now, 
with  their  contents,  designate  the  "water  bag,"  assist  in  dilating  the  os, 
and  that  the  uterine  contractions  propel  them  farther  into  the  vagina  in 
the  form  of  an  elongated  bladder  partly  filled  with  fluid.  This  soon 
appears  between  the  labia  of  the  vulva  as  a  round  distended  tumor,  at 
the  moment  a  pain  occurs,  but  flaccid  in  the  interval  ;  and  not  long  after- 
wards as  a  somewhat  voluminous  pediculated  tumor,  to  which  each 
pain  adds  a  little  more  fluid,  until  at  last  the  membranes  cannot  resist 
ihe  strain,  and  rupture,  when  the  allantoic,  and  then  the  amniotic  fluids 
escape  from  them,  leaving  a  variable  quantity  in  the  uterus  ;  some  of  this 
is  discharged  into  the  vagina  at  the  termination  of  each  pain,  and  assists 
in  lubrifying  the  mucous  membrane  and  aiding  in  the  passage  of  the 
fcEtus. 

It  may  be  remarked  that  numerous  causes  influence  the  period  when 
this  rupture  occurs.  In  the  Mare  the  membranes  are  thicker,  more  re- 
sisting, and  much  less  adherent  to  the  uterus  than  in  the  Cow  ;  so  that 
rupture  is  later  in  taking  place,  and  it  not  unfrequently  happens  that  the 
foal  is  born  in  them  ;  though  the  calf,  I  believe,  never  is.  But  there  are 
individual  differences  in  this  respect  even,  and  in  some  instances  it  will 
be  found  that  rupture  takes  place  at  the  commencement  of  parturition,  in 
others  towards  the  end  ;  though  when  this  takes  place  late  it  is  more 
favorable  than  when  it  occurs  early,  as  the  amniotic  fluid  preserves  the 
foetus  from  undue  compression  by  the  uterus,  while  it  powerfully  aids  in 
the  progressive  and  regular  dilatation  of  the  os  and  vulva,  and  lubrifies 
the  passages,  thus  diminishing  friction  and  protecting  the  maternal  organs 
from  injury.  When  rupture  occurs  too  early,  and  before  the  foetus  has  been 
sufficiently  expelled,  the  parts  become  dry,  and  labor  is  always  longer, 
and  more  painful  and  difficult  for  the  mother,  while  it  is  often  fatal  to  the 
foetus. 

SECTION    III.    SYMPTOMS    AND    COURSE    OF    PARTURITION. 

The  physiological  phenomena  just  alluded  to,  and  by  which  the  foetus 
is  born,  are  collectively  designated  as  "  labor."  The  entire  period  of 
labor  is,  for  facility  of  description  and  study,  divided  into  a  certain  num- 
ber of  stages  or  periods — usually  three  or  four.  These  are:  i.  Prelimi- 
nary stage ;  2 .  Dilatatio?i  of  the  os  uteri ;  3 .  Expiilsioti  of  the  fcstus ;  4. 
Expulsion  of  the  membranes. 

I.  Preliminary  Stage. — Various  precursory  signs  announce  the  ap- 
proaching termination  of  pregnancy  and  the  advent  of  labor.  These  may 
be  observed  some  hours,  sometimes  even  for  days,  before  that  event 
occurs. 

One  of  the  most  important  signs  is  the  enlargement  and  increased  sen- 
sibility of  the  mammae,  to  which  the  excess  of  blood  no  longer  required 
in  the  uterus  is  directed.     These  glands  become  voluminous,  hard  and 


220  NORMAL  PARTURITION. 

tender  ;  and  this  phenomenon  is  more  particularly  remarkable  in  those 
animals  whose  milk  is  not  utilized  after  the  young  have  been  weaned. 
The  mammary  glands  then  become  soft,  flaccid,  and  small,  and  cease 
to  secrete.  In  such  animals  as  the  Mare  and  Ewe,  these  glands,  ordi- 
narily small  and  scarcely  perceptible,  before  parturition  become  so  re- 
markably developed  as  to  cause  alarm  in  people  who  do  not  understand 
the  cause.  With  the  Mare  especially,  the  development  of  the  mammae 
is  sometimes  so  considerable,  that  the  engorgement  extends  beneath  the 
abdomen  and  simulates  oedema,  or  it  ascends  between  the  thighs  as  high 
as  the  vulva  as  a  prominent  ridge,  while  the  skin  in  this  region  is  red- 
dened. At  a  later  period,  the  teat  yields  a  serous  fluid  on  pressure,  or 
this  constitutes  a  crust  around  it ;  this  fluid  afterwards  becomes  some- 
what lactescent,  and  finally  appears  as  the  "colostrum  "  or  first  milk. 

Another  premonitory  sign  is  the  tumefaction  of  the  vulva,  increase  of  the 
space  between  the  labia,  which  become  soft  and  flabby^  while  their  lining 
membrane  is  reddened,  and  a  viscid  glairy  mucus  covers  it.  This  mucus, 
derived  from  the  vaginal  lining  membrane,  soon  becomes  so  abundant 
that  it  is  discharged  in  long  filamentous  streams,  particularly  in  the  Cow, 
and  soils  the  tail  and  hooks  j  it  is  destined  to  lubricate  the  genital  pas- 
sages, and  facilitate  the  extrusion  of  the  foetus. 

With  these  changes,  the  abdomen  falls,  or  rather  becomes  more  pen- 
dent ;  the  croup  looks  hollow,  as  do  the  flanks,  due  to  the  relaxation  of 
the  broad  ligaments.  The  spine,  particularly  in  the  lumbar  region,  be- 
comes more  horizontal  and  rather  inclines  downward,  as  if  yielding  to 
the  weight  of  the  abdomen.  The  haunches  appear  to  be  wider  apart, 
and  the  gluteal  muscles  to  subside,  owing  to  the  falling  in  or  modification 
of  the  sacro-ischiatic,  as  well  as  the  sub-ischiatic,  ligaments,  from  serous 
infiltration. 

The  animal  walks  sluggishly  and  unwilingly,  and  if  grazing  with 
others,  does  not  appear  to  care  about  following  them.  Sometimes,  as 
has  been  mentioned,  there  is  swelling  of  the  limbs,  particularly  the  hind 
ones. 

If  very  careful  vaginal  exploration  be  made  at  this  time,  it  will  be 
found  that  the  cervix  uteri  has  become  a  part  of  the  uterine  cavity,  and  is 
almost  completely  effaced,  being  reduced  to  merely  a  thin  circular  ring ; 
its  tissue  is  soft,  and  the  os  is  slightly  open  in  l^iose  animals  which  have 
previously  had  young. 

As  parturition  draws  nearer,  these  phenomena  are  more  marked.  The 
animal  also  begins  to  be  restless,  and  continually  agitated  ;  if  feeding,  it 
stops  for  some  moments,  as  if  listening  to  some  sound  only  audible  to 
itself,  or  as  if  experiencing  some  strange  internal  sensation  for  the  first 
time,  and  which  may  certainly  be  the  preparatory  or  commencing  contrac- 
tions of  the  uterus.  Not  unfrequently  the  animal  lies  down  and  gets  up 
again,  as  if  suffering  from  colic.  Some  are  quite  mute,  though  anxious 
and  uneasy  ;  while  others,  in  addition  to  exhibiting  restlessness  and  dis- 
tress, utter  a  half-stifled  cry  of  pain.  The  Mare  whisks  its  tail,  the  Cow 
bellows,  the  Ewe  bleats,  the  Bitch  often  whines,  and  the  Cat  emits  a  low 
cry  as  if  in  suffering.  If  the  animal  is  at  liberty,  it  seeks  a  remote  quiet 
place  in  which  to  bring  forth  its  young  ;  while  some — such  as  the  Bitch, 
Cat,  Sow,  and  Rabbit — prepare  a  special  nest. 

2.  Dilatation  of  the  Os  Uteri. — The  limit  between  this  stage  and  the 
former  is  not  so  well  marked  as  our  division  would  indicate.  Neverthe- 
less, it  is  meant  to  imply  that  the  stage  of  dilatation  of  the  os  terminates 


PHYSIOLOGY  OF  PARTURITION.  221 

pregnancy  and  ends  with  complete  extension  in  width  of  that  uterine 
passage.  It  is  marked  by  increasing  uneasiness  of  the  animal  :  pawing, 
lying  down  and  rising  frequently  in  a  kiud  of  objectless  fashion,  while  the 
expression  of  the  physiognomy  betrays  suffering.  When  the  uterine  con- 
tractions really  commence,  the  creature  suddenly  stops,  as  if  surprised  by 
the  pain  ;  its  eye  looks  animated  and  expresses  anguish  ;  the  skin  is  hot, 
pulse  quickened,  visible  mucous  membranes  injected  ;  the  abdominal 
walls  are  rigid  and  contracted,  the  flank  is  tense,  and  very  frequently 
fasces  or  urine  are  voided.  During  this  pain,  if  the  cervix  uteri  is  ex- 
plored, it  will  be  found  that  its  attenuated  border  has  a  tendency  to  be- 
come hard  and  prominent.  When  the  pain  has  passed,  calm  succeeds  ; 
the  cervix  becomes  thick  and  elastic,  and  the  os  is  markedly  enlarged. 
Each  pain  lasts  for  some  seconds  to  two  or  three  minutes,  the  interval  of 
quiet  continuing  to  about  fifteen  minutes  at  first ;  though  it  diminishes 
when  the  contractions  become  more  frequent,  more  energetic,  and  more 
prolonged,  and  dilatation  of  the  os  progresses.  Then  the  fcetal  membranes 
begin  to  be  detached  from  the  inner  surface  of  the  uterus  and  enter  the 
OS,  whence  they  pass  into  the  vagina  and  between  the  labia  of  the  vulva, 
where  they  appear  externally  as  the  "water-bag."  In  the  mean  time,  the 
fore  limbs  and  the  nose  and  head  of  the  foetus  enter  the  os,  and  dilate  it 
to  its  fullest  extent,  when  the  cavity  of  the  uterus  forms  a  canal  continu- 
ous with  the  vagina. 

3,  Expulsion  of  the  Foetus. — The  pains  become  more  severe,  frequent, 
and  sustained,  and  to  the  uterine  contractions  are  added  those  of  the 
diaphragm,  and  abdominal  and  other  muscles.  If  the  animal  is  stand- 
ing, it  brings  all  its  limbs  under  the  body,  arches  the  back,  elevates  the 
tail,  slightly  flexes  the  hocks,  makes  a  deep  inspiration,  closes  the  glottis 
to  imprison  the  air  in  the  chest,  and  by  a  powerful  contraction  of  all  the 
muscles  of  the  trunk,  it  brings  such  an  amount  of  pressure  to  bear  on  the 
foetus  as  to  propel  it  into  the  pelvic  cavity,  and  rupture  the  chorion.  At 
leach  contraction  the  "  water-bag,"  formed  by  the  allantois  and  amnion, 
^protruded  beyond  the  vulva,  increases  in  volume.  It  varies  in  different 
fanimals  ;  being  in  the  Cow  about  as  large  as  the  bladder  of  a  Pig,  and 
tin  the  Bitch  the  size  of  the  carp's  swimming  bladder.  When  it  is  very 
[large  in  advanced  parturition,  it  is  reckoned  a  good  sign  ;  though  it  may 
[not  indicate  a  good  presentation  of  the  foetus,  nor  an  easy  birth. 

The  water-bag  soon  ruptures,  and  its  contents  partly  escape  ;  that 
[behind  the  thorax  of  the  foetus  being  retained,  and  voided  only  in  small 
^quantity  as  the  uterus  contracts.  When  the  membranes  are  thinner  and 
^weaker  than  usual,  they  may  rupture  before  the  os  is  completely  dilated,  , 
tand  then  the  fluid  escapes  in  a  small  quantity  at  a  time  \  this  frequently 
^happens  with  primiparae,  though  it  is  sometimes  observed  in  protracted 
[labor,  which  is  the  most  painful.  In  general,  however,  no  harm  results 
^from  this  premature  rupture  if  parturition  is  not  too  long  delayed  ;  indeed, 
iin  some  cases  it  may  be  useful,  as  when  the  uterus  is  over-distended  with 
puid  in  hydramnios,  when  its  discharge  allows  the  organ  to  contract  more 
^freely.  In  other  instances  the  membranes  are  remarkably  strong  and 
iresisting,  and  withstand  the  contractions  for  a  long  time  after  they  have 
[been  extruded  beyond  the  vulva  ;  their  artificial  rupture  may  even  be 
trequired.  Sometimes  they  do  not  rupture  at  all,  and  the  foetus  is  born  in 
them,  or  even  after  them,  as  has  occurred  in  the  Cow.  The  rupture 
lusually  occurs  at  the  most  dependent  part  of  the  bag,  at  the  uterine  orifice, 
towards  the  os,  or  in  front  of  it.     Then  succeeds  a  brief  interval  of  quiet 


222  NORMAL  PARTURITION. 

— the  foetus  being  meanwhile  retained  in  the  uterus — during  which  the 
organ  is  closely  applied  to  the  body  of  the  foetus,  and  is  preparing  itself 
for  a  final  effort,  which  is  soon  made.  The  contractions  are  most 
energetic  and  rapid,  and  every  time  they  are  made  the  waters  flow  in 
small  quantity,  moistening  and  relaxing  the  parts  ;  the  foetus  passes  on 
until  the  fore  feet  and  muzzle,  forming  a  kind  of  cone,  appear  at  the 
vulva,  the  orifice  of  which  is  opened  by  them.  When  the  head  has  cleared 
the  vulva,  there  is  usually  a  short  pause,  as  if  to  allow  the  tissues  of  this 
region  to  become  accustomed  to  the  distention,  and  to  prepare  them  for 
the  still  greater  strain  which  is  yet  to  be  imposed  on  them.  The  thorax 
and  shoulders  of  the  foetus  have  now  arrived  at  the  inlet  of  the  pelvis, 
and  as  they  form  the  deepest  and  most  difficult  part  of  the  young  crea- 
ture's body,  the  contractions  which  ensue  for  its  complete  expulsion, 
though  most  powerful  and  continuous,  only  impel  it  slowly  towards  the 
outlet,  on  arriving  at  which  a  more  energetic  and  painful  effort  than  all 
the  others  pushes  it  through.  The  act  may  now  be  said  to  have  termi- 
nated ;  as  to  expel  the  croup  requires  only  a  few  comparatively  weak 
throes,  and  the  weight  of  the  anterior  part  of  the  body  of  the  foetus, 
hanging  beyond  the  vulva,  greatly  aids  them.  It  is  rare  indeed  that  the 
croup  offers  a  serious  obstacle  to  expulsion. 

During  this  act  the  creature  betrays  evidence  of  pain,  especially  if  it  be 
a  primipara  ;  and  this  is  particularly  marked  when  the  head  of  the  foetus 
passes  through  the  still  incompletely  dilated  os,  and  still  more  so  when 


Fig.  56. 
Cow  IN  THE  Act  of  Parturition  :    Standing  Position. 

the  chest  and  shoulders  distend  the  tissue  of  the  vulva  and  perineum  to 
the  utmost.  Then  the  pulse  is  hard  and  frequent,  and  the  skin  hot — 
sometimes  covered  with  perspiration — or  the  body  is  rigid.  The  Bitch 
and  Cat  often  utter  a  cry  of  pain  as  the  head  and  chest  pass  through  the 
vulva. 

After  the  young  animal  is  expelled,  the  umbilical  cord  is  torn,  and  the 
liquor  amnii  remaining  in  the  uterus  escapes,  accompanied  or  followed  by 
a  little  blood  resulting  from  the  sudden  separation  of  the  placentas. 

The  position  assumed  by  animals  during  parturition  is  somewhat  varia- 
ble. The  larger  animals  which  usually  only  bring  forth  one  at  a  birth, 
such  as  the  Mare,  Cow,  and  Sheep,  ordinarily  do  so  standing  ;  and  this 
position  has  the  following  advantages ;  the  vertebro-sacral  angle  is  effaced, 


PHYSIOLOGY  OF  PARTURITION. 


223 


and  the  obstacle  that  its  projection  might  offer  to  the  passage  of  the  foetus 
into  the  pelvis  is  diminished  ;  the  auxiliary  muscles — abdominal  and 
diaphragmatic — can  act  more  energetically ;  the  young  creature,  being 
sustained  by  the  umbilical  cord  when  it  has  cleared  the  vulva,  glides 
gently  on  the  half-flexed  hocks  of  the  parent,  and  so  reaches  the  ground 
without  injury  (Fig.  56). 

Such  an  attitude,  however,  is  far  from  being  constant  with  these 
animals  ;  and  very  often,  especially  with  the  Cow,  they  bring  forth  in  a 
reclining  position — maintained  from  the  very  commencement  of  the  act, 
and  only  rising  when  birth  is  completed  (Fig.  57).  These  cases,  which 
are  quite  natural,  though  debility  maybe  present,  offer  nothing  particular 
in  the  position  of  the  female  ;  it  being  merely  that  assumed  on  ordinary 
occasions,  though,  of  course,  parturition  is  more  difficult. 

The  animal  rests  on  the  sternum,  the  body  inclined  to  the  right  or  left 
side,  the  fore  limbs  flexed  beneath  the  chest,  and  the  hind  ones  beneath 
the  abdomen.  In  this  attitude  labor  is  carried  on  somewhat  as  when 
standing.  The  creature  reclining  on  the  breast  and  partially  on  the  quar- 
ter, arches  the  back  in  straining,  slightly  raises  itself  on  the  hind  feet, 
and  drops  again  when  the  pain  has  subsided. 


f  Fig.  57. 

Mare  in  the  Act  of  Parturition  :   Recumbent  Position. 

It  is  rare  indeed  that  these  animals  lie  full  length  on  one  side  of  the 
body  during  parturition,  and  when  it  does  occur  it  nearly  always  indicates 
a  long,  difficult,  exhausting  labor. 

Multiparous  animals — as  the  Bitch,  Cat,  and  Sow — always  assume  the 
recumbent  position,  and  lie  reclining  on  one  side,  with  the  body  disposed 
in  a  semicircular  fashion,  the  head  towards  the  tail.  This  position 
appears  to  be  very  favorable  to  birth,  the  sacro-vertebral  angle  being 
effaced,  and  the  young  being  spared  the  risk  of  falling  ;  in  addition,  each 
fcetus  as  it  issues  from  the  vulva  is  within  reach  of  the  mother's  mouth  -, 
so  that  it  can,  without  disturbing  itself,  remove  the  membranes  from  it, 
divide  the  umbilical  cord,  clean  it  with  its  tongue,  put  it  in  a  proper  posi- 
tion, and  even  direct  its  head  towards  the  teat,  in  order  to  get  it  soothed 
while  another  is  born.  It  may  be  remarked  that,  with  the  Sow,  the 
creature  is  expelled  with  such  force  from  the  vulva,  that  it  often  turns  a 
somersault.     It  may  also  be  observed,  that  with  the  small  multiparous 


224  NORMAL  PARTURITIONr 

animals  the  "water-bag"  usually  only  appears  with  the  first  of  the  litter, 
the  others  being  preceded  or  followed  by  their  ruptured  membranes. 

The  total  duration  of  parturition  is,  of  course,  extremely  variable,  not 
only  according  to  accidental  circumstances,  individual  peculiarities,  and 
species,  but  even  in  the  same  animal  at  different  births.  With  the  Mare 
it  is  usually  brief,  and  is  ordinarily  accomplished  in  about  ten  minutes, 
sometimes  in  five  ;  though  it  may  extend  to  a  quarter  or  half  an  hour, 
rarely  more.  This  rapidity  appears  to  be  due  to  the  fact  that  the  placenta 
is  detached  from  the  uterus  during  the  early  pains,  and  consequently  the 
foetus  cannot  live  long  after  this  occurs — three  hours  being  supposed  to 
be  the  limit — unless  it  can  breathe  by  the  lungs.  The  duration  in  the 
Cow  is,  on  the  average,  one  to  two  hours  ;  though  it  may  only  be  about 
half  an  hour,  or  be  extended,  without  injury  to  the  calf,  to  one  or  two 
days.  With  Cows  at  pasture  or  which  do  no  work,  it  is  sometimes  only 
fifteen  minutes.  With  the  sheep  the  period  is  also  brief,  being  about 
fifteen  minutes.  If  there  are  several  lambs,  there  is  usually  an  interval 
of  fifteen  minutes  to  two  hours  between  them  :  the  second  and  succeeding 
births  being  always  quicker  than  the  first. 

With  multiparous  animals — Sow,  Bitch,  and  Cat — there  is  ordinarily  a 
period  of  ten  or  fifteen  minutes,  half  an  hour,  an  hour,  or  even  more 
between  each  birth.  Not  unfrequently  the  Sow  brings  forth  ten  young 
ones  within  the  course  of  an  hour. 

We  have  mentioned  thsif  with  those  animals  which  are  delivered  in  a 
standing  position,  the  ummical  cord  is  ruptured  when  the  young  creature 
reaches  the  ground,  and  usually  close  to  its  abdomen.  If  the  mother  is 
recumbent  when  the  offspring  is  born,  the  cord  is  torn  as  she  gets  up, 
which  is  usually  immediately  after  parturition.  The  circulation  in  and 
by  the  cord  being  incomplete  shortly  before  and  during  labor,  its  texture 
appears  to  undergo  a  kind  of  softening  that  favors  rupture  ;  while  owing 
to  the  vessels  being  reduced  in  size,  and  the  way  in  which  their  rupture 
occurs,  haemorrhage  is  trifling.  Sometimes,  however,  the  cord  is  suffi- 
ciently strong  and  elastic  to  resist  spontaneous  rupture,  and  the  young 
creature  is  born  with  the  membranes  attached  to  it  by  means  of  this  bond 
of  union.  The  mother  then,  by  a  remarkable  instinct,  in  cleansing  the 
young  creature  with  its  tongue,  gnaws  through  the  cord  and  sets  free  its 
progeny.  The  Mare  and  Cow  have  been  known  to  do  this  at  times  ; 
otherwise,  it  is  usually  done  by  the  carnivora. 

Whether  the  cord  be  ruptured  spontaneously  or  gnawn  through  by  the 
parent,  there  is  nothing  to  be  feared  from  haemorrhage  from  either  the 
foetal  or  placental  end ;  for,  contrary  to  what  is  observed  in  the  human 
species,  the  blood  has  very  little  tendency  to  flow  from  the  umbilical 
vessels,  and  the  laceration  and  cold  soon  check  any  slight  escape.  But  it 
may  sometimes  happen  that  it  is  necessary  to  divide  the  cord  at  a  short 
distance  from  the  umbilicus,  and  this  is  usually  effected  either  by  scrap- 
ing, torsion,  or  cutting  directly  through  it  by  the  bistoury  or  scissors. 
Even  here  there  is  little  to  apprehend  from  bleeding.  Rainard,  in  thirty 
years'  experience,  and  other  authorities,  have  never  observed  any  harm  to 
result ;  and  the  cases  in  which  there  was  danger  are  certainly  very  few. 
Rainard  quotes-from  Brugnone,  that  Be'ranger  of  Carpi  has  seen  Horse 
and  Ass  foals  perish  from  haemorrhage  through  the  cord  having  been  cut 
and  no  ligature  applied ;  and  Peuch  has  witnessed  a  case  of  umbilical 
haemorrhage  in  a  new-born  calf  from  which,  notwithstanding  a  thread  tied 
round  the  cord,  the  blood  escaped  in  drops  ;  another  ligature  placed 


PHYSIOLOGY  OF  PARTURITION.  225 

above  the  other  did  not  check  this  escape,  and  it  was  necessary  to  fix  a 
compress,  steeped  in  perchloride  of  iron,  along  the  course  of  the  cord 
before  the  haemorrhage  could  be  checked.  It  must  be  borne  in  mind 
that  similar  accidents  are  possible,  if  a  ligature  is  not  applied  an  inch  or 
so  from  the  umbilicus.  Whether  it  be  tied  or  not,  the  portion  remaining 
attached  to  the  umbilicus  soon  becomes  dry  and  withered,  and  falls  off 
in  a  few  days  after  birth  ;  the  other  end  most  frequently  hanging  to  the 
fcetal  membranes,  which  immediately  after  parturition  protrude  from  the 
vagina. 

4.  Expulsion  of  the  Membranes. — The  expulsion  of  the  fcetal  membranes, 
or  "afterbirth,"  as  they  are  sometimes  designated,  may  occur  at  birth, 
immediately  after,  or  be  delayed  for  a  variable  period  :  this  depending 
not  only  upon  accidental  circumstances  and  individual  peculiarities,  but 
also  upon  species,  and,  consequently,  the  placental  connections. 

Immediately  after  the  foetus  is  expelled,  the  uterus  contracts  energeti- 
cally on  itself,  and  its  internal  capacity  rapidly  diminishes  ;  consequently, 
the  placental  villosities  are  detached  from  their  alveoli,  the  uterine  and 
chorionic  surfaces  become  wider  apart,  and  the  placenta  is  ultimately 
separated  from  the  uterus.  The  same  contractions  which  loosened  them, 
are  also  instrumental  in  forcing  the  membranes  through  the  gaping  flaccid 
OS  into  the  vagina  ;  and  the  auxiliary  muscles,  being  again  stimulated  by 
their  presence  here,  as  they  were  by  the  head  of  the  foetus  in  the  same 
passage,  add  their  powerful  contractions  ;  so  that  these  new  pains,  aided 
by  the  physical  weight  of  the  extruded  portion  with  its  appended  umbili- 
cal cord,  soon  bring  the  whole  mass  away.  The  contractions  of  the 
vagina  have  probably  little,  if  any  thing,  to  do  with  this  expulsion,  which 
is  rarely  followed  by  hemorrhage  in  animals;  though  in  woman,  oVvingto 
the  inertia  of  the  uterus,  this  accident  is  not  at  all  uncommon.  Some- 
times the  expulsion  of  the  membranes  is  expedited  by  the  young  creature, 
as  it  descends  from  the  vulva. 

With  the  Mare,  owing  to  the  disseminated  placenta  and  the  slight 
adherence  of  the  placental  villi,  the  separation  of  the  membranes  takes 
place  rapidly  ;  indeed,  the  foal  is  not  unfrequently  born  in  the  intact, 
envelopes.  But  generally  only  a  few  minutes  elapse  before  the  afterbirth 
is  detached.  Retention  of  the  placenta  is  therefore  exceedingly  rare  in 
the  Mare,  though  it  is  very  dangerous  ;  as  in  attempting  to  remove  it  there 
is  great  risk  of  haemorrhage. 

With  the  Cow,  because  of  the  multiple  placentulae,  the  number  of  which 
may  be  over  a  hundred,  the  adhesion  between  the  uterus  and  foetal  mem- 
branes is  very  intimate  ;  while  the  small  volume  of  the  cotyledons  offers 
but  little  surface  for  the  uterine  contractions  to  act  upon.  So  that  while 
it  happens  that  the  calf  is  never  born  in  its  intact  envelopes,  it  also  occurs 
that  the  afterbirth  is  only  slowly  and  tardily  extruded  :  two,  four,  or  more 
hours,  or  even  days,  being  required  ;  and,  indeed,  it  is  not  at  all  rare  for 
retention  to  take  place  in  this  animal,  and  the  envelopes  require  to  be 
removed  artificially. 

Multiparous  animals  get  rid  of  the  envelopes  as  they  expel  the  foetuses, 
the  birth  of  the  first  being  followed  in  a  very  brief  space  by  its  mem- 
branes ;  after  which  comes  the  second  foetus,  then  its  envelopes,  and  so 
on  ;  so  that  only  those  of  the  last  foetus  may  be  retained — an  accident 
which  sometimes  occurs.  In  these  animals,  the  membranes  appear  to 
be  expelled  without  any  difficulty  ;  the  Bitch,  for  instance,  runs  into  a 
corner,  and  assuming  a  position    as  if  about  to  micturate,   expels   the 

15 


2  26  NORMAL  PARTURITION. 

secundines  of  the  last  puppy,  devours  them,  and  returns  to  the  other 
puppies. 

With  animals  usually  uniparous,  but  which  sometimes  bring  forth 
two  or  mqre  young,  the  envelopes  of  each  foetus  are  expelled  immedi- 
ately after  it  is  born,  so  long  as  they  do  not  offer  an  obstacle  to  the 
passage  of  the  next  foetus  ;  so  that  in  a  double  birth  in  the  Cow  or  Ewe, 
a  foetus  being  lodged  in  each  horn,  the  second  may  be  born  without  the 
envelopes  of  the  first  having  been  discharged. 

We  may  here  note  the  strange  instinct  which  impels  not  only  carnivor- 
ous and  omnivorous,  but  also  herbivorous  animals — Bitch,  Cat,  Sow,  Cow, 
and  even  sometimes  the  Mare — to  devour  the  membranes  as  soon  as  they 
are  expelled,  if  they  are  not  quickly  removed  from  beyond  their  reach  ; 
at  times  they  even  devour  them  as  they  are  being  extruded,  and  the  work 
of  delivery  is  thus  hastened.  However  unnatural  and  disgusting  this 
propensity  may  appear,  and  though  the  cause  for  it  is  unknown,  it  does 
not  occasion  any  visible  inconvenience  to  the  creature. 

It  has  been  already  remarked,  that  when  the  young  creature  is  expelled 
in  its  intact  envelopes,  the  mother,  if  at  large,  frees  it  from  them  by 
gnawing  them  through  ;  more  rarely  does  the  progeny  release  itself  by 
its  own  efforts.  If  the  mother  should  chance  to  be  tied  up,  as  in  a  stall, 
assistance  may  be  required  to  cut  the  umbilical  cord  and  extract  the 
young  animal  from  its  imprisoning  membranes,  as  it  may  become  as- 
phyxiated. This  peculiarity  is  most  frequently  observed  in  the  Mare, 
with  which  birth  is  always  rapid,  and  the  chorion  strong  and  easily  de- 
tached from  the  uterus.     Rueff  states  that  it  is  not  unusual  in  the  Sow. 


CHAPTER  II. 

Presentations  of  the  Fcetus  and  Mechanism  of  Parturition. 

In  addition  to,  and  to  a  certain  extent  independent  of,  the  physiological 
phenomena  of  gestation  and  parturition,  there  are  in  the  latter  certain 
physical  and  mechanical  acts  which  have  been,  as  Saint  Cyr  truly  re- 
marks, hitherto  very  imperfectly  studied  in  veterinary  medicine,  but 
whose  consideration  is,  nevertheless,  very  important  in  a  practical  point 
of  view. 

These  acts  are  related  to  the  manner  in  which  the  foetus  presents  at 
the  pelvic  inlet  for  passage  through  the  outlet,  and  the  way  in  which  this 
passage  is  effected;  they  belong,  in  fact,  to  the  presentations  and  posi- 
tions of  the  foetus,  and  the  mechanism  of  parturition. 

The  presentations  and  positions  of  the  foetus  during  parturition,  as  well 
as  the  mechanism  of  that  act,  are  of  much  practical  importance  to  the 
veterinary  obstetrist,  and  demand  careful  consideration.  We  have  re- 
peatedly alluded  to  the  position  of  the  foetus  in  the  uterus  during  gesta- 
tion, and  have  stated  that  this  position  is  changed  as  parturition  draws 
near.  What  the  agency  or  influence  may  be  which  induces  this  change, 
has  not  been  ascertained  ;  but  it  has  been  surmised  that  it  is  due  to  an 
instinctive  tendency  of  the  fcetus  to  assume,  towards  the  termination  of 
pregnancy,  the  position  most  favorable  for  its  exit  through  the  pelvic  cav- 
ity;  though  it  is  indeed  very  questionable  whether  the  instinctive  facul- 


PRESENTATIONS  OF  THE  FCETUS, 


227 


ties  of  the  young  creature  are  already  sufficiently  developed  to  bring 
about  this  result,  which  may,  after  all,  be  due  to  some  reflex  action. 
However  this  may  be,  it  is  certain  that  the  foetus  is  very  far, from  being 
always  in  this  favorable  position,  and  that  the  resources  of  art  are  often 
needed  to  remedy  the  false  positions  the  young  creature  may  have  as- 
sumed at  the  termination  of  gestation. 

In  studying  the  various  positions  and  attitudes  the  foetus  assumes  at 
birth,  and  the  consequent  presentations  it  offers  towards  the  anterior 
opening  of  the  pelvis,  there  is  to  be  considered  (i)  the  region  of  its  body 
which  is  first  presented  to  the  pelvic  inlet,  and  (2)  the  relations  of,  or 
correspondence  between,  this  region  and  the  shape  and  dimensions  of 
the  pelvic  cavity  itself. 

The  first  has  been  designated  \\i^ presentation,  and  the  second  i\\& posi- 
tion of  the  foetus  •  and  the  inlet,  instead  of  the  outlet,  of  the  pelvis  is  con- 
sidered in  this  respect,  because  it  is  the  most  important  in  practice,  and 
the  position  may  be  altered  either  spontaneously  or  artificially  during 
labor ;  indeed,  this  alteration  has  often  to  be  effected  by  the  obstetrist 
in  order  to  render  birth  possible, 

SECTION    I. PRESENTATIONS, 

The  presentation  results  from  the  part  of  the  foetus  which  first  offers 
itself  at  the  pelvic  inlet — that  region  of  the  young  creature  \vhich  the 
hand  of  the  obstetrist  immediately  meets  on  being  passed  into  the  os, 
and  which  is  directly  opposite  the  inlet.  In  this  sense  the  head,  fore 
feet,  hind  feet,  croup,  etc.,  are  said  to  be  presented,  according  as  one  or 
other  of  them  first  offers  itself  on  exploration. 

These  presentations  are  extremely  variable,  as  any  part  of  the  foetus 
may  occupy  this  situation  ;  though  so  far  as  description  and  compreli^n- 
sibility  are  concerned,  their  study  can  be  greatly  simplified.  As  Rainard 
says  :  "  The  foetus,  when  covered  by  its  envelopes,  is  oval  shaped,  or  like 
an  olive,  which  it  is  desired  to  pass  down  the  neck  of  a  bottle,  and  which 
may  be  presented  to  this  in  three  ways — either  by  one  of  its  two  ends  or 
by  its  middle."  These  ends  are  the  anterior  part  of  the  chest  in  front, 
and  the  croup  behind  ;  and  it  is  these  parts  on  which  the  classification  of 
'these  presentations  is  based.  This  classification  gives  two  longitudinal, 
and  an  anterior  and  posterior  presentation  ;  and  as  the  foetus  may  also 
offer  itself  across  the  long  axis  of  the  uterine  cavity,  we  have  a  transverse 
presentation,  which^  may  again  be  dorso-himbar  or  sterno-abdominal,  accord- 
ing to  the  side  of  the  foetus  which  presents.  These  four  fundamental 
presentations  are,  therefore  : 

1.  Anterior  Presentation. — The  chest  of  the  foetus  presents  towards  the 
[inlet,  and  is  preceded,  accompanied,  or  followed  by  the  head  and  fore 

limbs:  the  situation  and  direction  of  which  may  vary  without  altering  the 
I  essential  features  of  the  presentation. 

2.  Posterior  Presentation. — The  croup  or  breech  is  facing  the  inlet,  and 
the  presence  or  absence  of  the  limbs  there  only  constitute  varieties  of  the 
presentation. 

3.  Dorso-lumbar  Presentation. — Any  portion  of  the  upper  part  of  the 
(body  opposite  the  inlet.     Lecoq  and  Rainard  admit  presentations  of  the 

withers,  back,  loins,  shoulder  or  haunch,  as  distinct  presentations  ;  but  I 
agree  with  Saint-Cyr  in  declaring  the  distinction  to  be  practically  useless. 
On  exploring  the  pelvic  cavity,  no  matter  what  part  of  the  back  is  first 


228  NORMAL  PARTURITION. 

touched,  the  hand  always  encounters  the  spine  of  the  foetus,  either  di- 
rectly in  the  axis  of  the  pelvis,  or  obliquely  and  at  some  distance  from  it. 
All  these  varieties  may,  therefore,  be  reduced  to  the  one  now  named,  and 
which  may  be  either  direct  or  oblique,  according  as  the  case  may  be. 

Sterno-abdo7mnal  PresentaHo?t. — The  limbs  in  this  are  in  reality  first 
touched,  and  we  may  have  all  four,  or  only  three  or  two  ;  these,  however, 
are  not  the  fixed  point  of  the  presentation,  which  is  the  inferior  part  of 
the  body — or  sterno-abdominal  region — hence  the  designation. 

These  four  principal  presentations  may  be  divided  into  natural  ox  nor- 
mal,  in  which  spontaneous  or  unaided  birth  is  possible  ;  and  into  rmnat- 
ural ox  abnormal.,  in  which  parturition  is  impossible  without  the  interven- 
tion of  man.  The  longitudinal  presentations  alone  comprise  the  first, 
although  they  are  not  always  tiortnal :  as  a  wrong  direction  of  the  head 
or  limbs  may  prove  an  obstacle  more  or  less  difficult  to  overcome,  and 
may  require  the  aid  of  art.  So  that,  taking  this  view  into  consideration, 
the  presentations  may  either  be  simple,  or  more  or  less  complicated,  accord- 
ing to  circumstances. 

SECTION    II. — POSITIONS. 

The  presentation  being  determined  by  the  part  of  the  foetus  which 
offers  at  the  pelvic  inlet,  it  must  be  evident  that  this  part,  whichever  it 
may  be,  may  vary  considerably  in  its  relations  to  the  circumference  of 
that  passage.  If,  says  Saint-Cyr,  the  chest  of  the  foetus  first  enters  it,  the 
attitude  of  this  region  may  be  very  different  in  different  cases  ;  in  one  the 
withers  may  correspond  to  the  sacrum  of  the  mother,  and  the  sternum  to 
the  pubis,  or  the  reverse  may  happen  ;  in  another  the  foetus  may  be  lying 
on  the  right  side,  the  sternum  n:orresponding  to  the  right  branch  of  the 
mother's  ilium,  and  the  withers  to  the  left  ilium,  or  vice  versd.  So  that 
here  are  four  different  positions  in  the  same  presentation — the  anterior  ; 
and  it  will  readily  be  understood  that  it  should  be  the  same,  or  nearly 
the  same,  for  the  other  presentations. 

The  position  has  accordingly  been  defined  to  be  the  relation  of  a  de- 
terminate point  on  the  surface  of  the  foetus,  to  an  equally  determinate 
point  of  the  pelvic  circumference.  The  points,  so  far  as  the  mother  is 
concerned,  may  be  determined  once  for  all,  and  they  will  always  remain 
the  same  for  every  presentation  ;  they  may  be,  for  instance,  the  sacral 
region  above,  the  pubic  below,  and  the  two  ascending  branches  of  the 
ilium  at  the  sides.  If,  with  the  foetus,  we  select  any  region — say  the 
withers — and  put  this  part  in  relation  with  any  of  th^se  four  points  of 
the  pelvic  circumference,  we  shall  have  four  successive  and  easily  recog- 
nized positions.  If,  therefore,  we  first  give  the  name  of  the  region  in 
the  foetus,  and  next  that  of  the  pelvic  circumference  with  which  it 
is  in  relation,  we  have  a  ready  means  of  designating  the  positions  : 
describing  the  foetus  to  be  in  a  vertebrosacral  position,  for  instance,  when 
its  vertebral  region  is  in  relation  with  the  sacrum  of  the  mother.  The 
fixed  points  may  be  invariable  in  the  latter ;  but  they  cannot  be  so  with 
the  foetus,  as  they  will  vary  with  each  presentation. 

With  regard  to  the  anterior  and  posterior  presentations,  Rainard  has 
selected  the  fixed  points  as  follows :  for  the  first,  he  has  taken  the  spi- 
nous processes  of  the  dorsal  vertebrEe  in  the  region  of  the  withers  ;  for 
the  second,  the  lumbar  vertebrae.  For  the  positions  in  the  other  two  pre- 
sentations, he  has  not  been  so  fortunate  in  a  designation,  in  the  opinion 


PRESENTATIONS  OF  THE  FCETUS. 


229 


of  Saint-Cyr,  who  has  very  judiciously  proposed  others  which  are  more 
exphcit  and  comprehensible.  The  latter  gives  the  various  positions 
which  should  be  recognized  in  each  presentation,  as  follows  : — 

A.  Anterior  Position. — The  chest  of  the  foetus  is  at  the  pelvic  in- 
let, and  it  is  desired  to  make  known  what  relation  this  part  has  to  the  pel- 
vic circumference.  The  determinate  point  on  the  foetus  is  the  vertebra? 
of  the  withers  ;  and  these  may  be  in  relation  with  the  sg,crum  above, 
the  pubis  below,  the  right  ascending  branch  of  the  ilium  on  the  right 
side,  and  the  left  ditto  on  the  left.  From  this  we  have  four  positions, 
named  by  Saint-Cyr  as  follows  : — 

I.  Vertebrosacral  position  (J^ig.  c,8). — This  is  the  most  favorable  and 
the  most  frequent  of  all,  and  is  said  to  be  the  only  natural  position.  The 
vertebrae  of  the  foetus  correspond  to  those  of  the  mother,  its  withers 
touching  the  sacrum  of  the  latter,  the  belly  corresponding  to  the  abdom- 
inal parietes,  and  its  sternum  to  the  pubis.  This  is  sometimes  named 
the  _^rst  anterior  position. 


Fig.  58. 
Vertebro-sacral  Position  of  the  Fcetus. 

2.  Vertebro-pubic  Position. — This  is  exactly  the  inverse  of  the  first :  the 
foetus  lying  on  its  back,  its  withers  towards  the  pubis,  and  the  sternum 
opposed  to  the  sacrum  of  the  female.  This  is  also  named  the  second 
anterior  positio7i. 

3.  Left  Vertebro-ilial  Position. — The  fcetus  lies  in  the  right  flank,  its 
head  to  the  left  side  of  the  mother,  the  neck  being  in  the  same  direction, 
and,  when  passing  through  the  pelvic  cavity,  touching  the  ascending 
branch  of  the  left  ilium.  The  feet,  when  they  are  not  in  the  pelvis,  must, 
of  course,  be  sought  for  on  the  opposite  side,  towards  the  right  flank  of 
the  mother. 

4.  Right  Vertebro-ilial  Position. — This  is  exactly  the  reverse  of  the  last- 
described  position,  the  withers  corresponding  to  the  right  ilium. 

The  two  last  are  sometimes  named  the  lateral  positions.  They  are  less 
frequent,  as  primary  positions,  than  the  first  two,  and  are  sometimes  met 


230 


NORMAL  PARTURITION. 


with  as  secondary  positions  after  the  reduction  of  a  mal-presentation — 
chiefly  the  dorsal  or  ventral. 

B.  Posterior  Presentation. — In  this  the  cioup  or  breech  first  pre- 
sents at  the  pelvic  inlet.  The  lumbar  region  of  the  foetus,  which  is  the 
determinate  point,  may  be  directed  towards  the  sacrum,  the  pubis,  or  the 
right  or  left  branch  of  the  ilium  of  the  female.  Hence  we  have  four 
positions,  as  in  the  preceding  presentation.     These  are  : — 

I.  Lumbosacral Positioti. — The  foetus  is  in  what  some  authorities  have 
called  a  ''  natural  "  position,  but  which  is  asserted  by  others  to  be  unnatu- 
ral. The  loins  are  towards  the  sacrum  of  the  mother,  the  right  coxo- 
femoral  articulation  towards  the  right  ilium,  and  the  left  articulation 
towards  the  left  ilium.  This  is  sometimes  named  the  first  posterior  posi- 
tion. 


Fig.  59. 

LUM BO-SACRAL    POSITION. 

2.  Lumbo-puhic  Position. — Some  practitioners  designate  this  the  poste- 
rior reversed  position.  The  foetus,  in  fact,  is  lying  on  its  back,  its  croup 
and  loins  corresponding  to  the  pubis  of  the  mother,  while  the  limbs  are 
towards  the  sacrum,  against  which  they  are  more  or  less  pressed.  This 
is  sometimes  termed  the  second  posterior  position. 

3.  Left  Lumbo-ilial  Position. — The  fcetus  is  lying'  on  its  left  flank,  its 
croup  and  loins  opposite  the  ascending  branch  of  the  left  ilium  of  the 
female,  and  the  limbs  towards  the  right  flank,  where  they  must  be  sought 
for  if  they  do  not  present  in  the  pelvis. 

4.  Right  Lumbo-ilial  Position. — This  is  exactly  the  reverse  of  the  pre- 
ceding position. 

C.  Dorso-lumbar  Presentation.  —  Here  the  foetus  is  presented 
across  or  transverse^  and  it  may  lie  on  one  or  other  of  its  sides,  its  head 
towards  one  of  the  maternal  flanks,  and  the  body  curved  like  that  of  a 


PRE  SENT  A  TIONS  OF  THE  FCETC/S. 


231 


Doo"  asleep.  In  this  we  have  two  distinct  positions,  according  as  the 
fcetus  lies  on  one  side  or  the  other.  But  it  may  also  assume  a  third  and 
almost  vertical  position — the  croup  on  the  floor  of  the  abdomen  of  the 
mother,  and  the  creature  in  the  attitude  of  a  Dog  sitting. 

The  important  consideration  m  these  three  positions  is  related  to  the 
situation  or  direction  of  the  head  ;  as  if  this  is  known,  we  may  easily 
infer  that  of  the  other  parts  of  its  body,  and  thus  appreciate  the  indica- 
tions for  delivery  to  be  followed  in  this  pathological  presentation.  Ac- 
cording to  the  direction  of  the  head,  the  three  following  positions  are 
described  ; — 

I.  Right  Cephalo-ilial  Position. — The  fcetus  is  on  its  right  side,  which 
rests  more  or  less  directly  on  the  abdominal  walls  of  the  mother,  the 
head  in  the  right  flank,  the  croup  towards  the  left  flank,  the  body  more 
or  less  curved,  and  the  dorso-lumbar  region  towards  the  pelvis,  in  which 
it  presents  (Fig.  60). 


Fig.  60. 
Right  Cephalo-ilial  Position  of  the  Foetus. 

2.  Left  Cephalo-ilial  Position. — This  is  the  reverse  of  the  preceding. 

3.  Cephalo-sacral  Position. — In  this  position  the  foetus  is  presented  by 
[the  back,  and  in  an  almost  vertical  attitude  :  the  croup  resting  on  the 
[floor  of  the  mother's  abdomen,  the  head  more  or  less  depressed,  and 
[directed  forward  towards  the  sacro-lumbar  region — the  creature  being 
^seated,  as  it  were,  on  the  udder  of  its  parent  (Fig.  61). 


D.  Sterno-Abdominal  Presentation. — In  this  presentation  the  foe- 
[tus  offers  the  abdomen  to  the  inlet  of  the  pelvis,  and  on  exploration  the 
mand  first  meets  this  part,  and  two  or  more  of  the  limbs,  but  always  at 
lleast  a  hind  and  fore  one.  The  head  may  be  found,  or  it  may  be  out  of 
Freach.  The  sternum  and  other  parts  on  the  lower  surface  of  the  body 
^can  also  be  felt. 

In  this  presentation  there  are  two  principal  positions  : — 
I.  Left   Cephalo-ilial  Position. — The  foetus  lies  on  the  right  side,  th6 
[head  towards  the  left  ilium  of  the  mother,  and  the  croup  to  the  right 
milium  (Fig   62). 


232 


NORMAL  PARTURITION. 


2.  Right  Cephalo-ilial  Position. — This  is  the  reverse  of  the  preceding. 

Saint-Cyr,  who  has  mainly  followed  Rainard  in  the  definition  of  these 
presentations  and  positions  of  the  foetus,  insists  on  the  necessity  for 
studying  them  carefully,  as  by  so  doing  those  who  commence  the  prac- 
tice of  obstetricy  will  be  greatly  enlightened  as  to  the  diffiGulties  they 
may  encounter,  and  the  readiest  and  most  scientific  way  of  overcoming 
them  ;  while  this  study  will  enable  the  skilled  practitioner  to  describe  his 
interesting  cases  with  more  clearness  and  precision.  To  render  what  has 
just  been  stated  more  convenient,  the  following  table  is  given,  in  order 
to  show  at  a  glance  the  different  presentations  and  positions. 


Fig.  6i. 
Cephalo-sacral  Position  of  the  Fcetus. 

Presentations  and  Positions  of  the  Fcetus. 


Anterior  Positions       .     . 

Posterior  Positions      .     . 

Dorso-lumbar  Positions    . 
Sterno-abdominal  Positions 


13 


Vertebro-sacral. 
Vertebro-pubic. 
Right  Vertebro-ilial. 
Left  Vertebro-ilial. 
Lumbo-sacral. 

6.  Lumbo-pubic. 

7.  Right  Lumbo-ilial. 

8.  Left  Lumbo-ilial. 

9.  Right  Cephalo-ilial. 

0.  Left  Cephalo-ilial. 

1.  Cephalo-sacral. 

2.  Right  Cephalo-ilial. 
Left  Cephalo-ilial. 


SECTION    III. mechanism    OF   PARTURITION. 

Under  normal  conditions,  it  may  be  said  that  the  pelvis  itself  does  not 
offer  any  obstacle  to  the  passage  of  the  foetus,  and  that  it  is  the  soft  parts 
alone  which  oppose  its  exit. 


PRESENTATIONS  OF  THE  FOETUS. 


233 


Of  the  different  presentations  we  have  enumerated,  the  anterior — in 
which  the  fore  feet,  head,  and  chest  present  simultaneously — is  the  only 
one  we  may  designate  as  "  natural,"  especially  with  the  larger  animals 
and  primiparae. 

Fromage  de  Feugre  was  the  first  to  point  this  out,  though  Ramard  was 
of  opinion  that  the  posterior  presentation  should  also  be  looked  upon  as 
normal ;  while  Desplas  gave  three  natural  positions— head  and  fore  limbs, 
head  onlv,  and  hind  limbs  only  ;  and  Delwart  gives  four  normal  position-^. 
But  experience  abundantly  proves  that  the  first  we  have  described  is  that 
which  alone  merits  the  designation,  as  it  is  the  one  in  which  birth  can 
take  place  without  artificial   aid.     It  is  true  that  birth  is  possible  when 


Fig.  62. 
Sterno-abdominal  Position  of  the  Fcetus. 


the  foal  or  the  calf  presents  posteriorly  at  the  pelvic  inlet ;  but  this  is  a 
rare  presentation,  and  under  the  most  auspicious  circumstances  it  is  much 
less  favorable,  and  more  difficult  for  the  mother,  while  it  is  very  often 
death  to  the  young  animal  (especially  in  the  Mare).  In  the  majority  of 
cases,  without  assistance  expulsion  proceeds  no  further  than  the  hocks, 
and  the  fcetus  dies  ;  and  even  sometimes  with  assistance  much  force  is 
necessary  to  deliver.  Whereas,  in  the  anterior  presentation,  the  cases 
are  exceptional  (and  these  chiefly  in  primiparge)  in  which  even  slight 
traction  is  necessary. 

We  will  follow  Saint-Cyr  in  first  studying  the  mechanism  of  parturition 
in  this  presentation,  in  which,  of  the  four  positions  pertaining  to  it,  the 
vertebrosacral  is  by  far  the  most  frequent  and  favorable.  This  we  will  now 
notice. 

I.  Mechanism  of  Parturition  in  the  Anterior  Vertebra- sacral  Position. — In 
this  position  it  has  been  stated  that  the  fcetus  presents  simultaneously 
with  the  head  and  fore  limbs,  the  back  directed  to  that  of  the  mother  and 


234 


NORMAL  PARTURITION. 


the  withers  towards  the  sacrum.  When  perfectly  natural,  the  head  and 
fore  legs  first  enter  the  inlet  ;  the  head  is  extended,  forehead  looking 
upwards  to  the  sacrum,  chin  towards  the  pubis,  nose  forward,  the  lower 
jaw  resting  on  the  outstretched  limbs,  the  feet  of  which  extend  a  little 
beyond  the  nose.  Then  comes  the  neck,  and  after  it  the  chest  and 
shoulders,  which  arrive  at  the  inlet  w^hen  the  nose  and  feet  show  them- 
selves at  the  rulva. 

In  this  course  it  will  be  observed  that,  so  far  as  the  head  and  limbs  are 
concerned,  there  is  no  difficulty,  as  the  pelvic  diameter  readily  admits 
them  when  the  soft  parts  are  sufficiently  relaxed.  With  the  chest,  how- 
ever, there  is  difficulty,  as  its  diameter  is  greater  than  that  of  the  pelvis  ; 
and  the  question  is,  therefore,  how  it  is  got  through  the  canal.  In  1870, 
Saint-Cyr  saw  four  well-bred  harness  and  saddle  Mares  give  birth  to  foals 
at  tiie  Lyons  Veterinary  School.  Gestation  had  been  regular,  and  par- 
turition, which  was  easy  and  favorable,  did  not  exceed  the  ordinary  dura- 
tion. In  taking  the  diameters  of  the  maternal  pelvis  by  the  method  al- 
ready described,  and  those  of  the  foetus  (dorso-sternal,  biscapulo-humeral, 
and  bicoxo-femoral),  it  was  found  that  in  these  four  instances  the  biscap- 
ulo-humeral diameter — the  largest  in  the  chest — was  easily  accommo- 
dated in  the  bis-iliac  diameter  of  the  female  pelvis,  which  was  greater  by 
42,  45,  48,  and  even  52  millimetres  (from  i^^  to  2  inches)  ;  while  the 
sterno-dorsal  diameter  of  the  young  creatures  exceeded  that  of  the  sacro- 
pubic  region  in  the  mothers  by  28,  85,  87,  88  millimetres  (from  i  to  3^ 
inches).  This  part  of  the  body  of  the  foetus  had,  therefore,  to  undergo  a 
corresponding  reduction  in  a  vertical  direction  before  it  could  clear  the 
inlet;  and  even  if  we  take  into  account  the  excess  of  the  lateral  diameter 
of  the  pelvis,  it  will  be  found  that  the  thorax  and  withers  of  the  foetus 
still  notably  exceed  in  size  the  opening  through  which  they  must  pass. 
That  they  do  pass  through  it,  and  with  ease  in  the  majority  of  cases, 
wdthout  injury  to  the  mother,  or  the  young  creature,  is  a  matter  of  daily 
experience  ;  but  the  mechanism  by  which  the  reduction  is  effected  has 
been  much  discussed. 

Lafosse  endeavored,  in  the  last  century,  to  describe  it,  and  came  to  the 
conclusion  that  the  head  once  through  the  inlet,  the  shoulders  of  the  foal, 
which  exceed  the  withers,  pass  by  their  upper  part  in  front  of  the  neck, 
thus  forming  a  kind  of  channel  which  glides  along  the  maternal  sacrum  ; 
also  that  the  spinous  processes  of  the  withers,  wdiich  are  almost  cartilagi- 
nous, bend  back  on  each  other,  and  to  right  and  left  of  the  spine,  thus 
preventing  too  great  compression  of  the  chest.  Altogether,  he  concluded, 
that  the  foal,  in  its  passage,  becomes  moulded  in  such  a  manner  that  the 
chest  has  the  form  of  the  keel  of  a  ship  gliding  on  the  stocks,  and  in 
every  way  corresponds  to  the  mother's  pelvis,  whose  internal  contour  it 
assumes. 

Rainard,  however,  takes  a  slightly  different  view  of  this  matter ;  for 
while  admitting'  with  Lafosse,  the  inclination  backward  of  the  dorsal 
spines  as  a  first  cause  in  diminishing  the  vertebrc-sternal  or  perpendicular 
diameter  of  the  thorax,  he  cannot  admit  that  the  upper  border  of  the 
scapulae  lie  against  the  neck,  but  states  that  the  shoulders,  on  arriving  at 
the  pelvic  entrance,  come  in  contact  with  the  ascending  branches  of  the 
ilium,  and  are  thrown  back  somewhat,  leaving  the  front  part  of  the  chest 
free,  and  thus  diminishing  its  diameter.  He  also  adds  that  the  withers 
first  enter  beneath  the  sacrum  ;  that  the  sternum  below  is  pushed  back 
by  the  anterior  border  of  the  pubis,  and  the  chest  in  this  way  submits  to 
a  process  of  elongation  which  notably  diminishes  its  vertical  diameter. 


PRESENTATIONS  OF  THE  FCETUS.  235 

Saint-Cyr  agrees  with  Rainard  in  this  interpretation  of  the  real  mech- 
anism of  parturition  in  the  Mare.  The  sternum  in  being  carried  back- 
wards, also  pulls  back  the  ribs  attached  to  it,  and  this  not  only  diminishes 
the  chest  in  a  vertical,  but  also  in  a  horizontal  direction,  as  is  witnessed 
in  studying  the  mechanism  of  respiration  in  the  living  animal,  in  which, 
during  expiration,  the  chest  decreases  in  width  and  depth.  When  the 
chest  is  so  altered  during  parturition,  the  foetus  becomes,  as  it  were,  elon- 
gated by  this  part  being  depressed  :  an  alteration  which  occurs  all  the 
more  readily,  from  the  bones  composing  the  thorax  being  soft  and  supple, 
and  the  organs  they  enclose  (the  lungs)  not  being  so  developed  as  they 
are  immediately  afterwards  ;  so  that  a  moderate  amount  of  pressure, 
provided  it  is  not  too  long  continued,  may  be  borne  with  comparative 
impunity. 

In  the  larger  animals,  the  pelvis  cannot  undergo  any  sensible  increase 
in  size  during  the  passage  of  the  deepest  portion  of  the  foetal  body 
through  the  inlet,  which  is,  in  the  Mare,  an  absolutely  inextensible  bony 
girdle.  Lafosse  has  sawn  through  the  pubis  of  Mares  about  to  foal,  and 
he  found  that  during  parturition  there  was  only  a  space  of  two  lines  be- 
tween the  sawn  margins.  So  that  it  is  the  body  of  the  foetus  which  has 
to  accommodate  itself  to  this  part  of  the  passage  at  this  stage  of  delivery. 

When,  however,  it  has  passed  through  the  inlet,  extensibility  of  the 
maternal  tissues  can,  and  does,  take  place,  and  permits  an  enlargement 
of  the  canal.  The  wide  sacro-ischiatic  ligaments  which  enclose  the  pelvis 
laterally,  are  softened  and  more  elastic  during  birth  ;  the  sacro-iliac  and 
sacro-lumbar  articulations  are  increased  in  mobility  ;  and  even  the  pos- 
terior part  of  the  ischio-pubic  symphysis  may  become  slightly  relaxed. 
So  that  when  once  approaching  the  outlet  the  progress  of  birth  is  more 
rapid,  and  this  progress  may  be  aided  if,  as  is  pointed  out  by  Lafosse, 
the  tail  of  the  animal  is  well  elevated. 

A  slight  check  to  expulsion  is  observed  (especially  in  the  Mare)  when 
the  croup  arrives  at  the  inlet,  as  this  part  nearly  corresponds  in  diameter 
to  this  opening,  being,  if  any  thing,  slightly  less.  However,  notwith- 
standing this,  in  consequence  of  the  croup  being  less  susceptible  of 
diminution  than  th'e  chest,  and  although  the  bones  may  yield  to  some 
extent,  friction  will  occur,  more  particularly  if  the  croup  is  largely  devel- 
oped, which  it  is  in  some  foals.  One  haunch  may  pass  into  the  inlet 
before  the  other,  however,  and  thus  facilitate  the  passage. 

With  the  Cow,  the  mechanism  of  parturition  in  this  presentation  is 
similar  to  that  in  the  Mare.  Saint-Cyr  shows,  from  actual  measurements 
of  Cow  and  foetus,  that  the  head  of  the  calf  can  easily  pass  into  the  inlet, 
owing  to  its  less  diameter  ;  and  that  the  principal  difficulty  is  encountered 
by. the  foetal  thorax,  which  is  slightly  larger  in  every  sense  than  the  inlet.* 

The  bicoxo-femoral  diameter  of  the  croup  slightly  exceeds  the  bis-iliac 
diameter  of  the  pelvis  ;  but  it  is  possible  that  the  pelvis  of  the  calf  being 
more  cartilaginous  and  supple  than  that  of  the  foal,  may  be  submitted  to 
a  slight  temporary  compression.  It  is  to  be  remarked,  however,  that  the 
progress  of  the  calf  through  the  pelvis  must  be  more  protracted  than  that 
of  the  foal,  owing  to  the  greater  length  of  the  maternal  pubic  symphysis, 
and  the  more  considerable  extent  of  the  pelvic  walls,  as  well  as  the  pecu- 
liar curve   in   the   floor  of  the  pelvis  ;  though  these   disadvantages  are 

*  Saint-Cyr  in  these  observations  measured  the  thorax  after  the  birth  of  the  young  creatures,  and  when 
the  lungs  had  become  expanded.  He  does  not  appear  to  have  made  any  allowance  for  this  expansion, 
which  of  course  makes  a  difference  in  the  size  of  the  thorax  after  birth. 


236  NORMAL  PARTURITION. 

somewhat  compensated  for  by  the  greater  mobility  of  the  sacrum.  And, 
as  we  have  seen,  such  is  really  the  case,  the  duration  of  parturition  being 
shorter  in  the  Mare  than  in  the  Cow.* 

With  regard  to  the  other  animals,  the  same,  remarks  will  apply.  We 
may  just  note  that  with  the  common-bred  Bitch,  which  has  a  more  or  less 
elongated  muzzle,  when  fecundated  by  a  Dog  of  the  same  conformation 
and  size,  and  which  in  due  course  brings  forth  from  five  to  eight  young, 
there  is  usually  no  difficulty  in  delivery.  The  conical  form  of  the  muzzle 
of  the  puppies,  and  the  softness  of  their  tissues,  permits  their  entering 
the  inlet  in  this  presentation,  and  passing  easily  through  it  under  the  in- 
fluence of  the  uterine  and  abdominal  contractions.  But  when  the  Bitch 
is  of  small  size,  and  is  fecun^dated  by  a  young,  vigorous,  and  larger  Dog, 
and  especially  if  the  muzzle  of  either  or  both  parents  is  short,  then  the 
head  of  the  puppies  is  usually  large  and  round,  with  the  forehead  high, 
and  the  presentation  offers  grave,  and  frequently  insurmountable  difficul- 
ties. This  is  more  especially  the  case  if  the  puppies  are  few  in  number, 
when  they  are  usually  .larger.  This  will  be  alluded  to  again  when  we 
come  to  treat  of  difficult  parturition. 

2.  Mecha?iism  of  Parturition  in  the  Anterior  Vertebro-pubic  Position. — 
In  this  position,  the  same  diameters  of  the  foetus  correspond  to  those  of 
the  maternal  pelvis  ;  though  in  practice  it  is  found  that  this  position  is 
less  favorable,  and  that  delivery  is  always  more  difficult  and  longer  than 
in  the  first  anterior  position.  This  appears  to  be  due  to  the  fact  that  in 
the  latter  the  dorsal  spines,  or  withers,  the  most  prominent  part  of  the 
foetus,  glide  along  the  vertebral  column  of  the  mother  in  the  kind  of 
channel  formed  by  the  psoas  muscles,  and  is  naturally  directed  towards 
the  pelvis  ;  while  in  the  vertebro-pubic  position,  it  comes  against  the 
brim  of  the  pubis,  where  greater,  more  frequent,  and  more  continued  con- 
tractions are  needed  to  raise  it  to  this  kind  of  step  leading  to  the  inlet. 
And  when  it  has  cleared  this  obstacle,  the  foetus  still  passes  with  difficulty 
through  the  canal,  as  the  curve  of  this  passage  is  exactly  the  reverse  of 
that  offered  by  the  body  of  the  foetus  ;  all  the  articulations  of  the  ver- 
tebrae, but  particularly  that  of  the  atlas  with  the  occiput,  and  those  of  all 
the  limbs,  being  flexed  downwards,  or  in  a  contrary  direction  to  the  curve 
of  the  sacrum.  Consequently,  in  order  to  accommodate  themselves  to 
this  curvature,  all  diese  articulations  must  be  forcibly  extended — an  un- 
favorable condition  ;  while  the  pressure  and  friction  must  be  consider- 
able. And  not  only  is  progress  through  the  pelvic  canal  slower  and  more 
difficult,  but  the*  maternal  organs  are  also  exposed  to  injury,  and  some- 
times receive  serious  damage  :  the  feet  of  the  foetus  having  a  natural 
tendency  to  be  carried  upwards,  may  squeeze  the  vagina  against  the 
sacrum,  or  press  against  the  perineum,  etc.,  when  we  may  have  lacera- 
tions of  the  vagina,  vulva,  perineum,  or  other  part. 

3.  Mechanis7n  of  Parturition  i?i  the  Anterior  Vertebro-ilial  Positions. — 
These  lateral  positions — two  in  number  and  symmetrical — are,  according 
to  Saint-Cyr,  rarely  primary,  but,  as  Rainard  remarks,  are  sometimes 
found  as  secondary  positions,  due  to  the  reduction  of  some  mal-presenta- 
tions.  The  latter  authority  asserts  that  spontaneous  birth  is  impossible 
in  these  positions,  because  the  chest  of  the  foetus  presents  its  greatest 
diameter  to  the  smallest  diameter  of  the  pelvis  of  the  mother.  This, 
however,  is  an  exaggeration,  as  Saint-Cyr  points  out  that  the  bis-iliac 

*  The  fact  that  parturition  is  more  quickly  performed  in  the  Mare  than  any  other  quadruped  was  well 
known  to  Aristotle  :  Equa,  omnium  quadrtipedem,facillime,  parit. 


PRESENTATIONS  OF  THE  FCETUS.  237 

diameter  is  sometimes  equal,  or  even  superior,  to  the  sacro-pubic  diame- 
ter ;  so  that  it  is  not  always  absolutely  impossible  for  delivery  to  occur 
spontaneously  in  these  positions ;  though  it  is  very  true  that  it  is  always 
more  difficult,  and  so?netimes  impossible,  if  the  position  is  not  altered. 
Independently  of  the  disproportion  between  the  diameters  of  the  pelvis 
and  the  corresponding  diameters  of  the  foetus,  here  also  we  find  the  two 
salient  parts  of  the  latter — the  sternum  and  dorsal  spines — jamming 
against  the  two  resisting  parts  of  the  pelvic  circumference — the  ascending 
branch  of  each  ilium,  and  it  will  be  readily  seen  that  in  some  cases  these 
will  prove  an  insurmountable  obstacle.  Nevertheless,  as  a  general  rule, 
this  obstacle  may  be  easily  turned  by  merely  causing  the  body  of  the 
foetus  to  rotate  on  its  axis,  in  such  a  manner  that  its  greatest  diameter 
will  be  brought  opposite  the  oblique  diameter  of  the  inlet,  which  extends 
from  the  ileo-pectineal  ridge  to  the  sacro-iliac  articulation  on  the  opposite 
side.  Then  its  entrance  into  the  pelvic  cavity,  and  complete  expulsion, 
is  rendered  possible. 

4.  Mechanism  of  Parturition  in  the  Posterior  Lumbosacral  Position. — Of 
the  four  positions  in  which  we  may  have  a  breech  or  posterior  presenta- 
tion, only  one,  in  the  opinion  of  Saint-Cyr,  is  compatible  with  spontaneous 
delivery — the  lumbosacral ;  though  even  this  is  denied  by  other  author- 
ities. The  foetus  is  presented  by  the  breech,  the  loins  towards  the  sacrum 
of  the  mother,  the  hind  limbs  in  complete  extension  and  entering  the 
inlet,  so  as  to  open  the  passage  for  the  body  -,  and  though  this  position 
may  appear  to  be  favorable  for  the  expulsion  of  the  young  creature,  yet 
it  is  far  less  so  than  the  first  anterior  position.  The  croup  of  the  foetus 
is  a  rounded  voluminous  mass  which  does  not  admit  of  much  compres- 
sion, and  the  diameters  of  which — particularly  the  transverse — are  neatly 
equal  to  those  of  the  pelvis  ;  it  is,  therefore,  not  well  disposed  for  passing 
through  the  latter,  and,  in  addition,  its  upper  part  presses  against  the 
sacro-vertebral  angle  ;  while  the  stifles,  which  are  salient,  press  against 
the  edge  of  the  pubis,  and  the  hip  joints  against  the  branches  of  the 
plium.  Entrance  into  the  inlet  must  therefore  be  slow,  difficult,  and  pain- 
ful for  the  mother,  and  when  this  first  obstacle  is  overcome  and  the  croup 
is  in  the  pelvic  cavity,  the  chest  has  to  follow,  and  to  submit  to  the  same 
compression  at  the  inlet  as  in  the  anterior  presentation.  But  this  part 
of  the  foetus  is  much  less  favorably  disposed  for  such  a  reduction  of 
dimensions  in  this  position  ;  as  the  resistance  offered  by  the  walls  of  the 
maternal  pelvis  has  a  tendency  to  erect  the  dorsal  spines,  and  to  carry 
the  ribs  and  sternum  forward — ail  this  going  to  increase  the  diameter  of 
the  foetus  in  every  direction.  It  is  only,  then,  by  direct  compression  or 
crushing,  that  the  necessary  diminution  in  the  diameters  of  the  young 
creature  can  be  effected,  and  not  by  a  kind  of  physiological  decrease,  as 
in  the  anterior  presentation. 

There  is  also  the  obstacle  offered  by  the  hair  of  the  foetus,  the  "  set  " 
of  which  is  against  the  direction  of  movement ;  and  this  obstacle  will  be 
greatly  increased  if  the  fluids  have  escaped  for  some  time,  and  the  parts 
are  more  or  less  dry. 

Taking  all  these  considerations  into  account,  it  will  be  seen  that  in  this 
position,  even  when  birth  is  possible  with  extraneous  assistance,  labor 
must  be  long  and  exhausting,  and  that  the  young  creature  incurs  the 
greatest  danger.  Labor,  however,  is  more  likely  to  be  successful  and  less 
tedious  if  the  haunches  of  the  foetus  present  one  after  the  other  at  the 
inlet ;  so  that  a  slight  obliquity  in  the  presentation  makes  a  great  differ- 


238  NORMAL  PARTURITION, 

ence  ;  and  it  is  just  possible  that  when  birth  takes  place  in   this  position 
without  aid,  this  obliquity  may  have  been  present. 

In  the  Cow,  the  calf  is  more  frequently  born  alive  in  this  position  than 
the  foal,  and  birth  is  easier  ;  a  circumstance  which  is,  in  all  probability, 
due  to  the  smaller  dimensions  of  the  croup  in  the  young  of  the  bovine 
species. 


CHAPTER  III. 

Necessary  Aid  in  Normal  Parturition. 

Although,  as  a  rule,  parturition  is  generally  effected  in  animals  in  what 
v/e  have  designated  a  "  spontaneous  ''  manner  (without  the  intervention 
of  man),  and  without  danger  or  prejudice  to  the  mother  or  offspring  ;  and 
although  these  do  not  require  that  minute  and  scrupulous  attention  be- 
stowed on  woman,  even  when  birth  has  been  easy  ;  yet  from  the  nature 
of  this  act  and  the  unfavorable  consequences  which  are  sometimes  noted, 
certain  precautions  should  be  observed  by  the  owner  of  the  animals  at 
this  period,  and  especially  if  these  should  happen  to  be  valuable  and  very 
artificially  kept.  These  attentions  and  precautions  should  be  entrusted 
for  their  carrying  out  to  competent  persons  selected  by  the  owner  ;  as  it 
is  seldom  that  the  veterinarian  is  called  in  unless  something  serious  has 
occurred.  The  mother  as  well  as  the  offspring  require  watching,  and 
more  or  less  nursing. 
• 

SECTION    I. ATTENTION   TO    THE    MOTHER. 

With  the  smaller  animals,  except  perhaps  the  Bitch,  but  little  prepara- 
tion is  needed,  and  the  act  of  parturition  is  accomplished  without  any 
trouble.  But  with  the  larger  and  more  valuable  creatures — such  as  the 
Mare  and  Cow,  and  even  the  Sheep — certain  precautions  should  be 
adopted.  With  the  Mare  and  Cow  particularly,  this  function  is  accom- 
panied by  pain,  restlessness,  and  a  certain  amount  of  excitement,  which 
necessitate  attention.  For  instance,  an  animal  tied  up  in  a  stall  among 
other  animals  of  the  same  or  different  species,  is  more  exposed  to  acci- 
dents than  one  which  is  in  a  place  by  itself,  or  which  is  at  liberty  in  a 
pasture  or  meadow.  Therefore,  the  Mare  about  to  foal  should  be  allowed 
a  roomy  loose-box,  well  supplied  with  soft  litter  ;  and  the  Cow  should,  if 
possible,  be  similarly  provided.  If  either  animal  must  be  kept  tied,  then 
the  fastening  should'  be  of  such  a  kind  that  it  can  readily  be  undone  when 
required.  The  Sow  should  have  a  separate  sty,  and  even  the  Sheep  may 
need  a  separate  allotment.  If  kept  in  a  dwelling,  the  temperature  should 
be  comfortable  and  the  ventilation  good. 

A.  During  Labor. — When  parturition  commences,  it  is  rare  indeed 
that  any  thing  requires  to  be  done  during  at  least  the  two  first  stages — 
those  of  preparation  and  dilatation  of  the  os.  Therefore,  the  animal  should 
be  allowed  perfect  quietude  ;  and  if  the  light  in  the  stable  is  too  bright, 
it  may  be  partially  excluded.  A  trustworthy  person  may  remain  with  it, 
in  order  to  avert  accidents  ;  but  he  should  keep  himself  out  of  sight,  and 
meddle  with  the  animal  as  little  as  possible.     Some  creatures,  and  partic- 


NECESSARY  AID  IN  NORMAL  PARTURITION. 


239 


I 


ularly  primiparas,  are  rendered  peevish  and  fidgety  if  they  see  any  one 
present  during  parturition. 

Unless  something  irregular  or  abnormal  occurs  during  this  act,  all 
should  be  left  to  nature.  The  irregularities  are  few  in  number,  the  princi- 
pal h^xwg  hurried  and  protracted  parturition^  they  being  only  modifications 
of  natural  labor;  the  difficult  cases  coming  under  the  head  of  dystokia,  to 
be  treated  of  in  another  division  of  this  volume. 

Whether  called  in  to  a  case  of  irregular  or  abnormal  parturition,  the 
first  care  of  the  veterinary  surgeon  will  be  to  assure  himself  as  to  the  state 
of  the  animal  and  the  progress  made  in  the  act.  In  this  direction,  it  must 
be  remembered  that  for  the  accomplishment  of  this  function  in  a  physio- 
logical manner — i.e.,  by  the  force  of  nature  only — and  without  prejudice  to 
the  mother  or  offspring,  there  is  required  a  definite  action,  proportionate 
to  the  constitution  of  the  former,  of  the  forces  destined  for  the  expulsion 
of  the  latter.  The  labor-pains  should  be  normal,  the  act  should  be  neither 
hurried  or  abrupt,  nor  yet  too  slow;  and  the  mother  should  not  exhibit 
any  constitutional  weakness  or  physical  debility.  In  addition,  the  foetus 
should  be  normal  as  well  as  its  membranes  ;  and  the  genital  passages  of 
the  mother  ought  to  be  in  a  properly  formed  and  healthy  condition.  The 
fcetus  should  be  alive  and  natural  in  form  and  size,  particularly  with  regard 
to  the  volume  of  the  head  and  thorax;  and  it  ought  to  be  in  such  a  posi- 
tion that  it  can  be  expelled  without  assistance.  The  foetal  envelopes 
should  possess  a  certain  degree  of  thickness  and  resistance,  so  that  they 
may  not  rupture  too  soon,  nor  yet  resist  the  action  of  the  uterus  too  long. 
The  pelvis  of  the  mother  should  have  a  convenient  shape  and  capacity  ; 
the  genital  passages  soft  and  elastic  ;  the  os,  vagina,  and  vulva  properly 
formed  and  extensible  ;  and  the  other  pelvic  organs  in  a  normal  state. 

If  the  act  of  parturition  is  not  sufficiently  advanced,  and  the  soft  parts 
through  which  the  foetus  has  to  pass  are  not  enough  dilated,  time  should 
be  allowed  for  this  to  take  place.  As  a  rule,  there  should  be  no  hurry  to 
interfere  with  the  progress  of  the  case,  as  a  somewhat  long  period  is  often 
required  for  preparation  ;  and  if  this  is  accelerated  by  the  intervention  of 
art,  accidents  are  more  likely  to  occur  than  if  the  labor  had  been  long 
and  protracted. 

Vitulary  or  parturient  fever  has  been  remarked  as  more  common  in 
Cows  which  have  calved  quickly  or  abruptly  ;  and  in  such  instances  it 
has  also  been  noticed  that  the  uterine  contractions  do  not  sufficiently  de- 
tach the  foetal  membranes. 

In  parturition,  there  is  as  much  wisdom  shown  in  remaining  a  specta- 
tor sometimes,  as  in  interfering  at  other  times  when  circumstances  require 
it.  It  is  only  when  obstacles,  insurmountable  by  the  natural  efforts  of 
the  animal,  offer  themselves  that  aid  must  be  rendered.  So  long  as  the 
course  of  parturition  remains  normal,  nothing  should  be  done,  under  or- 
dinary circumstances. 

With  the  Mare,  however,  delay  should  not  be  pushed  too  far,  as  the 
foetal  placenta  is  very  easily  detached  from  the  uterine  surface,  and  the 
foetus  may  perish  of  asphyxia  or  inanition. 

The  intelligent  owner  of  an  animal  which  is  about  to  bring  forth, 
should  himself  be  able  to  ascertain  the  position  of  the  foetus,  and  decide 
as  to  whether  parturition  may  terminate  in  a  natural  manner,  or  if  the  ex- 
isting obstacles  are  easy  to  overcome.  If  they  are  not,  he  certainly  should 
not  venture  to  attempt  delivering  the  animal  himself,  or  to  pull  about  the 
mother  or  foetus ;  as  this  may  only  tend  to  aggravate  the  accident,  and 


240  NORMAL  PARTURITION. 

render  relief  more  difficult.  The  veterinary  surgeon  should  be  sent  for, 
as  his  knowledge  and  practised  manipulative  skill  will,  in  the  majority  of 
cases,  bring  the  most  complicated  labor  to  a  prompt  and  happy  termina- 
tion— preserving  the  mother,  and  often  the  produce. 

This  appeal  to  the  veterinarian  is  not  always  made,  however,  until  the 
owner,  his  servants  and  neighbors,  or  the  empiric,  have  done  great  dam- 
age, and  caused  the  loss  of  valuable  time  ;  then  he  is  sent  for,  but  now 
the  case  may  be  one  of  extreme  difficulty  or  hopelessness,  from  exhaus- 
tion or  injury. 

We  shall  only  notice  in  this  place  what  has  been  designated  abrupt^ 
tumultuous,  disordered,  or  false  labor  {^partus  prcecipitatus) ,  and  protracted 
labor;  both  due  to  anomalies  in  the  expelling  forces. 

1.  Tumultuous  Labor. — In  this  kind  of  labor  the  act  of  parturition  is 
deranged  and  precipitate  ;  and  though  the  pains  are  excessive  and  fre- 
quent, yet  no  progress  appears  to  be  made,  the  parts  not  being  prepared, 
and  the  cervix  is  often  in  a  state  of  spasmodic  contraction,  rigid,  and 
painful.  Otherwise  the  maternal  organs  are  well  formed,  the  passage 
roomy  enough,  and  the  foetus  in  a  good  position. 

Sometimes  the  uterus  itself  is  in  a  state  of  contraction,  the  contractions 
assuming  the  opposite  direction  of  those  occurring  in  healthy  labor, — 
commencing  at  the  cervix  they  pass  towards  the  fundus  of  the  uterus. 

This  condition,  in  which  the  phenomena  are  at  first  alarming,  is  most 
frequently  observed  in  young,  well-fed,  vigorous,  irritable  animals,  and 
especially  primiparae,  which  are  excited  and  troubled  at  the  first  pains, 
and  give  themselves  up  to  violent  expulsive  efforts  which  hinder  the 
natural  course  of  parturition. 

In  the  majority  of  cases,  amendment  is  ensured  by  diverting  the  ani- 
mal's attention,  in  walking  it  about  for  a  short  time,  wisping.the  abdomen 
gently,  and  keeping  it  in  a  quiet  and  dark  place.  If,  however,  the  pains 
are  violent,  and  the  agitation  great  and  persistent,  other  measures  must 
be  resorted  to.  Some  authorities  recommend  bleeding,  but  this  should, 
if  possible,  be  dispensed  with.  Blankets  steeped  in  hot  water  should 
be  applied  to  the  loins  and  abdomen,  warm  enemas  should  be  administered, 
and,  if  deemed  necessary,  chloroform,  aether,  opium,  or  chloral  given  in 
draught  or  in  enema — the  latter  being  generally  preferable.  Not  unfre- 
quently  good  results  are  produced  by  injecting  tepid  water  into  the  vagina, 
and  raising  the  animal's  hind  quarters  ;  and  at  other  times,  when  the  cervix 
is  in  a  state  of  spasm,  relief  is  soon  obtained  by  applying  a  little  extract  of 
belladonna  to  it.  With  small  animals,  a  few  drops  of  laudanum,  either  in 
draught  or  enema,  and  a  warm  bath,  are  usually  sufficient. 

Quiet,  soothing,  and  simple  treatment  wall  generally  bring  about  a  nor- 
mal state  of  affairs ;  the  agitation  and  irregular  straining  subside,  and 
easy  parturition  occurs  in  six,  twelve,  or  twenty-four  hours. 

2.  Protracted  Labor. — Protracted  labor,  due  solely  to  the  inability  of 
the  uterus  to  expel  its  contents,  or  to  pathological  weakness  of  the  expel- 
ling forces,  is  rare,  except  in  those  cases  in  which  exhaustion  results  from 
violent  and  long-continued  attempts  to  overcome  some  material  obstacle 
to  birth.  Then,  most  commonly,  the  membranes  have  ruptured,  the  wa- 
ters have  entirely  escaped,  and  the  uterus,  in  a  state  of  general  tonic 
contraction — tetanus  uteri — is  closely  applied  to  the  foetus,  but  makes  no 
effort  to  expel  it.  This  usually,  if  not  always,  happens  when  the  foetus  is 
dead.  But  primary  inertia,  as  Saint-Cyr  remarks,  due  to  constitutional 
weakness,  and  in  the  absence  of  any  material  obstacle  to  the  extrusion  of 
the  foetus,  is  not  common. 


NECESSARY  AID  IN  NORMAL  PARTURITION.  241 

It  is  observed,  nevertheless,  in  emaciated,  puny,  and  frequently  old 
animals,  which  are  debilitated  from  lack  of  sufficient  and  good  food,  pro- 
longed lactation,  overwork,  or  worn  by  chronic  wasting  diseases.  It  may 
also  be  due  to  congenitally  feeble  development  of  the  uterine  muscular 
fibres,  and  to  diminished  contractility  of  these  by  over-distention  of  the 
uterus  during  pregnancy,  or  by  disease. 

The  symptoms  in  the  Mare  and  Cow  are  :  comparatively  shallow  and 
repeated  inspirations,  feeble  and  unfrequent  straining,  weak  pulse,  rest- 
lessness and  symptoms  of  suffering,  extremely  slow  progress  in  birth, — 
parturition  in  the  Cow  being  extended  to  twenty-four,  and  even  forty- 
eight  hour's,  though  the  foetus  may  be  in  a  good  position,  of  ordinary  size, 
and  the  passage  clear.  If  the  hand  is  introduced  into  the  vagina,  it  will 
be  discovered  that  the  uterine  contractions  are  weak. 

There  is  no  urgent  danger  to  the  mother  in  this  condition  ;  though  the 
life  of  the  foetus  is  often  imperilled,  as  the  placenta  may  be  detached 
more  or  less  from  the  uterus,  and  this  may  lead  to  fatal  consequences. 

An  examination  is  of  course  necessary,  in  order  to  ascertain  whether 
there  is  any  obstacle  to  parturition.  Should  such  not  be  found,  then 
stimulants  may  be  given  ;  and  such  ecbolics  as  rue,  saffron,  savine,  and 
particularly  ergot  of  rye,  have  been  recommended  by  various  writers. 
These  may  be  useful,  but  it  will  generally  be  found  that,  active  interven- 
tion is  preferable,  and  more  especially  as  there  is  little,  if  any  thing,  to 
prevent  the  toetus  being  easily  reached  ;  for  should  the  os  be  insufficiently 
dilated,  it  may  readily  be  made  wide  enough  for  the  hand  to  be  passed 
into  the  uterus.  Moderate  and  judicious  traction  on  the  parts  which  pre- 
sent, when  the  mother  makes  expulsive  efforts,  will  bring  the  foetus  into 
the  pelvic  cavity,  and  through  the  vulva. 

Death  of  the  Fcetus. — When  parturition  is  retarded,  it  is  often  a 
question  whether  the  foetus  is  dead  or  alive,  and  to  answer  it  correctly  is 
sometimes  difficult.  Auscultation  in  the  larger  animals  cannot,  as  it  may 
in  the  human  species,  furnish  any  certain  evidence  in  this  respect.  The 
foetor  of  the  liquor  amnii  has  been  held  to  prove  the  death  of  the  fcetus  ; 
but  though  it  is  a  good,  yet  it  is  not  an  infallible  sign.  When  decompo- 
sition has,  however,  well  advanced,  and  the  foetus  is  emphysematous  and 
its  hair  easily  removed,  then  there  can  be  no  doubt  as  to  its  being  dead. 
The  coldness  of  the  parts  external  to  the  vulva  of  the  mother,  when  well 
marked,  is  also  a  sign  of  death.  Of  course,  so  long  as  the  fcetus  displays 
active  movements,  it  is  alive  ;  but  the  absence  of  these  is  not  an  absolute 
proof  that  it  no  longer  lives  ;  for  sometimes  when  it  is  partly  in  the  pelvis 
and  the  waters  have  escaped,  so  that  the  uterus  encloses  it  firmly,  though 
still  living  it  remains  immovable,  and  cannot  be  stimulated  to  movement. 
Should  the  presentation  be  anterior,  then  passing  the  fingers  into  its 
mouth  and  titillating  the  tongue  will  prove  a  test  of  its  vitality,  as  the 
jaws  and  tongue  are  almost  certain  to  move  if  it  lives ;  but  the  absence 
of  movement  will  not  be  infallible,  though  it  will  constitute  very  prob- 
able, evidence  of  death.  If  the  umbilical  cord  can  be  reached  and  seized 
between  the  thumb  and  index  finger,  slight  compression  will  discover 
whether  or  not  the  arteries  pulsate.  The  absence  of  pulsation  affords  a 
strong,  but  not  in  every  case  a  sure,  presumption  that  the  fcetus  is  dead. 

Gelle,  many  years  ago,  gave  an  empirical  test  which,  he  asserted,  was 
constantly  successful  ;  though  it  is  difficult  to  say  why  it  should  be.  This 
method  consists  in  passing  a  blanket  or  sheet  under  the  belly  of  the  Cow, 

16 


2  42  NORMAL  PARTURITION. 

and  lifting  it  up  by  assistants  at  each  side.  If  the  foetus  is  not  dead,  the 
Cow  exhibits  dislike  of  the  pressure  ;  but  if  dead,  then  it  rests  on  the 
shee  . 

Another  authority  states  that,  with  the  Mare,  the  expulsive  efforts 
cease  for  the  time  being  as  soon  as  the  foal  is  dead,  and  if  it  has  not 
entered  the  pelvic  inlet  ;  if  it  has  passed  into  this,  the  pains  continue  as 
usual. 

The  causes  of  death  of  the  fcetus  during  parturition  are  not  numerous, 
and  may  be  enumerated  as  follows  : — i.  Ktiots  on  the  umbilical  cord, 
which,  though  not  unfrequent  in  the  human  fcetus,  appear  to  be  ver}^  rare 
in  animals  ;  2.  Twists  of  the  cord  around  the  body,  neck,  or  limbs  of  the 
foetus,  and  which  may  be  sufficiently  tight  to  interrupt  the  circulation  in 
the  umbilical  vessels  ;  3.  Premature  nipture  of  the  membranes  and  escajDe 
of  the  whole  of  the  liquor  amnii,  which,  if  parturition  is  not  soon  com- 
pleted, exposes  the  foetus  to  great  danger  from  immediate  pressure  of  the 
uterus  upon  it ;  4.  Distmio?i,  moro.  or  less  complete  and  extensive,  be- 
tween the  uterus  and  foetal  envelopes,  by  which  the  vital  connection  be- 
tween the  mother  and  fcetus  is  interrupted,  and  if  the  latter  is  not  quickly 
expelled  it  must  die  from  asphyxia.  Owing  to  the  difference  in  the  pla- 
centation  of  the  various  animals,  it  happens  that  this  foetal  asphyxia  is  not 
equally  common  in  all;  a  fact  which  experience  and  clinical  observation 
have  abundantly  demonstrated. 

Many  veterinarians,  and  among  them  Saint-Cyr,  have  been  struck  by 
the  fact,  that  no  matter  how  soon  they  were  called  in  to  a  case  of  difficult 
parturition  in  the  Mare,  nor  how  trifling  the  difficulty  might  be  and  rapid 
the  delivery,  a  living  foal  was  never  produced  ;  while  in  cases  in  Cows, 
though  incomparably  more  difficult,  and  requiring  manipulation  for  more 
than  an  hour,  living  calves  were  the  rule.  So  common  is  this  experience, 
that  a  very  distinguished  French  veterinary  surgeon — Donnarieix — has 
laid  it  down  as  a  maxim  that  the  foal  does  not  live  more  than  three 
hours,  often  less,  in  the  uterus,  after  the  first  expulsive  efforts  ;  while  the 
calf  in  the  same  conditions  can  live  much  longer-^-sometimes  for  several 
days — after  the  commencement  of  labor.  The  explanation  he  gives,  and 
which  we  think  is  correct,  is  based  on  the  manner  in  which  the  foetal  pla- 
centa is  inserted  into  the  uterus.  In  the  Cow,  the  placentulae,  multiple 
and  independent  of  each  other,  adhere  firmly  and  closely  to  the  uterine 
cotyledons,  so  that  the  placental  circulation  may  persist  for  a  long  time, 
notwithstanding  the  energy  of  the  uterine  contractions  ;  while  in  the 
Mare,  the  placental  apparatus  being  everywhere  distributed  over  the 
chorion,  adheres  but  feebly  to  the  uterine  mucous  membrane,  and  gives 
way  as  soon  as  labor  commences,  so  that  fcetal  asphyxia  is  imminent  if 
bii'th  be  not  prompt. 

It  was,  and  still  is,  believed  by  many  that  the  foetus  plays  an  active 
part  in  delivery,  and  particularly  in  rupturing  its  membranes  ;  while 
others  consider  that  its  death  increases  to  a  marked  degree  the  difficulties 
of  parturition,  because  it  does  not  then  stimulate  the  contractions  of  the 
uterus,  and  its  flaccid  tissues  do  not  afford  that  resistance  to  the  uterine 
muscles  which  they  do  when  it  is  alive.  But  Saint-Cyr  denies  that  the 
death  of  the  foetus  renders  parturition  slower  or  more  difficult ;  though 
he  admits  .that  if,  at  the  commencement  of  this  act,  there  may  chance  to 
be  any  trifling  irregularities  in  presentation  or  position,  these  may  be 
rectified  to  a  certain  extent  by  the  automatic  or  more  or  less  instinctive 
movements  of  the  living  foetus.     He  concludes,  that  though  the  death  of 


jyecessa ry  aid  in  norma l  par TURITION.         2 43 

the  foetus  has  certainly  a  great  importance,  so  far  as  the  interests  of  the 
breeder  are  involved,  as  well  as  with  regard  to  obstetrical  operations  in 
difficult  cases  ;  yet  it  has  little  or  none  so  far  as  parturition  itself  and  its 
results  to  the  mother  are  concerned. 

In  the  expulsive  period,  or  third  stage  in  parturition,  it  is  usual  to 
consider  such  matters,  as  when  to  rupture  the  water-bag,  and  when  to  use 
traction  on  the  foetus.  We  will  follow  this  custom,  and  notice  these 
points. 

Rupture  of  the  Water-bag. — This  should  not  be  artificially  ruptured  too 
early  ;  indeed,  in  the  Cow,  it  should  never,  as  a  rule,  be  opened  artifi- 
cially, as  it  is  always  spontaneously  ruptured  at  the  proper  time,  and  not 
unfrequently  sooner  than  it  might  be.  Besides,  the  want  of  tenacity  in 
the  membranes,  their  thinness,  and  the  firmness  of  their  adhesion  to  the 
uterus,  renders  this  non-interference  all  the  more  necessary. 

With  the  Mare,  however,  matters  are  different.  In  this  animal  the 
foetal  membranes  are  thick,  firm,  and  feebly  adherent  to  the  uterus  ;  so 
that  the  foal  is  sometimes  born  completely  enveloped  in  them.  It  is, 
therefore,  well  to  incise  them  when  the  water-bag  appears  as  a  large 
tumor  beyond  the  vulva  ;  until  this  happens  nothing  should  be  done, 
unless  the  os  is  completely  dilated,  and  the  head  and  feet  of  the  foetus 
are  well  in  it.  The  membranes  may  be  torn  by  the  fingers,  or  cut  by 
scissors  or  a  knife,  care  being  taken  not  to  injure  the  foal. 

When  the  water-bag  is  ruptured  too  earh^,  the  uterus  contracts  on  the 
foetus,  as  has  been  said,  and  becomes  moulded  on  it;  this  is  opposed  to 
birth.  Besides,  the  genital  passage  becomes  dry  and  adherent,  and  this 
is  an  additional  obstacle.  To  remedy  this,  recourse  must  be  had  to 
injections  into  the  vagina  of  mucilaginous  fluids,  milk,  glycerine  and 
water,  oil,  lard,  bran  and  water,  or  even  simple  tepid  water,  which  may 
be  introduced  by  a  funnel,  the  Cow's  hind  quarters  being  slightly  raised. 

Traction  on  the  Foitus. — When  the  membranes  are  once  ruptured,  the 
natural  expulsion  of  the  foetus  should  be  waited  for.  In  some  instances, 
however,  this  expulsion  may  be  conveniently  assisted  by  judicious  trac- 
tion on  the  foetus.  If  it  is  in  the  anterior  vertebro-sacral  position,  gentle 
traction  may  be  made  on  the  pastern  of  each  fore  leg  when  these  and 
the  head  have  cleared  the  vulva,  the  tractions  coinciding  with  the  throes 
of  the  mother,  which  they  should  supplement,  but  must  not  supplant. 
They  ought  to  be  made  in  a  slightly  oblique  direction  downwards, 
towards  the  hocks  of  the  mother,  so  as  to  allow  the  body  of  the  foetus  to 
follow  the  curve  of  the  pelvis  ;  inclining  the  traction  a  little  to  the  right 
and  left,  will  also  aid  in  passing  the  shoulders  and  afterwards,  the 
haunches.  The  head  and  neck,  when  they  are  clear  of  the  vulva,  should 
be  supported.  If  the  foetus  is  in  the  vertebro-pubic  position,  the  direc- 
tion of  the  feet  must  be  watched  and  directed,  as  they  have  a  tendency 
to  press  against  the  sacrum,  and  may  seriously  injure  the  passage.  They 
should  therefore  be  seized  while  the}'-  a^:e  yet  in  the  vagina,  and  brought 
gently  outside  the  vulva  along  with  the  head,  when  traction  may  then  be 
employed.  This  should  at  first  be  made  upwards,  so  as  to  clear  the 
withers  from  the  brim  of  the  f>elvis,  against  which  it  sometimes  /jams. 
When  this  is  effected,  then  the  same  procedure  as  in  the  other  case  is  to 
be  adopted. 

In  the  vertebro-iliac  positions,  it  is  always  useful,  when  they  are  recog- 
nized in  time,  and  before  the  chest  has  entered  the  pelvis,  to  attempt  to 


244 


NORMAL  PARTURITION. 


modify  them  by  converting  them  into  one  of  the  preceding  positions,  and 
particularly  the  vertebro-sacral  ;  though  this  modification  requires  the 
manipulative  skill  of  an  experienced  veterinary  surgeon.  If  the  foetus  is 
already  in  the  canal,  delivery  must  be  attempted  according  to  the  prin- 
ciples already  indicated  :  directing  the  feet  towards  the  centre  of  the 
passage  and  outside  the  vulva,  and  employing  moderate  traction  on  the 
limbs. 

When  the  foetus  presents  posteriorly,  in  the  lumbo-sacral  position,  with 
the  croup  towards  the  maternal  sacrum,  the  only  way  in  which  birth  can 
be  effected  naturally  is  when  the  feet  of  the  hinder  extremities  lead  and 
dilate  the  os.  This  position  is  recognized  by  the  coronary  and  pastern 
joints  being  bent  upwards,  and  by  the  hocks,  which  are  deeper  situated, 
are  flexed  in  the  opposite  direction,  and  are  distinguished  by  their  broad 
flat  sides  and  the  blunt  point  of  the  calcis,  which  points  in  a  contrary 
direction  to  the  flexure  of  the  joint.  In  this  position,  the  two  limbs  are 
to  be  seized  at  the  pastern,  and  traction  exercised  at  first  slightly 
upwards,  in  order  to  carry  the  stifles  over  the  brim  of  the  pubis,  which 
sometimes  checks  them  ;  then  downwards,  to  bring  the  croup  below  the 
sacrum  ;  and  lastly,  an  alternate  movement  from  right  to  left  and  left  to 
right,  to  free  the  haunches,  one  after  the  other.  It  is  well  to  see  that  the 
tail  of  the  foetus  is  in  a  right  direction  before  traction  has  been  much 
practised. 

The  other  positions  will  be  referred  to  in  the  second  division  of  this 
work.^ 

We  mav  remark,  however,  with  regard  to  gemellar  parturition,  that  this 
kind  of  pregnancy  is  not  usually  recognized  in  uniparous  animals  until 
birth  takes  place.  The  escape  of  only  a  small  quantity  of  liquor  amnii, 
and  the  small  size  of  the  creature  first  delivered,  when  compared  with 
the  size  of  the  mother's  abdomen,  are  not  infallible  indications  that  more 
young  will  be  produced.  Soon,  however,  another  water-bag  appears, 
and  another  foetus  presents  at  the  vulva.  Not  unfrequently,  when  the 
position  of  the  two  foetuses  is  natural,  they  present  one  after  the  other 
successively,  and  without  any  assistance  being  required.  This  is  the 
case  more  particularly  with  the  Sheep  and  Goat — animals  which  so  often 
produce  twins.  But  sometimes,  and  especially  with  the  larger  animals, 
the  two  foetuses  present  themselves  simultaneously  at  the  pelvic  inlet,  and 
neither  can  pass  through.  In  such  a  case,  which  it  must  be  confessed  is 
rare,  it  is  necessary  to  push  back  the  one  least  favorably  presenting,  and 
to  keep  it  away  until  the  fore  limbs  of  the  other  are  engaged  in  the  pas- 
sage. If  the  two  foetuses  chance  to  be  in  an  unfavorable  position,  the 
anterior  extremities  of  one  should  be  sought  for  (recognized  by  the  knees, 
and  to  a  certain  extent  by  the  pasterns),  or  the  hind  limbs  (recognized 
by  the  pasterns  and  hocks)  if  they  are  convenient  for  the  purpose,  and 
traction  exercised  as  in  the  case  of  a  single  foetus,  and  according  to  the 
directions  given  above,  taking  care  to  keep  the  other  foetus  out  of  the 
way.  Should  it  not  be  possible  to  extract  this  foetus,  it  may  be  that  cer- 
tain parts  of  the  other  stop  its  progress,  or  that  the  expulsive  forces  are 
expended  on  the  latter,  although  it  is  farthest  from  the  os.  It  is  then 
necessary  to  push  back  and  turn  the  former,  and  endeavor  to  extract  it 
by  the  extremity  opposite  to  that  which  was  first  tried.  But  if  the  fore 
limbs  have  been  got  into  the  passage,  as  well  as  the  head,  the  position 
need  not  be  changed,  the  procedure  being  then  the  same  as  for  a  foetus 
disproportionately  large. 


NECESSARY  AID  IN  NORMAL  PARTURITION. 


245 


Another  remark  is  with  reference  to  the  operator.  In  exploring  the 
genital  passages,  gentleness  and  tact  should  be  scrupulously  observed, 
and  the  hand  and  arm  should  be  well  oiled,  the  nail  of  the  fingers  being 
cut  at  least  moderately  short.  It  requires  some  experience  to  be  able 
to  ascertain,  by  the  sense  of  touch,  what  parts  of  the  foetus  present,  and 
those  which  are  an  obstacle  to  birth ;  as  well  as  knowledge  to  guide  one 
in  placing  the  parts  in  a  favorable  position,  and  particularly  in  one  which 
approaches  what  we  have  designated  the  "  natural "  presentation.  The 
time  chosen  for  exploration  should  be  the  interval  between  the  labor 
pains,  and  care  must  be  taken  not  to  rupture  the  membranes,  should  they 
still  be  intact.  The  exploration  may  be  made  while  the  animal  is  stand- 
ing or  lying  ;  both  positions  have  certain  advantages,  though  the  first  is 
generally  preferable,  and  is  certainly  less  fatiguing. 

It  must  not  be  forgotten  that,  when  traction  is  required,  this  should  be 
slow  and  moderate,  and  only  applied  when  the  animal  itself  makes  ex- 
pulsive efforts.  In  many  cases  the  resistance  to  be  overcome  is  often 
very  slightly  superior  to  the  forces  exerted  by  the  parturient  animal. 
Violent  and  sudden  traction  is  to  be  deprecated,  as  it  may  inflict  serious 
injury,  while  doing  little,  if  any  thing,  in  aiding  delivery ;  and  even  should 
this  be  effected,  it  must  be  remembered  that  the  contractile  power  of  the 
uterus  is  deranged  when  the  contents  of  the  organ  are  attempted  to  be , 
suddenly  and  forcibly  removed.  The  simplest  and  safest  traction  is  that 
made  by  the  hands  of  the  operator — for  both  hands  may,  in  some  cases, 
be  introduced  into  the  vagina.  Should  he  not  have  sufficient  strei^th  or 
purchase,  an  assistant  may  clasp  him  around  the  chest  and  pull  at  and 
with  him — gradually  and  steadily  during  the  throes.  But  we  shall  recur 
to  this  subject  again. 

B.  After  Labor. — The  attention  to  be  paid  to  the  mother  after  par- 
turition will  differ  not  only  according  to  the  species  to  which  it  belongs, 
but  also  according  to  its  temperament,  strength,  and  the  kind  of  labor 
which  it  has  undergone.  When  this  has  been  natural,  and  the  animal  is 
vigorous  and  not  much  fatigued,  simple  hygienic  measures  are  all  that  is 
necessary.  It  should  be  kept  comfortable,  with  plenty  of  pure  air,  but 
away  from  draughts.  If  it  has  been  perspiring,  the  body,  and  particularly 
the  belly,  should  be  well  wisped  if  it  is  a  larger  animal  ;  indeed  this  fric- 
tion is  always  to  be  recommended,  as  it  often  allays  the  restlessness  which 
sometimes  persists  after  delivery,  regulates  the  circulation,  and  appears 
to  hasten  the  retraction  of  the  uterus.  It  may  be  necessary  to  cover  the 
body  with  a  blanket,  as  the  animal  is  very  susceptible  to  cold  at  this 
period.  A  gallon  or  so  of  nourishing,  tepid  gruel,  or  even  soup,  may  be 
given  ;  after  which  the  diet  should  be  moderate  and  easily  digested. 
Clean  dry  litter  should  be  plentifully  supplied,  and  the  animal  left  alone 
for  half  an  hour  or  so,  after  which  it  may  be  visited,  offered  more  gruel, 
and  the  offspring  assisted  to  the  teat,  if  it  has  not  already  found  it.  From 
three  to  eight,  or  even  fifteen  days'  rest  should  be  allowed,  according  to 
circumstances  ;  and  in  order  to  permit  lactation  to  be  fully  established, 
and  the  animal  quite  recovered. 

When  parturition  has  been  protracted,  and  the  animal  has  suffered 
much,  and  especially  if  the  generative  organs  have  been  bruised  and  in- 
flamed, nursing  should  be  continued  longer,  and  greater  precautions 
adopted.  Every  care  ought  to  be  taken  to  prevent  metritis  or  metro- 
peritonitis ;  and  with  this  object  in  view  tepid  vaginal  injections,  to  which 


246  NORMAL  PARTURITION. 

may  be  added  a  little  per-manganate  of  potass  or  chloral,  may  be  em- 
ployed :  warm  cloths  being  applied  to  the  loins,  the  animal  allowed  light 
diet,  with  small  doses  of  sulphate  of  magnesia,  and  kept  clean  in  a  good 
stable,  and  in  a  pure  atmosphere. 

When  the  animals  are  old,  weak,  or  exhausted  by  protracted  labor,  or 
if  there  has  been  haemorrhage,  stimulants  should  be  administered,  and 
strengthening  food.  Sometimes  the  debility  is  so  extreme,  that  the  animal 
scarcely  gives  any  indication  of  life.  There  is  then  all  the  more  need 
for  careful  nursing  and  quietude.  Friction  to  the  surface  of  the  body, 
clothing,  and  a  good  bed  are  particularly  necessary  ;  and  as  lactation  is 
established  with  difficulty  in  these  cases,  this  *inust  be  attended  to.  It 
must  be  borne  in  mind  that  cold  and  damp  are  dangerous  immediately, 
and  indeed  for  some  time  after  parturition.  Therefore,  when  turned  out 
to  pasture,  care  should  be  taken  to  afford  protection  in  bad  weather,  and 
damp  cold  localities  should  be  avoided. 

With  regard  to  Ewes,  if  the  weather  is  mild  and  the  situation  favorable, 
protection  is  not  required  ;  but  if  cold  winds  and  wet  prevail,  then  shelter 
is  necessary.  When  more  than  one  lamb  is  likely  to  be  produced,  the 
first  should  be  kept  warm  and  receive  a  little  Cow's  milk  diluted  with 
water,  until  the  Ewe  has  finished  lambing.  Twin  lambs  may  easily  be 
reared  by  a  strong  mother,  if  supplied  with  a  sufficiency  of  suitable  food  ; 
but,  as  a  rule,  if  there  are  more  than  two,  they  should  be  put  to  another 
Ewe  or  reared  artificially.  In  order  to  overcome  the  repugnance  so 
oftei^pmanifested  by  the  Ewe  to  a  strange  lamb,  if  its  own  lamb  has  died, 
the  foster-lamb  may  be  rubbed  with  the  skin  of  the  dead  creature,  or  ihe 
two  may  be  placed  together  during  the  night,  or  even  put  into  a  dark  shed 
along  with  a  Dog,  which  will  induce  the  Ewe  to  protect  and  take  to  the 
lamb. 

The  Goat  is  more  exposed  to  long  and  difficult  parturition  than  the 
Sheep,  and  not  unfrequently  requires  assistance.  The  same  care  is  ne- 
'  cessary  as  for  the  Sheep. 

The  Sow  generally  suffers  from  weakness  and  prostration  often  parturi- 
tion, and  requires  plenty  of  nourishing  and  easily-digested  food.  When 
this  is  given  there  is  less  likelihood  of  the  animal  not  devouring  its  young, 
and  all  the  more  so  if  it  is  not  irritated  by  the  presence  of  people. 

The  Bitch  should  not  be  allowed  to  rear  too  many  puppies,  and  warmth, 
a  dry  abode,  and  good  food  must  not  be  withheld.  Bitches  do  not 
readily  take  to  strange  puppies  ;  sprinkling  these  with  some  of  its  milk 
has  been  sometimes  successful.  Constipation  is  not  unfrequent  after 
parturition,  and  this  may  be  removed  by  castor-oil  or  manna. 

SECTION    II. ATTENTION    TO    THE    OFFSPRING. 

No  special  rules  can  be  laid  down  for  the  management  of  new-born 
animals,  as  this  must  vary  more  or  less  according  to  the  species.  How- 
ever, there  are  some  general  rules  which  it  may  be  well  to  observe,  and 
these  we  will  refer  to. 

With  regard  to  the  foal  or  other  creature  which  may  be  born  in  the 
foetal  membranes,  it  is  evident  that  it  must  be  freed  from  them  immedi- 
ately, or  it  will  perish  from  suffocation  ;  as  through  having  no  longer  any 
communication  with  the  mother  by  means  of  the  umbilical  cord,  the 
blood  cannot  be  oxygenated.  If  the  umbilical  cord  is  not  ruptured,  it 
may  be  double  ligatured  about  two  inches  from  the  umbilicus,  and  then 


NECESSARY  AID  IN  NORMAL  PARTURITION.        -  247 

divided  between  the  ligatures  ;  or  it  may  be  severed  by  scraping  it  through 
with  a  jagged  knife. 

Immediately  after  delivery,  and  having  removed  the  mucus  which  some- 
times clogs  the  mouth  and  nostrils,  and  hinders  respiration,  the  young 
animal  should  be  examined  to  ascertain  whether  it  be  strong  or  weak, 
whether  all  the  natural  apertures  exist — such  as  the  eyes,  mouth,  anus, 
vulva,  urethra — and  if  any  of  them  chance  to  be  absent,  to  make  artificial 
ones  soon,  if  possible,  by  a  kind  of  puncture,  enlarging  afterwards  by  the 
knife  and  sound,  and  preventing  union  by  pledgets  of  lint,  etc. 

Suspended  Animation. — Whenever  the  connection  with  the  mother  is 
interrupted  by  rupture  or  occlusion  of  the  umbilical  cord,  the  young 
creature  must  breathe,  respiration  being  now  carried  on  by  the  lungs, 
through  the  nostrils. 

The  establishment  of  respiration  is  a  purely  reflex  act.  The  foetus, 
hitherto  maintained  at  a  certain  and  always  uniform  degree  of  warmth  in 
its  liquid  bed  in  the  uterus,  is  suddenly  ushered  into  the  cold  and  dry  air 
of  the  outer  world  ;  and  this  transition  operates  chiefly  on  the  skin, 
producing  a  peculiar  impression — such  as  we  ourselves  experience  in 
being  suddenly  immersed  in  cold  water ;  this  impression  is  at  once 
transmitted  to  the  cerebro-spinal  centre,  whence  the  reflex  influence  of 
the  spinal  cord  is  called  into  play,  and  the  respiratory  muscles  are  excited 
to  movement  by  the  centrifugal  nerves  issuing  therefrom.  All  these 
muscles  contract  simultaneously,  the  chest  is  dilated,  and  the  air  rushes 
into  the  air-passages  and  lungs,  distending  the  air-cells  in  the  latter,  and 
instituting  the  process  of  respiration,  which  is  only  to  cease  with  the 
death  of  the  creature.  This  reflex  act  may  also  be  produced  by  pressure 
on  the  umbilical  cord,  or  any  thing  which  hinders  the  oxygenation  of  the 
blood  in  the  foetus  ;  hence  it  has  been  inferred  that  the  excess  of 
carbonic  acid  in  the  circulating  fluid  acts  as  a  stimulus  to  the  medulla 
oblongata. 

It  sometimes  happens  that  the  young  creature  is  in  a  state  of  syncope 
when  born,  or  very  soon  after,  and  gives  no  sign  of  life  ;  and  observers 
have  distinguished  syncope  from  weakness,  in  which  the  animal  is  cold 
and  does  not  breathe,  the  mucous  membranes  being  pale  and  the  body 
flaccid  ;  and  syncope  from  plethora  or  cyanosis,  when  the  inucous  mem- 
branes are  of  a  livid  blue  tint,  the  lips  and  tongue  swollen,  and  the  eyes 
injected. 

In  the  first  form,  resuscitation  is  to  be  attempted  by  pouring  cold 
water  on  the  head,  beating  the  body  with  a  cloth  dipped  in  cold  water — 
particularl}-  about  the  face  and  chest — dry-rubbing  the  limbs,  titillating 
the  nostrils  with  a  feather,  puffing  tobacco-smoke  into  them,  imitating  the 
respiratory  movements,  as  in  a  case  of  asphyxia,  and  inflating  the  lungs 
by  means  of  a  pair  of  bellows,  acting  through  the  nostrils.  So  long  as 
the  heart  pulsates  there  is  a  probability  of  restoration  to  life. 

In  the  second  form,  allowing  a  little  blood  to  flow  from  the  umbilical 
cord,  and  even  cutting  this  or  fomenting  it  with  hot  water  to  induce 
haemorrhage,  is  very  useful,  in  conjunction  with  cold  water  to  the  head 
and  cold  water  enemas.  But,  as  a  rule,  death  is  always  imminent  in  these 
cases  of  syncope. 

General  Care. — With  the  larger  animals,  the  newly-born  creature 
should  be  placed  before  the  mother,  if  it  is  not  near  her;  and  it  generally 
follows  that  she  instinctively  licks  off  the  viscid  matter  which   covers  its 


248  NORMAL  PARTURITION. 

skin ;  and  in  doing  this  the  cutaneous  circulation  is  excited,  and,  by 
sympathy,  the  other  organs  of  the  young  animal.  Consequently,  it 
becomes  revived,  soon  endeavors  to  get  up,  and  though  it  may  fall 
several  times,  yet  it  generally  quickl}'-  succeeds  in  maintaining  itself  on 
its  limbs,  and  instinctively  seeks  the  maternal  teat.  It  is  very  rare  that 
the  mother  does  not  voluntarily,  and  at  once,  commence  to  cleanse  its 
progeny ;  nevertheless,  there  are  exceptions,  chiefly  among  the  primip- 
arae,  and  especially  when  the  labor  has  been  long  and  painful.  But  it 
will  generally  be  found  that  sprinkling  the  young  animal  with  a  little 
flour,  bran,  or  salt  will  excite  the  attention  of  the  mother  and  induce  the 
cleaning  process.  Should  it  not  do  so,  then  the  creature  must  be  well 
dried  and  rubbed  with  a  sponge,  hay-wisp,  or  a  cloth,  and  kept  warm. 
This  is  more  particularly  necessary  when  the  mother  is  indifferent  to  it, 
which  sometimes  happens  with  primiparae  when  people  are  present. 
Indeed,  some  Mares  become  quite  savage  after  parturition,  and  will  not 
allow  their  foal  to  come  near  them,  and  will  even  kill  it;  though  this  most 
frequently  happens  when  they  are  tormented  by  spectators.  Other 
Mares,  vicious  before  parturition,  sometimes  become  remarkably  quiet 
when  they  have  a  foal  by  their  side.  When  they  exhibit  any  aversion  to 
their  progeny,  it  is  well  to  leave  them  quietly  together  for  some  time. 

If  the  foal  or  calf  is  weak,  and  cannot  reach  the  teat  within  half  an 
hour  or  so  after  birth  (for  in  uniparous  animals  the  mammae  are  inguinal, 
so  that  the  young  are  always  suckled  in  a  standing  posture),  it  will  be 
found  necessary  to  assist  it  by  bringing  it  to  the  mother,  and  applying 
the  teat  to  its  mouth,  at  the  same  time  caressing  and  soothing  the  parent 
if  disinclined  to  it  by  temper  or  painfulness  of  the  udder.  This  coaxing 
and  handling  should  be  performed  by  some  one  accustomed  to  the 
animal.  It  may  be  necessary  to  have  a  second  person  at  hand  to  hold 
the  Mare  by  the  head  or  lift  up  its  fore  foot. 

Sometimes  from  weakness  or  inexperience  of  the  foal,  and  temper  of 
the  Mare,  the  former  runs  the  risk  of  perishing  from  starvation.  The 
Mare  should  be  safely  secured,  and  two  persons  ought  then  to  push  and 
support  the  young  animal  behind  by  joining  one  of  their  hands,  while 
the  other  hands  are  employed  in  directing  it  towards  the  teat,  which  it 
should  be  allowed  to  use  for  two  or  three  minutes.  After  one  or  two 
attempts  of  this  kind,  the  foal  begins  to  find  its  way  to  the  udder  by 
itself,  while  the  Mare  becomes  reconciled  to  it.  When  the  foal  exliibits 
great  debility,  it  may  be  preferable  to  feed  it  for  a  day  or  two  with  the 
milk  of  the  Mare,  which  has  been  drawn  by  hand. 

With  the  Cow,  these  difficulties  are  seldom  present,  and  if  an  animal 
will  not  take  to  its  calf  this  is  generally  transferred  to  another  Cow,  or 
it  may  be  artificially  reared.  The  foal  may  even  be  reared  in  this 
manner,  though  not  so  easily  as  the  calf.  The  milk  of  the  Cow  or  Goat 
will  suffice,  and  there  is  generally  little  difficulty  in  teaching  it  to  drink  it 
by  at  first  pouring  a  little  into  its  mouth  while  the  finger  is  inserted 
therein  ;  or  a  piece  of  cloth  steeped  in  milk,  or  even  a  bottle  and  tube 
may  be  used. 

Calves  are  often  harshly  treated  after  birth ;  they  are  not  allowed  to 
suck,  even  for  a  number  of  days,  for  fear  of  damaging  the  Cow,  but  are 
kept  apart  and  fed  on  drawn  milk.  Calves  intended  for  slaughter  may 
be  artificially  fed,  and  especially  if  nutritive  substances  are  added  to  the 
milk ;  but  for  those  intended  to  be  reared,  it  is  a  mistake  to  separate 
them'  from  the  Cow  during  the  early  days  of  their  existence. 


NECESSARY  AID  IN  NORMAL  PARTURITION. 


249 


Lambs,  when  able  to  stand,  and  if  they  do  not  readily  find  their  way  to 
the  teat,  should  have  a  little  milk  from  it  pressed  into  their  mouth.  With 
twin  lambs,  if  the  Ewe  is  in  good  condition,  the  udder  well  filled,  and  the 
weather  and  pasture  favorable,  both  may  be  suckled  ;  in  the  opposite 
conditions  it  maybe  necessary  to  remove  one.  If  the  Ewe  does  not  yield 
sufficient  milk,  this  may  be  largely  remedied  by  giving  a  liberal  supply  of 
good  food.' 

Multiparous  animals,  such  as  the  Bitch  and  Sow,  usually  lie  when 
suckling  their  young  j  so  that  there  is  seldom  any  difficulty  with  them. 
The  only  care  generally  required  in  the  case  of  young  pigs,  is  to  prevent 
their  being  crushed  by  the  Sow  in  the  act  of  lying  down  or  moving.  If 
the  litter  is  large,  plenty  of  good  food  is  necessary. 

It  is  well  to  remember  that  if  a  Sow  has  more  young  in  the  litter  than 
teats,  unless  watched  the  weakest  wiM  die  of  starvation.  Each  young  pig 
has  its  own  particular  teat,  to  which  it  is  persistently  attached  ;  and  if 
the  creature  is  ill  and  does  not  suck,  or  if  there  is  not  a  claimant  for  the 
teat,  the  gland  there  will  cease  secreting  milk.  The  pectoral  teats  and 
glands  are  the  largest  and  most  active,  and  the  weakest  of  the  litter 
should  be  put  to  them.  In  general,  a  Sow  should  not  be  allowed  to  rear 
more  than  ten  in  a  litter.  Cleanliness  and  warmth  are  required  for 
young  pigs. 

Puppies  do  not  require  any  special  care  beyond  a  warm,  clean,  and  dry 
abode. 

After  the  first  milk  has  been  taken,  there  is  usually  an  abundant 
evacuation  of  black  resinous  matter — meconium — from  the  intestines  of 
the  young  animal,  caused  by  the  "  colostrum,"  as  this  milk  is  named  ; 
and  it  is  well  to  notice  if  this  evacuation  occurs,  as  when  it  does  not, 
serious  constipation  may  ensue.  With  new-born  animals  which,  for  some 
reason  or  another,  are  deprived  of  this  colostrum,  a  mild  laxative — such 
as  castor-oil,  or.  honey  and  water — should  be  administered  to  obviate  this 
condition. 

At  birth  the  feet  of  hoofed  animals  are  covered  with  a  soft  yellow  horn, 
which  in  some  countries  it  is  the  custom  to  remove,  from  a  belief  that 
this  removal  hardens  the  succeeding  horn.  Tt  is  unnecessary  to  state 
that  this  is  a  popular  fallacy,  and  that  it  is  really  injurious  to  deprive  the 
foot  of  this  temporary  protection. 

The  young,  with  their  parents,  should  be  kept  apart  from  others — for 
some  time  at  least,  and  especially  the  equine  species  ;  and  it  must  not  be 
forgotten  that  a  mild  dry  temperature  is  most  favorable  for  all  young 
creatures. 

Gentle  exercise  is  as  necessary  for  the  foal  or  calf,  as  it  is  for  their 
parents,  a  few  days  after  birth.  Therefore  it  is  that  a  meadow  is  pref- 
erable to  a  stable,  as,  in  addition  to  the  more  favorable  nature  of  the 
food,  sufficient  exercise  is  afforded.  Indeed,  with  the  Mare  light  and 
regular  work  may  be  imposed  a  short  time  after  foaling,  and  with  much 
benefit  to  it  and  the  foal.  The  latter  will  follow  its  dam,  provided  the 
pace  is  not  too  fast,  and  a  halt  be  frequently  allowed  for  it  to  get  to  the 
teat.  It  is  astonishing  sometimes  to  observe  how  well  foals  travel  soon 
after  birth,  even  over  bad  roads  and  during  inclement  weather,  and  for 
great  distances,  provided  the  journey  is  short  each  day.  Huzard  has 
seen  buffalo  calves,  born  during  the  night,  follow  their  mother  next  day, 
and  make  a  daily  journey  of  six  or  eight  leagues  without  appearing 
fatigued. 


250  NORMAL  PARTURITION. 

It  is  not  rare  to  find  newly-born  animals,  particularly  when  parturition 
has  been  laborious,  injured  more  or  less,  from  the  manipulation  of  the 
obstetrist  during  birth,  the  lesions  being  more  or  less  serious.  The  most 
frequent  injuries  are  those  due  to  obstetrical  instruments  and  appliances. 
The  wounds  may  be  dressed  wath  cold  water,  with  slightly  alcoholized 
water,  or  some  dilute  tincture — such  as  that  of  arnica  ;  but  salts  of  lead, 
or  other  poisonous  salts,  should  not  be  employed.  Abrasions,  which  are 
generally  superficial,  may  be  treated  with  glycerine  and  water,  to  which 
a  very  little  carbolic  acid  has  been  added;  or  by  lard,  or  any  mucilagi- 
nous substance.  Sprains  should  have  cold  water  irrigation  if  possible, 
refrigerant  lotions,  or  friction  with  soap  liniment.  Wounds  and  lacera- 
tions, if  very  severe,  must  have  appropriate  surgical  treatment.     . 


CHAPTER  IV. 

Sequelae  of  Parturition. 

We  have  stated  that  gestation  and  parturition  are  physiological  processes, 
and  we  may  now  add  to  these  \\\^  puerperal  state.  But  though  in  one 
respect  eminently  physiological,  the  puerperal  condition  is  marked  by 
special  features,  which  distinguish  it  from  other  physiological  states,  and 
which,  occurring  under  other  circumstances,  would  be  more  allied  to 
pathological  changes.  We  refer  now  more  particularly  to  the  functional 
and  organic  alterations  which  take  place  after  delivery.  True,  we  do  not 
have  in  animals  such  important,  nor  so  many,  sequelae  as  are  noted  in 
women  at  this  period,  some  of  which  are  really  pathological.  Neverthe- 
less, we  have  certain  phenomena  occurring  during  the  return  of  the  econ- 
omy and  the  generative  organs  to  the  condition  they  were  in  previous  to 
pregnancy,  which  are  not  only  very  characteristic,  but  are  worthy  of  seri- 
ous attention.  These  phenomena  have  been  divided  into  fimdmial  and 
organic. 

SECTION  r. FUNCTIONAL  MODIFICATIONS. 

The  functional  modifications  include  the  afterpains^  lochia,  7nilk-fever, 
and  lactation. 

I.  After-pains. — These  are  the  painful  sensations  in  the  abdomen, 
indications  of  which  are  frequently  observed  in  animals,  and  which  per- 
sist after  the  expulsion  of  the  foetus  and  the  secundines.  They  are  due 
to  the  contractions  of  the  uterus,  which  go  on  for  some  time,  and  which 
eventually  reduce  the  organ  to  its  ordinary  volume  and  diminish  its  cavity. 
After  an  easy  labor,  there  are  generally  few  or  no  symptoms  of  these 
pains  ;  and  when  they  are  present  the  only  indications  are  whisking  of  the 
tail,  at  which  time,  according  to  Saint-Cyr,  the  abdomen  appears  to  be 
harder.  They  seldom  continue  longer  than  twelve  or  twenty-four  hours 
in  these  cases,  and  do  not  require  special  treatment. 

In  other  cases,  however,  and  particularly  when  birth  has  been  very 
sudden  and  rapid,  they  persist  longer  and  are  more  severe.  The  animal 
paws  and  exhibits  suffering  ;  it  also  stretches  as  if  trying  to  micturate, 
arches   the  back,   contracts  the   abdominal   muscles,   and  strains.     The 


SEQ  UEL^  OF  PA  R  TURITION.  251 

access  of  these  attacks  is  not  regular ;  and  when  they  are  frequent,  se- 
(^ere,  and  continue  beyond  twenty-four  hours,  we  may  apprehend  the  reten- 
tion of  a  portion  of  the  foetal  membranes  in  the  uterus,  or  commencing 
inversion  of  that  organ.  This  will  necessitate  an  exploration,  in  order 
to  discover  the  cause  ;  which,  when  ascertained,  should  receive  appropriate 
treatment,  to  be  hereafter  described. 

2.  Lochia. — The  term  lochia  has  been  giv-en  to  the  sanguinolent,  sero- 
sanguinolent,  and  muco-purulent,  and  finally  mucus  vaginal  evacuations 
occurring  after  parturition,  and  generally  persisting  until  the  uterus  has 
regained  its  ante-pregnant  condition.  The  existence  of  this  evacuation, 
so  marked  in  woman,  has  often  been  denied  in  animals  ;  but  there  can 
be  no  doubt  whatever  as  to  the  fact  of  its  presence.  It  has  been  wit- 
nessed by  several  veterinarians  in  the  Mare,  Cow,  Sheep,  and  Bitch,  and 
we  have  noted  it  repeatedly  in  the  Sow  and  Cat.  But  it  is  considerably 
less  in  these  animals  than  in  woman,  and  does  not  flow  continuously  as 
ih  her,  but  at  irregular  periods  ;  the  discharge  accumulating  in  the  uterus, 
and  only  escaping  when  the  animal  undergoes  exertion,  and  in  defecation 
or  micturition.  In  the  Cat,  however,  we  have  witnessed  this  discharge  — 
very  slight — flowing  constantly  for  four  days  after  parturition  ;  and  with 
the  Bitch  we  have  a  sanguinolent,  then  a  mucus  discharge  persisting  al- 
most continuously  for  several  days  subsequent  to  that  event. 

In  the  larger  animals,  this  discharge  can  be  seen  about  the  inferior 
commissure  of  the  vulva  ;  it  sometimes  accumulates  about  the  thighs  and 
tail  in  flakes  and  patches,  as  well  as  on  the  litter  ;  and  when  the  animal 
has  been  lying  it  forms  small  pools  on  the  ground. 

When  we  remember  that  the  uterus  has  for  a  long  period  nourished 
one  or  more  foetuses,  we  can  scarcely  wonder  that  it  cannot  all  at  once 
cease  its  secretory  function,  and  that  its  mucous  membrane  should  con- 
tinue in  a  hyperaemic  condition  until  the  lacteal  secretion  in  the  mammai 
is  fully  established.  As  much  as  seven  to  eight  quarts  of  sero-sanguino- 
lent  fluid  have  been  removed  from  the  uterine  cavity  of  a  Mare  which  had 
foaled  three  days  previously. 

When  not  mixed  with  blood,  this  discharge  is  albuminous  and  chylous- 
looking ;  it  is  rarely  purulent,  and  then  probably  only  from  traumatic 
causes  ;  neither  does  it  have  a  bad  odor,  unless  the  uterus  or  vagina  is 
the  seat  of  some  pathological  process,  or  a  portion  of  the  placenta  is 
retained.  According  to  some  authorities,  the  average  duration  of  the 
discharge  is  from  two  to  three  weeks  ;  but  Saint-Cyr  believes  that  when 
it  is  prolonged  beyond  five  to  eight  days,  it  is  no  longer  a  physiological, 
but  a  pathological  process.  This  is  about  the  period  which  is  necessary, 
in  the  larger  animals,  for  the  return  of  the  vulva  to  its  normal  dimensions 
and  ordinary  form. 

Of  the  importance  of  the  lochia  there  can  be  no  doubt.  By  them  the 
uterus  is  relieved  from  its  physiological  hypertrophied  condition,  and  of 
the  excitement  of  which  it  was  the  Seat  during  pregnancy  and  parturition. 
But  it  can  not  have  the  same  importance  as  innvoman,  in  whom  the  lining 
membrane  of  the  uterus  is  thrown  off  pretty  nearly  after  every  delivery. 
It  is  not  so  with  animals,  as  we  shall  see  hereafter. 

One  or  two  veterinary  authorities  have  attached  so  much  importance  to 
the  lochia  in  animals,  that  to  their  suspension  or  suppression  they  attrib- 
ute such  serious  results  as  :  sanguine  plethora,  articular  rheumatism  in 
the  Cow,  laminitis  in  the  Mare,  metro-vaginitis,  cystitis,  nephritis,  peri- 


-S' 


NORMAL  PARTURITION. 


tonitis,  mammitis,  inflammation  of  the  intestines  or  spinal  cord,  coryza, 
vitulary  fever,  etc.  But  tliere  is  evidently  exaggeration  in  this  ;  and  we 
are  inclined  to  think  that,  at  the  most,  the  untimely  cessation  of  this  dis- 
charge can  only  cause,  as  has  been  stated,  dulness,  indifference  of  the 
mother  to  its  progeny  and  surroundings,  inappetence,  suppression  of  milk, 
slight  fever,  with  dry  erect  coat,  and  constipation. 

To  avoid  this  untimely  cessation  of  the  lochia,  it  has  been  recommended 
that,  with  the  larger  animals,  before  and  after  parturition  the  food  should 
be  sound  and  nutritive,  but  moderate  in  quantity,  and  such  as  will  not 
predispose  to  plethora  or  congestion;  not" to  travel  or  fatigue  animals 
towards  the  end  of  pregnancy ;  to  shelter  them  at  this  period  ;  not  to 
hurry  labor,  and  only  to  render  assistance  when  necessary  ;  and  after 
delivery  to  attend  to  the  removal  of  the  secundines,  which  are  sometimes 
retained  in  the  Cow  for  an  abnormal  period,  but  should  not  be  allowed  to 
remain  longer  than  four  or  five  days. 

3.  MiLK-FEVER. — In  woman  the  establishing  of  the  lacteal  secretion 
after  delivery — generally  forty-eight  hours — is  usually  accompanied  by  a 
general  febrile  condition,  in  which  this  fluid  changes  from  colostrum  to 
ordinary  milk.  This  is  tlie  so-called  "  milk-fever,"  a  pathological  condi- 
tion said  by  some  authorities  to  be  present  in  animals,  and  denied  by 
others.  The  latter  assert  that,  when  parturition  has  been  quite  normal, 
there  is  only  observed  a  little  dulness,  lassitude,  the  pulse  fuller  and 
quicker  than  usual,  and  less  appetite  for  the  first  day — all  consequences 
of  the  suffering  undergone  during  even  the  easiest  parturition.  In  a  day 
or  two,  however,  all  this  has  disappeared,  except  perhaps  a  little  weak- 
ness, which  soon  vanishes  also.  But  when  parturition  has  not  been 
altogether  natural,  and  complications  arise,  then  there  may  certainly  be 
fever,  though  this  has  nothing  to  do  with  the  change  of  the  colostrum  to 
milk — a  gradual  process  ;  indeed,  when  traumatic  fever  sets  in  this  secre- 
tion is  diminished  or  suspended. 

Saint-Cyr  is  disposed  to  deny  the  existence  of  this  so-called  "  milk 
fever  ''  in  animals,  and  he  quotes  eminent  accoucheurs,  who  are  inclined  to 
doubt  the  existence  of  this  fever  in  woman  as  related  to  the  lacteal  secre- 
tion, but  as  due  rather  to  traumatism  from  injury  to  the  genital  organs 
during  child-birth.  His  own  observations  on  Cows  are  certainly  not 
favorable  to  the  existence  of  this  fever  in  these  animals  ;  and  even  among 
those  who  believe  in  it,  there  are  many  who  admit  that  it  is  scarcely  per- 
ceptible. 

Rainard,  for  instance,  accounts  for  its  being  so  little  marked  in  animals, 
by  noticing  that  in  woman  the  uterus  receives  its  blood  from  the  ab- 
dominal (mferior)  aorta,  but  the  mammae  from  the  pectoral  (or  anterior) 
aorta;  but  in  animals,  uterus  and  mammae  are  supplied  by  the  posterior 
aorta.  In  woman,  when  lactation  is  established,  there  is  an  alteration  in 
the  circulation,  and  consequently  a  general  disturbance  which  has  been  ' 
hitherto  designated  "inflammatory"  or  "  angiotenic  fever;"  but  in 
animals  this  change  in  the' circulation  does  not  occur.  Therefore,  this 
'•  angiotenic  fever  "  should  not  be  present. 

4.  Lactation. — Before  parturition,  preparation  for  the  secretion  of 
milk  is  already  being  made  in  the  mammary  glands,  and  shortly  before 
thnt  event  a  thin  serous  or  milky  fluid  can  often  be  expressed  from  the 
teat ;  while  immediately  after  delivery,  the  oedematous  tumefaction  which 


SEQUELS  OF  PARTURITION. 


253 


had  been  observed  in  these  glands  for  some  time,  begins  to  disappear  as 
they  increase  in  volume,  become  firmer,  tenser,  and  more  sensitive,  and 
receive  a  larger  quantity  of  blood.  Then  their  activity  is  suddenly  brought 
into  full  operation,  and  their  secretion  reaches  its  maximum.  At  the 
same  time  this  fluid  is  modified  in  quality  in  a  notable  but  gradual  manner, 
so  that  it  is  very  different  three  or  four  days  after  parturition  from  what 
it  was  on  t^ie  first  or  second  day — being  colostrum  at  the  early  period, 
and  milk  subsequently. 

Colostrum. — The  first  milk, or  "colostrum,"  secreted  after  delivery  is  a 
viscid,  dirty-white,  or  yellowish  fluid,  sweet,  though  unpleasant  to  the 
taste,  and  of  a  greater  density  than  that  of  ordinary  milk,  being  in  the 
Cow  I  "063.  It  is  very  rich  in  solid  elements,  these  varying  according  to 
individuals,  and  even  breeds.  The  fat  globules  are  present  only  in  com- 
paratively small  number,  and  are  less  in  size  than  in  milk  at  a  later  period  ; 
l3ut  there  are  numerous  colostrum  corpuscles — bodies  of  a  large  size, 
spherical  or  ovoid  in  shape — of  ten  agglomerated  in  masses  by  a  tenacious 
viscid  matter,  and  among  them  many  leucocytes  endowed  with  movement. 
Boussingault  gives  its  composition  in  the  Cow  as  follows  : — 

Water 75-8 

Albumen  and  casein  ...  15 'o 

Butter 2-6 

Milk-sugar 3-6 

Salts  ......  3'o 

Dumas  gives  the  colostrum  of  various  animals  as  below  : — 


Water  - 
Fat 

Albumen 
Mucus  - 
Sugar 


Cow. 

Ass. 

Goat. 

803-3 

8284 

641-0 

260 

1"^ 
1 160 

520 

1507 

245-0 

20-0 

70 

300 

traces. 

43"o 

32-0 

It  is  admitted  that  milk  is  due  to  a  fatty  degeneration  of  the  epithelial 
cells  of  the  gland  follicles,  in  which  they  are  greatly  multiplied  and 
developed  during  lactation.  These  cells  rupture,  and  nothing  remains 
but  the  fat  globules  of  the  milk. 


Fig.  63. 
Mammary  Gland  during  Lactation. 
A,  Lobule  of  the  Mammary  Gland  filled  with  Cells;  B,  Milk  or  Fat  Globules;  C,  Colostrum. 
a,  Ceil  filled  with  Fat  Granules  and  with  a  visible  Nucleus  ;  b.  Cells  from  which  the  Nucleus 
has  disappeared. 

But  in  the  colostrum  the  epithelial  cells  have  not  undergone  this 
[change  ;  their  wall  is  intact,  and  they  still  contain  their  oil  granules, 
^and   consequently   constitute   the   colostrum    corpuscles.     Colostrum   is 


254 


NORMAL  PARTURITION. 


coagulable  by  heat,  and  it  may  be  said  that  the  albumen  takes  the  place 
of  casein  ;  but  soon  after  parturition  the  former  disappears  and  the  latter 
is  present.  Towards  the  end  of  lactation,  however,  if  the  animal  is  preg- 
nant, the  milk  again  loses  its  casein,  and  becomes  very  albuminous  ; 
consequently,  coagulable  by  heat.  Its  sugar  also  diminishes  or  disap- 
pears altogether.  The  leucocytes  seem  to  be  increased  in  number  in 
the  colostrum,  as  the  animal  is  disturbed  or  its  health  deranged  ;  and  as 
the  young  creatures  are  often  attacked  by  diarrhoea,  this  is  ascribed  to 
the  presence  of  these  particles. 

Milk. — Towards  the  fifth  or  sixth  day,  or  even  longer,  after  parturition 
in  the  Cow  and  Mare,  earlier  with  some  of  the  other  animals,  the  colos- 
trum disappears,  and  then  we  have  the  ordinary  milk.  This  is  an  opaque, 
pure  white,  or  slightly  yellowish  fluid,  possessing  a  sweet  taste,  and  a 
faint  odor  somewhat  resembling  that  of  the  animal  from  which  it  is 
obtained  ;  it  is  unctuous  to  the  touch,  has  an  average  density  of  1032  to 
1 041,  according  to  the  species  and  other  circumstances;*  and  is  com- 
posed of  three  essential  parts — water,  butter,  and  casein.  We  hav^e  in 
addition  albumen,  milk-sugar,  and  mineral  matters. 

The  three  principal  constituents  are  easily  separated — the  fat  or  cream 
by  allowing  the  fluid  to  stand  at  rest  for  some  time ;  by  pressure  the 
casein  is  separated  in  a  solid  mass  ;  and  the  remaining  portion  contains 
the  water. 

The  milk  varies  considerabl}'-,  as  has  been  said,  according  to  species, 
breed,  age,  food,  the  period  of  lactation  and  milking,  climate,  state  of 
health,  etc.  In  herbivorous  animals  it  is  generally  alkaline  ;  in  carnivo- 
rous, acid. 

Vernois  and  Becquerel  give  a  comparative  table  of  the  composition  of 
the  milk  of  various  animals,  as  below  : — 


Specific  Gravity 
Weight  of  Water     - 
Weight  of  Solid  Parts 
Fat  -----    - 

Casein     and     Extractive 

Matters  .  -  -  . 
Milk-sugar  -  -  -  ■ 
Salts  (by  incineration) 


Woman 

1032-67 

889-08 

110-97 

26-66 

Cow. 

Goat. 

Sheep. 

'033-38 
864-06 

135-94 
36-12 

1033-53 

844-90 

155-10 

56-87 

1040-9S 

167-6S 
51-3' 

39-24 

43*64 

1-38 

IP 

6-64 

55-M 

36-91 

6-18 

69-78 

39'43 
7-16 

Camel. 


1033-74 
904-30 
134-00  95-70 
36-00       24*36 


40-00 
58-00 


33-35 
32-76 

5-23 


Ass. 

Sow. 

1034-57 

_ 

890-12 

854-90 

109-88 

145-10 

1^-53 

19-50 

35-65 

84-50 

50-46 

30-30 

5-24 

10-90 

Bitch. 


1041-62 

772-08 

227-92 

87-95 

116-88 
15-29 

7-80 


Doyere  furnishes  us  with  another  interesting  analysis,  which  we  cannot 
omit  publishing  here  : —  * 


Constituents. 

Woman. 

Cow. 



87-60 

Goat. 

Sheep. 

Llama. 

Ass. 

Mare. 

Water-         - 

87-38 
380 

87-30 

8 1 -60 

8660 

89-63 

91-37 

Fat       - 

2-20 

4-40 

7-50 

310 

1-50 

0-55 

Casein 

0-34 

300 

350 

4-00 

3-00 

060 

0-78 

Albumen      - 

1-30 

I -20 

i"3S 

1-70 

0-90 

135 

140 

Sugar  -        -       .  - 

7-00 

4-70 

3-10 

4-30 

5-6o 

640 

550 

Salts    - 

0-18 

070 

0-35 

■   0-90 

080 

0-32 

0-40 

*  Cow's  milk  of  good  quality,  according  to  Voelcker,  has  a  specific  gravity  of  about  1030 ;  Woman's 
lilk,  1020  ;  Goat's  and  Eve's  milk,  1035  ;  Ass's  milk,  1019. 


SEQUELS  OF  PARTURITION, 


255 


The  salts  contained  in  the  milk  varies  with  the  character  of  the  food, 
and  also  according  to  the  time  that  has  elapsed  since  parturition  ;  this 
fluid  being  particularly  rich  in  inorganic  elements  during  the  first  third  of 
the  period  of  lactation.  According  to  the  analyses  of  Haidlen  and  Furs- 
tenberg,  there  is  in  it  1000  parts  of  ash  ;  475  phosphate  of  lime,  magnesia, 
iron,  etc.  ;  219  carbonate  of  lime  and  salts,  which  are  more  especially 
combined  with  the  casein  ;  343  of  sodium  salts,  with  traces  of  sulphur 
and  flouride  of  calcium.  Milk  also  contains  such  gases  as  carbonic  acid, 
oxygen,  and  nitrogen,  in  solution. 

In  the  Cow  the  flow  of  milk  becomes  very  plentiful  in  about  a  week 
after  calving,  but  after  a  month  or  so  it  gradually  diminishes  in  quantity 
for  about  ten  months,  when  the  animal,  as  a  rule,  "  runs  dry."  In  the 
first  and  second  months  after  calving,  when  the  yield  is  abundant,  it  is 
generally  more  watery  than  after  the  fourth  or  fifth  month  ;  and  the  fur- 
ther the  diminution  in  quantity  proceeds,  the  better  it  becomes  in  quality, 
other  circumstances  being  equal. 

It  will  be  seen  from  the  above  table,  that  the  milk  of  the  *Cow  closely 
approaches  that  of  woman,  and  this  accounts  for  the  readiness  with  which 
it  can  be  substituted  for  the  latter  without  injury  to  the  child.  It  is,  when 
compared  with  that  of  Solipeds,  more  rich  in  casein  and  fat.  The  milk  of 
the  Goat  is  the  most  nutritive,  and  contains  more  casein  ;  but  it  is  viscid 
and  has  a  peculiar  odor,  something  like  that  of  the  cutaneous  transpira- 
tion of  this  animal,  and  particularly  during  the  rutting  season;  this  odor 
is  not  so  powerful  in  white  goats,  nor  in  those  without  horns,  if  they  are 
properly  kept.  The  milk  of  the  sheep  contains  more  fat  than  that  of  the 
Cow  and  Goat,  while  the  casein  is  in  larger  quantity,  but  is  also  viscid. 
It  has  less  water  than  that  of  the  Cow,  and  altogether  is  particularly 
rich,  especially  soon  after  lambing.  This  is  well  seen  in  the  subjoined 
analysis,  and  it  will  explain  the  difficulty  which  is  experienced  in  bringing 
up  a  lamb  when  the  Ewe  has  died  soon  after  parturition  : — 


Water    - 

Fat        -         -         - 
Casein  -         -         - 
Milk-sugar    - 
Mineral  Matters  (Ash) 


Ewe's  Milk  \  Ewe's  Milk 
Three  Weeks  [  Six  Weeks 
after  Lambing.  '  after  Lambing. 


75-00 

8670 

1278 

3-67 

658 

4-44 

4-66 

400 

•98 

119 

loo-oo 

I  GO  "00 

The  milk  of  the  Mare  appears  to  contain  the  largest  portion  of  ^yater 
and  the  smallest  quantity  of  fat,  the  milk  of  the  Ass  coming  next  to  it  in 
these  constituents.  This  contains  little  casein,  scarcely  any  fat,  and  a 
small  quantity  of  ash.  On  the  other  hand,  it  is  comparatively  rich  in 
milk-sugar,  which  is,  according  to  Voelcker,  a  very  digestible  material  and 
a  good  aperient,  particularly  for  children.  But  of  all  animals,  the  carni- 
vora  have  the  richest  milk  ;  the  casein  and  fat  being  particularly  abun- 
dant, and  no  other  food  will  at  all  compare  with  it  in  these  constituents. 
Solid  butcher's  meat  contains  less  real  nutriment  and  more  water  than 
this  description  of  milk.     This  explains  at  once  the  extreme  difficulty  of 


256  NORMAL  PARTURITION. 

bringing  up  a  puppy  by  hand.  No  kind  of  food  is  sufficiently  concen- 
trated adequately  to  provide  for  the  nourishment  of  a  puppy,  strong  beef- 
tea  being  perhaps  the  best  substitute  for  that  purpose.  The  milk  of 
carnivorous  animals  has  another  peculiarity,  in  the  very  small  proportion 
or  entire  absence  of  milk-sugar.  This  substance  is  very  abundant  in  the 
milk  of  herbivorous  animals  ;  and  when  carnivorous  creatures  are  put  on 
more  or  less  of  a  vegetable'diet,  it  appears  in  their  milk,  and  increases  as 
this  diet  is  increased  ;  whereas,  by  feeding  them  entirely  on  flesh,  the 
sugar  vanishes.     The  proportion  of  salts  is  also  comparatively  large.* 

According  to  the  richness  of  milk  in  fixed  constituents,  Colin  classes 
that  of  animals  in  the  following  decreasing  order : 

Bitch  Sow  Woman 

Ewe  Cow  Ass 

Goat  Camel  Mare. 

Milk  is  a  typical  food,  and  when  healthy  and  in  sufficient  quantity, 
contains  all  the  constituents  for  the  maintenance  and  growth  of  the  young 
creature. t  This  is  particularly  noted  immediately  after  birth,  and  before 
it  begins  to  seek  at  all  for  other  food.  It  is  at  this  period,  also,  that 
growth  is  most  rapid  ;  and  it  has  been  observed  that  puppies  double  their 
initial  weight  in  six  days  only.  Colin  has  stated  that,  in  thirty  days,  ten 
•puppies — reduced  to  nine  on  the  twenty-fifth  day — living  on  the  milk  of 
the  mother  alone,  except  for  the  last  ten  days,  showed  a  total  increase 
of  35/^  lbs.,  the  entire  weight  having  been  trebled  since  birth.  A  simi- 
lar increase  may  be  observed  in  other  young  creatures  while  being  suckled. 
When,  from  some  cause  or  another,  the  progeny  cannot  obtain  milk 
sufficient  in  quantity  or  proper  in  quality,  it  is  necessary  that  this  be 
remedied.  A  calf  can  be  readily  artificially  reared  in  an  ordinary  estab- 
lishment, if  it  has  had  one  or  two  days  colostrum  :  or  a  substitute  for  the 
mother  in  another  Cow  may  be  procured.  It  is  not  so  with  the  fo^l, 
which  is  much  more  difficult  to  rear,  and  another  Mare,  even  if  procured, 
will  not  alwa3's  readily  play  the  part  of  nurse.  Nevertheless,  many 
animals  can  be  reared  by  judicious  and  patient  management,  and  if  arti- 
ficial food  must  be  resorted  to,  this  should  come  as  near  as  possible,  in 
chemical  composition,  that  furnished  by  nature. 

In  some  instances,  the  mammary  secretion  may  become  a  source  of 
embarrassment,  or  ev-en  of  danger,  when  it  is  too  abundant  or  is  not  with- 
drawn when  secreted.  This  happens  more  particularly  with  the  Bitch, 
Cat,  Mare,  or  other  animal  which  is  suddenly  deprived  of  its  young  by 
death,  or  for  special  reasons  ;  and  the  retention  of  the  milk  is  often  a 
cause  of  discomfort  and  disturbance,  culminating  not  unfrequently  in 
inflammation  of  the  gland.  In  such  cases  the  milk  should  be  withdrawn 
until  its  secretion  is  diminished  or  altogether  ceases,  and  mild  diuretics 
or  purgatives  may  be  administered  to  hasten  this  end.  Camphor,  in 
small  and  frequent  doses,  has  been  recommended  with  this  object,  as 
well  as  an  infusion  of  walnut-leaves  and  powdered  white  agaric. 

*  According  to  a  French  medical  journal,  Montbrun-les-Bains,  in  the  Drome,  is  celebrated  for  nurses, 
who  continue  to  give  the  breast  for  two  years  and  more.  When  one  of  these  women  loses  her  nursling, 
she  takes  a  puppy-dog  instead,  which  then  becomes  one  of  the  family.  But  it  has  been  observed  that  all 
these  dogs  become  affected  with  rickets,  and  this  has  led  a  medical  man  to  conclude  that  woman's  milk  is 
deficient  in  some  principle  contained  in  dog's  milk,  and  that  consequently  the  latter  might  be  a  cure  for 
rickets.     An  observation  published  by  him  would  seem  to  confirm  this  view. 

t  The  mammary  secretion  may  be  present  in  animals  without  these  being  in  the  pregnant  or  parturient 
state,  or  even  having  been  so.  We  have  already  alluded  to  Bitches  yielding  milk  without  having  puppies. 
Rabbits  have  done  the  same  without  having  been  fecundated,  and  have  reared  the  young  of  other 
Rabbits  :  Bitches  have  done  the  same.  Virgin  or  barren  Ewes  have  also  yielded  milk,  as  have  likewise 
Mares — Mule  and  Horse — and  Fillies. 


SEQUELS  OF  PARTURITION.  257 

Whatever  general  treatment  may  be  adopted  in  such  instances,  local 
treatment  must  not  be  overlooked ;  and  in  addition  to  removing  as  much 
of  the  contents  of  the  mammary  glands  as  possible,  these  may  be  kept 
healthy,  or  cured  when  congested  or  inflamed,  by  suitable  treatment. 
Soothing  liniments  or  embrocations  should  be  timeously  applied  by  fric- 
tion to  the  skin  covering  them. 


SECTION    II. ORGANIC  MODIFICATIONS. 

Gestation  and  parturition  being  completed,  it  is  necessary  that  the 
genital  oigans  should  return  to  their  non-puerperal  state.  Indeed,  this 
return  to  tneir  ordinary  physiological  condition  is  commenced  in  the 
uterus  even  during  labor,  and  remarkable  modifications  occur  more  par- 
ticularly in  the  uterus  and  its  membranes  then,  and  for  some  time  after- 
wards. Theses  changes  are  connected  with  the  diminution  of  the  uterus 
in  volume,  alterations  in  its  mucous  membrane,  and  the  reforming  of  its 
cervix. 

The  powerful  contractions  of  the  uterus  during  parturition,  undoubtedly 
tend  to  use  up  the  contents  of  the  cells  of  the  non-striped  muscular  fibre 
composing  its  middle  coat ;  the  simultaneous  compression  of  the  capil- 
laries and  afferent  vessels  preventing  the  expended  protoplasm  from  being 
replaced.  After  the  expulsion  of  the  foetus  and  its  membranes,  this 
wasting  or  oxidation  of  these  fibres  continues  :  the  uterus  still  contracting 
at  intervals,  and  producing  those  sensations  known  as  the  "  after-pains," 
— the  contractions  being  slow,  gradual,  and  continuous,  and  lasting  until 
the  whole  of  its  inner  surface  is  more  or  less  in  contact,  and  its  cavity  has 
regained  its  ordinary  dimensions.  In  this  process  the  muscular  fibres 
continue  to  undergo  alteration,  the  contractions  of  the  organ  diminishing 
in  force  as  this  change  goes  on  ;  and  this  change  is  essentially  related  to 
the  conversion  into  fat  of  the  albuminous  substance  of  the  protoplasm  of 
which  their  cells  are  composed.  The  fibres  become  degenerated  and 
absorbed,  and  it  is  some  time  before  they  are  replaced  by  others  which 
have  much  smaller  cells.  The  bloodvessels  of  the  organ  also  undergo 
similar  alterations,  after  the  uterine  contractions  have  more  or  less  sus- 
pended the  flow  of  blood  in  their  interior.  They  become  wrinkled  and 
sinuous,  and  gradually  less  permeable  to  the  circulating  fluid,  and  the 
walls  of  the  veins  and  capillaries  are  attacked  by  fatty  degeneration,  and 
are  absorbed  in  large  numbers. 

This  gradual  interstitial  absorption  occurring  after  parturition,  brings 
about  a  considerable  reduction  in  the  weight  and  volume  of  the  organ. 
Thus  the  uterus  of  the  Cow,  which,  immediately  after  delivery,  will  weigh 
from  thirteen  to  fifteen  pounds,  will  be  no  more  than  seventeen  to  twenty- 
one  ounces  when  this  process  is  completed  ;  and  the  uterus  of  a  Ewe 
will  be  found  reduced  to  a  twelfth  or  thirteenth  of  its  weight  at  parturition. 

At  the  same  time,  the  mucous  membrane  lining  the  organ  is  undergoing 
corresponding,  but  perhaps  less  profound,  modifications  to  those  observed 
in  woman  after  the  uterus  has  got  rid  of  its  contents.  When  treating  of 
the  physiology  of  gestation,  we  described  the  manner  in  which  this  mem- 
brane* became  enormously  thickened,  either  wholly  or  partially,  to  con- 
stitute a  most  important  glandular  and  vascular  structure" for  the  develop- 
ment of  the  young  creature.  But  after  parturition,  fatty  degeneration 
attacks  this  structure  and  completely  destroys   it,  and  this  destruction 


258  NORMAL  PARTURITION. 

takes  place  in  a  remarkably  brief  period  in  some  animals.  With  the 
Bitch,  Cat,  and  Rabbit,  as  with  woman,  the  whole  of  the  glandular  layer 
of  the  membrane  corresponding  to  the  insertion  of  the  foetal  placenta — 
the  decidua  vera — is  completely  detached  and  eliminated. 

In  Ruminants  the  cotyledons,  which  had  gradually  acquirec^uch  large 
dimensions  during  pr*egnancy,  shrink,  their  follicular  receptacles  contract 
so  as  to  be  scarcely  visible  to  the  naked  eye,  and  many  of  these  maternal 
placentse  even  appear  to  subside  altogether,  or  to  be  reduced  to  exceed- 
ingly small  proportions.  With  Solipeds  and  the  Sow,  which  have  a 
diffused  placenta,  the  follicles  which  received  the  placental  papillae  of  the 
chorion  also  disappear;  and  the  membrane,  greatly  thinned,  assumes  its 
ordinary  ridged  appearamce,  though  the  ridges  or  folds  are  larger  and 
more  numerous  than  before  conception.  In  a  Mare  killed  eighteen  or 
twenty  hours  after  parturition,  Ercolani  found  the  maternal  portion  of  the 
placenta  reduced  to  one-half  its  thickness  ;  its  color,  instead  of  being  a 
dull  red,  had  become  yellowish  ;  the  follicles,  from  being  one  to  two 
millimetres  in  length,  were  reduced  ta  one  and  half  a  millimetre,  and  the 
capillary  network  around  them  was  no  longer  visible. 

The  evacuation  of  the  detached  elements  is  accompanied  by  an  ap- 
parently large  mucous  secretion,  which,  often  sanguinolent,  constitutes 
what  we  have  described  as  the  "lochia." 

Finally,  a  new^  epithelium  is  formed  in  the  place  of  that  which  has  been 
shed,  and  the  uterine  interior  presents  the  appearance  it  had  before  im- 
pregnation. According  to  Friedlander,  the  formation  of  the  new  mucous 
membrane  takes  place  in  the  following  manner  : — All  that  has  remained 
behind  of  the  cellular  layer  richly  infiltrated  with  blood,  as  well  as  the 
upper  portions  of  the  glandular  layer,  gradually  exfoliates  and  is  dis- 
charged in  the  lochia.  The  flatly  compressed  glandular  tubes  situated 
close  to  the  muscular  coat  are  opened  up,  and  their  cylindrical  epithelium 
forms  the  new  mucous  epithelium  of  the  internal  surface  of  the  uterus. 
The  connective  tissue  situated  between  the  tubular  glands,  accordingly 
proliferates,  and  becomes  reorganized.  In  consequence  of  the  increase 
in  thickness  of  the  mucous  membrane,  the  previous  shallow  depressions 
of  the  epithelium  are  deepened,  and  in  that  way  the  uterine  glands  are 
also  reformed  in  the  new  mucous  membrane. 

Coincidently  with  this  return  to  small  proportions,  the  uterine  cervix 
also  regains  its  former  shape.  During  the  passage  of  the  foetus,  in  process 
of  dilatation  the  os  and  vagina  form  a  continuous  canal  without  any  inter- 
ruption, and  the  cervix  is  effaced.  Immediately  after  the  fcetus  has 
passed  through,  however,  the  .latter  reappears,  the  os  is  closed,  and  the 
uterus  and  vagina  are  again  separated  by  the  sphincter-like  ring  which 
the  uterine  neck  exhibits  in  the  cavity  of  the  latter.  The  cervix  is  at  this 
time  soft  and  flabby,  and  the  os,  not  entirely  closed,  is  readily  dilated  by 
the  fingers.  But  it  gradually  contracts  and  closes,  as  its  texture  becomes 
firmer,  and  in  doing  so  it  elongates  towards  the  vagina,  into  which  it  pro- 
jects, until  it  has  regained  its  natural  form  and  consistence  ;  though  it  is 
always  shorter  and  less  regular  in  shape,  particularly  attheos,  in  animals 
which  have  had  several  young,  than  in  those  which  have  never  been 
pregnant.  The  uterus  itself  does  not  completely  assume  the  dimensions 
it  had  in  non-pregnant  animals,  but  is  always  larger  after  it  has  contained 
one  or  more  foetuses. 

It  may  be  noted  that  the  broad  ligaments  of  the  uterus  become  short- 
ened after  parturition,  and  consequently  raise  the  organ  towards  the 


SEQUELS  OF  PARTURITION.  259 

lumbar  region,  and  in  the  direction   of  the  pelvis  ;  while  their  muscular 
fasciculi  undergo  fatty  degeneration  and  absorption. 

Such  are  the  organic  modifications  the  genital  organs  undergo  after 
labor,  when  everything  occurs  regularly.  But  it  sometimes  happens  that 
the  muscular  layer  of  the  uterus  appears  to  be  struck  with  paralysis  soon, 
or  even  immediately  after  birth ;  so  that  it  remains  "distended  and  its 
cavity  so  large  that  the  arm  can  easily  be  introduced  into  it.  This  inertia 
is  not  so  much  to  be  dreaded  in  animals  as  in  woman,  though  it  is  often 
troublesome  and  sometimes  serious  in  them.  The  debris  of  the  decidua 
vera,  and  other  effete  matters,  accumulate  in  its  cavity,  and  the  os  being 
always  more  or  less  patent,  the  air  obtains  admission,  putrefaction  com- 
mences, and  grave  results  may  follow.  An  exploration  will  discover  a 
variable  quantity  of  sanious,  and  more  or  less  foul-smelling,  matter  in  the 
cavity  of  the  organ  ;  and  until  this  is  removed,  and  the  organ  made  to 
contract  on  itself,  danger  may  be  apprehended. 


PART  SECOND. 

DYSTOKIA. 
GENERAL  CONSIDERATIONS. 

In  studying  the  physiology  of  parturition,  we  saw  that  a  favorable  ter- 
mination of  labor  depended  on  two  factors,  one  of  which  was  a  proper 
degree  of  activity  of  the  expelling  powers,  and  the  other  a  normal  condi- 
tion of  the  obstacles  to  be  overcome  by  these  powers.  When  these  are 
out  of  proportion  to  each  other,  then  we  have  difficult  parturition  or 
Dystokia  (o''>'^  difficult ;  roxoc,  birtJi).  Difficult  parturition  may  be  due 
to  too  feeble  pains,  or  to  an  obstacle  which  the  unaided  efforts  of  the 
animal  cannot  surmount  except  after  an  unusual  period  of  labor,  or  not 
at  all. 

We  have  already  alluded  to  the  nature  of  and  variations  in  the  expel- 
ling forces,  and  also  to  the  causes  of  protracted  labor.  We  have  now  to 
treat  of  the  difficulties  attending  parturition,  with  their  consequences — 
proximate  or  remote,  and  the  means  to  be  adopted  for  overcoming,  pre- 
venting, or  remedying  these.  This  involves  a  study  of  the  necessary  ob- 
stetrical operations,  the  accidents  attending  or  following  parturition,  and 
the  diseased  conditions  more  or  less  related  to  the  puerperal  state — all  of 
which  may  be  included  under  the  head  of  "  pathology  of  parturition." 

The  difficulties  attending  parturition  depend  upon  the  resistance  op- 
posed to  the  expelling  powers,  and  this  is  determined  by  the  relation  of 
the  object  to  be  expelled — the  presenting  part  of  the  foetus — to  the  mater- 
nal genital  passages.  Consequently,  an  exaggerated  resistance  may  be 
due  to  abnormal  conditions  of  the  parturient  passages,  or  to  some  un- 
natural condition  of  the  young  animal.  In  the  first  we  have  Maternal 
Dystokia,  and  in  the  second  Fcetal Dystokia.  These  necessitate  particular 
operations,  some  of  which  demand  much  study,  address,  and  manipula-' 
five  power  on  the  part  of  the  obstetrist.  In  addition,  we  have  dangerous 
accidents  sometimes  occurring  during  parturition,  which,  if  they  do  not 
happen  to  interfere  with  the  mechanism  of  that  act,  may  nevertheless 
require  the  highest  degree  of  surgical  skill  to  remedy.  And,  finally,  there 
are  the  maladies  which  accompany  the  parturient  state,  some  of  them 
being  serious,  and  needing  great  clinical  knowledge  for  their  successful 
treatment. 

These  difficulties,  accidents,  and  diseases  do  not  occur  with  the  same 
gravity,  nor  with  the  same  frequency,  in  all  the  domesticated  animals  ; 
indeed,  with  regard  to  the  latter,  some  species  appear  to  be  altogether 
exempted  from  at  least  one  or  more  of  them. 

Cases  of  dvstokia  are  much  more  frequent  in  the  bovine  species  than 
in  any  other  ;*  and  least  so,  perhaps,  in  the  equine  species.     These  tvvo 

*  The  Camel,  and  particularly  the  Bactrian,  which  is  characteristic  of  Mongolia,  appears  generally  to 
require  assistance  during  parturition.  At  least  we  may  infer  this  from  the  statement  of  Colonel  Prejevalsky, 
who,  in  speaking  of  the  Mongolian  Camel,  says:— 'The  males  become  vicious  during  the  rutting  season, 
which  is  in   February,  and  they  will  then  fight  with  one  another,  and  sometimes  attack  mankind.     The 


GENERAL  CONSIDERATIONS.  261 

species  are  those  which  the  obstetrist  is  generally  called  upon  to  attend 
during  protracted  or  difficult  parturition  ;  and  every  practitioner  who  has 
had  any  experience  in  this  matter,  will  testify  that  for  one  case  in  the 
Mare  or  other  animal  there  will  be  at  least  ten  in  the  Cow.  Two  Danish 
veterinarians,  Nielsen  and  Tallich,  have  estimated,  that  while  they  have 
had  ten  cases  in  the  Mare,  the  first  has  had  190,  and  the  second  159  in 
the  Cow  ;  and  yet  these  writers  practised  in  a  district  where  more  Horses 
than  Cows  were  reared. 

We  have  already  said  that  the  Mare  is,  of  all  quadrupeds,  the  one 
which  brings  forth  its  young  most  easily — a  fact  noted  by  Aristotle.  But 
this  remark  only  applies  to  normal  parturition  in  that  animal  ;  in  abnor- 
mal cases  there  is,  as  a  rule,  more  urgency  and  danger  than  in  the  Cow, 
as  well  as  more  difficulty  in  affording  relief.  Indeed,  a  very  able  veterin- 
arian, Donnarieix,  who  has  had  an  extensive  experience  in  obstetricy,  de- 
clares that  obstetrical  operations  in  the  Mare  are  a  labor  of  Hercules  ;  while 
in  the  Cow  they  are,  comparatively,  child's  play.  This  experience  will  not 
quite  accord  with  that  of  every  practitioner  ;  as  in  both  animals  difficul- 
ties in  parturition  will  be  sometimes  encountered,  which  baffle  the  skill 
of  the  most  competent,  and  often  prove  insurmountable.  One  of  these 
difficulties  in  the  Mare  is  related  to  the  difference  in  the  vitality  of  the 
foal  and  calf  when  parturition  has  commenced — a  difference  which  we 
have  before  pointed  out  as  due  to  the  particular  arrangement  of  the  ma- 
ternal and  foetal  placentae  in  each  species,  and  which  it  is  of  great  impor- 
tance to  remember  in  choosing  the  means  to  be  employed  in  overcoming 
obstacles  to  parturition  in  either  the  Mare  or  Cow.  The  following  com- 
parison has  been  drawn  by  Donnarieix,  between  parturition  in  the  Mare 
and  Cow,  and  fairly  accounts  for  the  differences  in  each  animal  : — 

Mare.  Cow. 

1.  Delivery  is  often  followed  by  i.  Delivery  always  terminates 
insuccess.  favorably. 

2.  A  wound  inflicted  on  the  geni-  2.  A  wound  of  these  organs 
tal  organs  is  generally  fatal.  rarely  causes  death. 

3.  Inversion  of  the  uterus  is  3.  Inversion  of  the  uterus  is  often 
nearly  always  irremediable.  curable. 

4.  Mares  nearly  always  succumb  4.  This  accident  is  not  generally 
to  penetrating  wounds  of  the  abdo-  fatal  in  Cows.  ^ 
men  during  parturition. 

5.  Delivery  of  the  most  simple  5.  Delivery,  even  in  the  most 
kind  is  occasionally  followed  by  bad  complicated  cases,  generally  proves 
results.  In  abnormal  and  laborious  comparatively  easy,  and  obstetrical 
parturitions  not  unfrequently  Mare  operations  successful. 

and  foal  succumb. 

6.  Difficult  parturition  proves  a  6.  Such  parturitions  are  not  of 
Herculean  task  to  the  operator.            much    account    to    a    practitioner 

skilled  in  the  necessary  operations. 

interference  of  man  is  needed  to  bring  the  sexes  together.  The  period  of  gestation  is  thirteen  months,  at 
the  expiration  of  which  the  dam  gives  birth  to  one,  or,  as  an  exception,  two,  foals.  Human  assistance  is 
also  required  at  the  time  of  parturition.  The  new-bom  Camel  is  the  most  helpless  creature  nnaginable  ;  it 
must  be  lifted  by  hand  and  placed  under  the  mother's  teats  ;  but  as  soon  as  it  can  walk,  it  follows  her 
about  everywhere,  and  the  latter  is  so  attached  to  her  offspring,  th.at  she  cannot  bear  to  be  separated  from 
it.  The  female  Camel  is  granted  its  liberty  for  a  whole  year  after  parturition  ;  so  that  it  only  foals  every 
other  y&2,x."  —Mongolia,  the  Tangtit  Country,  and  ike  Solitudes  of  Northern  Tibet,  vol.  i.,  p.  124. 
London,  1876. 


262 


DYSTOKIA. 


Ma  re — continued. 
7.  The  duration  of  the  life  of  the 
fcEtus  in  a  case  of  abnormal  labor, 
does  not  extend  beyond  the  fourth 
hour,  on  account  of  the  young  ani- 
mal having  to  maintain  its  inde- 
pendent existence,  as  if  already 
born. 


8.  The  neck  of  the  foal  being 
very  long,  the  head  is  usually  found 
deeply  buried  in  the  flank  when- 
ever it  is  turned  backwards.  The 
operatQr  has  very  great  difficulty 
in  reaching  the  head  with  his  hand  ; 
indeed,  it  is  often  impossible  to 
bring  it  into  its  natural  position. 
The  loop  slips  off  the  neck  of  the 
lower  jaw,  and  has  constantly  to  be 
replaced  ;  it  is  scarcely  possible  to 
fix  a  cord  there,  this  portion  of  the 
jaw  being  so  short  and  the  foetus 
having  no  teeth. 

9.  When  once  the  amniotic  fluid 
has  escaped,  the  introduction  of  the 
hand  is  difficult,  owing  to  the  geni- 
tal organs  becoming  dry  \  this  dry- 
ness causes  an  efflux  of  blood  to 
the  mucous  membranes.  The  re- 
sistance made  by  the  foetal  mem- 
branes to  manipulation,  when  made 
to  ascertain  either  the  position  of 
the  foetus  or  for  correcting  the  po- 
sition, together  with  the  struggles 
and  violence  of  the  Mare,  which 
now  and  then  drops  as  if  dead,  are 
all  difficulties  to  be  overcome. 


Cow — continued. 

7.  Under  the  same  circumstance 
the  calf  may  live  four  or  five  days 
in' utero,  as  life  is  maintained  by 
the  placental  connections.  These 
differences  are  explained  by  the 
mechanism  of  foetal  life  in  the  two 
species  of  animals,  as  well  as  by 
the  anatomy  of  the  uterus  and  foe- 
tal membranes. 

8.  The  neck  of  the  foetus  being 
shorter  and  thicker,  the  head  is 
less  twisted,  and  the  operator  can 
with  greater  ease  bring  it  back  into 
its  normal  position.  In  addition, 
there  are  teeth  in  the  lower  jaw, 
the  neck  of  which  is  narrow  ;  so 
that  the  slip-knot  does  not  leave  it, 
and  straightening  of  the  head  and 
neck  becomes  an  easier  affair. 


9.  The  genital  organs  are  con- 
tinually lubricated  by  a  mucus  fluid 
which,  while  it  facilitates  the  in- 
troduction of  the  hand,  renders 
easy  any  necessary  correction  of 
position,  and  favors  parturient  ope- 
rations. Besides,  any  movement 
made  is  not,  in  general,  of  much 
consequence. 


Presentations  which,  in  the  Cow,  owing  to  its  phlegmatic  tempera- 
ment, intervals  of  quietude,  and  more  gentle  and  tractable  nature,  are 
common,  and  as  a  rule  adjijstable,  are  yet  most  difficult  in  the  Mare,  and 
if  not  quickly  attended  to,  rapidly  lead  to  a  fatal  termination.  With  re- 
gard to  difficult  parturition  in  the  other  domesticated  animals,  the  Goat 
and  Ewe  come  next  to  the  Cow  in  the  order  of  frequency  ;  though  cases 
of  dystokia  are  not  so  often  noted  in  them  as  in  that  animal.  It  is  to  be 
remarked,  however,  that  assistance  is  not  so  easily  rendered  them,  owing 
to  the  introduction  of  the  hand  into  the  uterus  not  being  always  possible. 
In  the  Goat  the  act  is  sometimes  very  prolonged,  though  on  account  of 
the  multiple  placentae  the  foetus  may  live  as  long  as  in  the  Cow.  With 
the  Ewe  the  same  occurrence  is  observed,  but  in  this  creature  it  is  some- 
limes  possible  to  introduce  the  hand  into  the  genital  passages.  It  is  rare 
indeed  that  the  obstetrist  is  required  to  attend  upon  the  healthy  Sow, 


GENERAL  CONSIDERATIONS. 


263 


this  animal  appearing  to  be  almost  exempt  from  difficulties  in  parturi- 
tion. In  cases  of  raciiitism,  however,  there  is  sometimes  so  much  de- 
formity of  the  pelvis,  that  aid  is  required.  Notwithstanding  the  narrow- 
ness of  the  passage,  the  hand  or  fingers  may  be  passed  into  them. 

Cases  of  dystokia  are  not  unfrequent  in  the  Bitch,  and  particularly  if 
it  is  of  small  size,  or  belongs  to  a  breed  with  a  large  round  head  and 
short  nose.  Numbers  of  Bitches  perish  every  year  from  non-delivery  of 
their  puppies  ;  these  latter  may  also  succumb  before  the  decease  of  their 
parent,  as  it  often  happens  that  the  death  of  one  entails  destruction  on 
the  others.  Cats  are  sometimes  subjects  of  difficult  parturition,  from  the 
same  causes  as  Bitches. 

A  very  great  disadvantage  under  which  the  veterinary  obstetrist  labors 
in  cases  of  dystokia,  is  the  late  period  at  which  his  services  are  gen- 
erally called  into  request,  and  often  after  serious  and  even  irreparable 
injury  has  been  done  by  unskilful  hands  ;  and  this  in  instances  in  which 
a  little  scientific  manipulation  and  some  surgical  knowledge  would  have, 
perhaps,  made  all  right  and  safe  in  a  few  minutes.  Saint-Cyr  justly 
says,  in  commenting  on  some  remarks  made  with  regard  to  the  services 
a  veterinary  surgeon  may  render  in  difficult  parturition,  that  these  can  be 
beneficial  only  on  the  absolute  condition  that  he  is  present  in  good  time. 
Called  upon  too  late,  when  the  "  waters  "  have  escaped  for  a  long 
period,  and  the  neighboring  empiric  has  exhausted  his  science,  aggra- 
vated a  bad  presentation,  irritated  the  generative  organs  by  manipula- 
tions, tractions,  and  violent  means  ;  then  all  the  ability  of  the  most  ex- 
perienced practitioner  may  be  useless.  He  will  find  the  passages  dry, 
burning,  swollen  by  inflammation,  the  fcetus  more  or  less  advanced  into 
the  pelvic  cavity,  where  it  is,  it  may  be  said,  "  wedged,"  or  like  a  nail 
driven  into  wood  ;  with  the  uterus  spasmodically  contracted  on  itself, 
and  so  closely  applied  to  the  body  of  the  fcetus  that  it  is  almost  impos- 
sible to  pass  the  hand  between  them.  How  is  it  possible  to  manipulate 
in  such  a  place — how  change  the  vicious  position  of  a  fcetus  which  the 
greatest  efforts  can  neither  make  advance  or  retire  ?  How  can  a  sharp 
instrument  be  carried  into  the  uterine  cavity,  and  used  with  safety,  when 
the  hand  alone  can  scarcely  be  made  to  enter  it  .-• 

It  is  in  these  circumstances  that  a  practical  knowledge  of  obstetricy  is 
most  valuable,  and  renders  he  who  possesses  it  a  very  great  acquisition 
to  an  agricultural  or  pastoral  district.  And  this  knowledge  may  be  said 
to  be  special  ;  for  obstetricy  is  not  like  the  other  branches  of  veterinary 
surgery,  in  forming  a  portion  of  every  veterinarian's  practice.  On  the 
contrary,  it  is  rarely  practised  in  towns  or  cities,  but  is  almost  exclusively 
limited  to  animal-rearing  localities  ;  there  alone  is  to  be  found  the  school 
in  which  the  practitioner  may  be  initiated  into  all  the  difficulties  of  this 
complex  art,  and  the  best  and  readiest  means  of  surmounting  them.  And 
it  must  be  confessed  that  the  practice  of  this  art  is  not  particularly  allur- 
ing, and  is  attended  with  many  more  inconveniences,  hardships,  and  dif- 
ficulties than  fall  to  the  lot  of  the  human  obstetrist;  indeed,  we  know  of 
no  more  arduous  and  anxious  occupation  than  that  of  the  country  prac- 
titioner in  a  cattle-breeding  district,  and  he  requires  physical  endow- 
ments which  are  certainly  not  needed  by  the  attendant  on  woman. 

Veterinary  accouchments  are  generally  difficult  and  perplexing,  as  well 
as  fatiguing,  says  Zundel.  Long  and  powerful  arms  are  necessary,  as 
well  as  much  address  in  using  them  and  the  fingers  ;  bodily  activity  is 
above  all  essential,  in  order  to  go  about  an  animal,  to  place  one's  self  in 


264  DYSTOKIA. 

the  most  favorable  position  for  exploring  and  operating,  and  to  avoid 
injury  from  the  creature.  The  veterinary  obstetrist  should  also  be  gifted 
with  presence  of  mind,  coolness,  and  fertility  of  resource;  so  as  to  take 
into  consideration  all  the  circumstances  of  the  case,  devise  his  method  of 
procedure,  and  carry  it  out  promptly. 

The  conditions  under  which  the  veterinarian  has  to  perform  his  task 
are  not  favorable  or  encouraging.  It  is  any  thing  but  easy  to  practise 
the  necessary  manipulations  in  the  larger  animals — such  as  the  Mare  or 
Cow — in  such  a  great  cavity  as  the  abdomen,  and  in  the  uterus  which 
lies  deep  in  it,  and  contains  a  voluminous  foetus.  In  practising  these 
manipulations,  the  operator  has  to  contend  with  the  struggles  and  dis- 
ordered movements  of  the  animal,  which  sometimes,  in  the  midst  of  its 
sufferings,  does  not  hesitate  to  use  its  feet,  horns,  or  teeth  as  weapons  of 
defence,  or  to  crush  its  medical  attendant  against  the  adjoining  wall.  In 
addition,  the  violent  contractions  of  the  uterus,  and  especially  of  the  cer- 
vix, fatigue  the  operator  extremely.  Sometimes  these  manipulations  are 
continued  for  hours,  until  the  various  obstacles  to  delivery  are  successively 
overcome,  or  the  creature  is  doomed  to  perish. 

Add  to  this,  that  Cows  and  Mares  during  parturition  often  inhabit  close 
foul  stables,  with  a  poisonous  atmosphere,  destitute  of  light,  and  perhaps 
also  cold  and  damp.  Here  the  veterinarian  must  do  his  duty — cold,  wet, 
and  dirty,  exposed  to  draughts  and  every  kind  of  discomfort.  Most 
frequently,  too,  he  is  left  to  his  own  resources  ;  for  it  is  rare  that  intelli- 
gent and  obedient  assistants  can  be  found  in  such  places.  And  all  this 
after  driving  long  distances,  often  at  night  and  in  bad  weather.  How 
different  to  the  accoucheur  of  woman  ! 

All  the  inconveniences,  risks,  and  hardships  of  the  veterinary  obstetrist 
do  not  end  here.  After  manipulations,  sometimes  long  continued,  in  a 
uterus  containing  infective  matter  resulting  from  retention  of  a  dead  foetus, 
or  fcetal  membranes  in  process  of  decomposition,  he  is  exposed  to  the 
most  serious  septic  diseases,  and  may  even  lose  his  life.  A  cutaneous 
eruption  indeed  often  appears  on  the  arms  of  the  operator,  only  through 
having  manipulated  for  some  time  in  genital  organs,  the  mucous  mem- 
brane of  which  was  only  irritated  and  inflamed,  or  simply  swollen  and 
bruised — no  putrefaction  or  suppuration  being  present.  Most  frequently 
the  disease  is  merely  local,  and  is  sometimes  a  simple,  limited,  erythe- 
matous redness  which  disappears  in  tweni^y-four  hours  ;  at  other  times  it 
is  a  trifling  eczema  without  pustules,  but  with  intense  itching  ;  frequently 
it  is  a  pustular,  sometimes  confluent,  ecthyma,  the  crusts  on  which  are 
occasionally  not  detached  for  months  ;  in  other  cases  there  are  furuncles, 
abscesses  on  the  arm,  or  even  over  the  body.  In  the  majority  of  cases, 
the  affection  is  accompanied  by  fever,  anorexia,  great  uneasiness,  and 
pains  so  acute  that  sleep  is  impossible  ;  there  may  also  be  tumefaction  of 
the  axillary  glands.  The  course  of  the  disease  is  generally  irregular, 
relapses  are  common,  and  it  is  a  long  time  before  its  effects  pass  off. 
Death  sometimes  occurs,  and  amputation  of  a  portion  of  the  arm  has  been 
necessary.*  Such  are  the  difficulties  and  risks  of  the  veterinary  accou- 
cheur. We  will  now  refer  more  particularly  to  his  line  of  conduct  in 
practice. 

.  Proprietors  of  animals  should,  in  their  own  interests,  suffer  no  delay  to 
occur  in  sending  for  the  veterinary  surgeon  as  soon  as  they  perceive  that 
parturition  is  not  progressing  regularly;  and  they  should  carefully  abstain 

*  Veterinary  yournal,  vol.  ii.,  p.  :!i8. 


GENERAL  CONSIDERATIONS.  265 

from  any  violent  handling  of,  or  traction  on,  the  foetus  which  might  render 
irremediable  a  difficulty  often  easy  to  surmount  at  the  commencement,  by 
anv  one  sufficiently  acquainted  with  obstetrics. 

<3n  his  part,  the  veterinarian  should  not  lose  time  in  giving  his  services  ; 
as  every  minute's  delay  may  render  the  case  more  difficult,  and  tend  to 
compromise  the  life  of  not  only  the  young  animal,  but  also  that  of  the 
mother,  as  well  as  the  interests  of  the  owner  and  his  own  reputation.  It 
is  essential  that  he  should  be  provided  with  certain  instruments,  as  obstet- 
rical operations  are  partly  performed  by  means  of  these,  as  well  as  by 
the  unarmed  hand,  which  is,  after  all,  the  most  perfect  instrument,  and 
should  always  be  preferred  to  instruments  when  possible.  Some  opera- 
tions, however,  can  only  be  undertaken  with  instruments,  and  it  is  there- 
fore necessary  that  the  obstetrist  be  provided  with  at  least  those  which 
are  most  useful  and  indispensable  :  such  as  one  or  two  knives,  cords, 
hooks,  Schaack's  head-collar  or  some  other  pattern,  etc.,  and  these  should 
be  so  portable  as  to  be  carried  in  a  leather  or  canvas  bag,  or  a  small 
box. 

On  reaching  the  patient,  all  information  concerning  it  should  be  gath- 
ered at  once,  and  an  examination  immediately  made  into  its  condition. 
The  period  when  labor  commenced  ;  if  the  "  water-bag  "  has  ruptured, 
and  when  ;  if  the  animal  has  gone  its  full  time,  or  exceeded  it  ;  if  it  is  a 
primipara,  or,  if  not,  if  its  previous  parturitions  were  favorable  ;  all  these 
and  other  useful  points  in  its  history  should  be  obtained. 

The  examination  should  comprise :  the  general  appearance  of  the 
animal  ;  whether  weak  or  strong ;  the  character  of  the  pulse  ;  and  the 
nature,  frequency,  and  intensity  of  the  expulsive  efforts  ;  as  well  as  the 
condition  of  the  mammae,  and  external  genital  organs.  After  this,  if  further 
examination  is  necessary,  direct  exploration  of  the  internal  genital  organs 
should  be  made.  We  have  already  described  the  mode  of  procedure  to 
be  adopted  in  this  exploration  ;  but  because  of  its  importance,  we  will 
again  notice  it. 

If  possible,  the  Mare  and  Cow  should  be  examined  in  a  standing  atti- 
tude, as  this  is  the  best.  If,  however,  the  animal  is  lying,  and  from 
exhaustion  or  paralysis  it  cannot  get  up,  then  of  course  the  examination 
must  be  made  in  this  position  ;  indeed,  it  may  be  advantageous  to  examine 
in  both  positions. 

When  standing,  it  should  be  approached  gently  and  coaxingly,  and 
rigorous  restraint  is  seldom  necessary ;  for  the  pains  of  labor  usually 
render  the  most  vicious  animals  tractable.  With  the  Mare  it  generally 
suffices  to  have  one  of  the  fore  feet  held  up  by  an  assistant,  while  the 
examination  is  made  ;  if  young  and  dangerous,  it  may  be  necessary  to 
employ  a  side-line  on  a  hind  pastern,  or  hobbles  on  both  hind  pasterns, 
and  perhaps  a  twitch  on  the  nose.  With  the  Cow,  a  strong  man  holding 
the  animal's  head  is  sufficient  to  make  it  stand  quiet. 

Lateral  movements  may  be  prevented  by  placing  the  animal  against  a 
wall  or  partition  on  one  side,  and  a  powerful  man  at  the  other  side  ;  or  a 
man  at  each  side.  The  operator  must  be  on  his  guard  against  the  animal 
suddenly  dropping,  which  would  expose  him  to  serious  injury.  When  the 
floor  inclines  from  the  tail  towards  the  head  of  the  animal  it  is  most 
favorable  for  an  exploration,  as  the  mass  of  intestines  is  thrown  forward 
against  the  diaphragm  ;  so  that  they  do  not  press  on  the  uterus,  which  is 
then  more  free  and  better  adapted  for  manoeuvres  in  its  interior. 

When  the  operator  has  to  explore  in  the  lying  position,  he  finds  it  much 


266  DYSrOKIA. 

more  fatiguing  and  difficult,  as  he  has  then  to  kneel,  and  to  accommodate 
himself  to  the  animal.  In  the  decubitus,  it  is  still  more  necessary  that 
the  croup  should  be  higher  than  the  front  part  of  the  body,  in  order  to 
get  the  digestive  organs  out  of  the  way  ;  the  lateral  pressure  of  the  viscera 
should  also  be  diminished  by  having  the  spine  higher  than  the  limbs  ; 
and  it  must  be  borne  in  mind  that  the  more  an  animal  is  raised  above  the 
ground  when  it  is  lying,  the  easier  is  the  manipulation.  For  the  same 
reason,  the  smaller  animals  should  be  raised  as  high  as  the  operator's 
hand  :  the  Sheep,  Sow,  and  Goat  on  several  bundles  of  straw  ;  the  Bitch 
and  Cat  on  a  table  covered  with  straw  or  a  cloth.  The  two  latter  animals 
must  be  so  secured  that  they  will  not  bite  or  scratch  the  operator. 

To  compel  a  Cow  to  get  up,  Schaack  recommends  that  a  small  Dog  be 
introduced  into  the  stable,  and  made  to  bark  at  and  excite  the  animal. 

The  coat  must  be  removed,  and  the  shirt-sleeve  rolled  as  high  as  the 
shoulder  ;  indeed,  with  large  animals,  when  there  is  a  likelihood  of  much 
manipulation  being  required  with  the  cavity  of  the  uterus,  it  has  been 
recommended  to  remove  the  shirt  and  underclothing  from  the  arm  and 
shoulder  altogether. 

My  friend,  Mr.  Cartwright,  of  Whitchurch,  employs  a  large,  thick,  and 
long  woollen  sleeveless  vest  that  buttons  close  up  around  the  neck  ;  this 
is  ver}^  suitable  for  such  cases,  as  it  not  only  admits  of  the  shirt  being 
removed,  but,  besides  keeping  the  operator's  clothes  clean,  it  prevents 
him  catching  cold.  Other  operators  wear  a  long  gown,  like  a  dissecting- 
room  gown. 

The  back  of  the  hand  and  arm  should  be  well  smeared  with  oil,  grease, 
or  even  butter,  not  qnly  to  render  their  introduction  into  the  genital  pas- 
sages more  easy,  and  less  irritating  to  the  lining  membrane,  but  also  to 
some  extent  to  prevent  the  operator  becoming  infected.  It  is  scarcely 
necessary  to  add  that  rings  should  not  be  worn  on  the  fingers.  The 
right  hand  is  usually  introduced,  but  it  is  well  to  be  able  to  use  both 
hands  ;  certain  manipulations  being  more  easily  executed  with  the  left 
than  the  right  hand  ;  and,  besides,  in  protracted  operations  one  hand 
relieves  the  other. 

Before  commencing  the  examination  of  the  genital  passages,  it  is  well 
to  empty  the  rectum,  and  if  possible  the  bladder.  While  emptying  the 
former  viscus,  useful  information  may  be  gleaned  in  ascertaining  the  con- 
dition of  the  uterus  through  its  walls,  as  well  as  of  the  pelvis  and  pelvic 
cavity. 

The  fingers  being  gathered  together  in  a  cone-like  form,  the  hand — 
which  should  not  be  cold — is  inserted  carefully  into  the  vagina  at  a 
moment  when  the  animal  is  not  straining  :  the  outer  margin  (little  finger) 
being  downwards,  thumb  towards  the  rectum,  and  pushed  gently  inwards 
by  a  slight  rotatory  movement ;  but  the  advance  of  the  hand  must  be 
momentarily  checked  if  the  straining  is  at  all  sevefe,  or  until  the  animal, 
if  irritable,  has  become  reconciled  to  it.  When  once  through  the  vulva, 
more  room  is  found  in  the  vagina,  and  the  hand  and  fore-arm  can  then 
penetrate  with  ease  as  far  as  the  cervix  uteri. 

The  object  of  exploration  being  to  ascertain,  in  the  first  place,  the  con- 
dition of  the  genital  passages,  as  well  as  the  state  of  the  pelvic  cavity  in 
general,  the  operator  has  to  satisfy  himself  whether  the  vagina  is  empty, 
or  if  it  already  contains  some  portion  of  the  foetus  or  its  membranes,  and 
what  these  are  ;  if  there  is  any  abnormal  condition  or  contraction  of  the 
vagina,  or  any  tumors  either  within  or  external  to  that  canal,  as  well  as 


GENERAL  CONSIDERATIONS.  267 

the  seat  of  these,  and  if  possible  their  nature.  He  has  also  to  satisfy 
himself  that  the  pelvis  is  wide,  regular  in  form,  or  more  or  less  deformed 
and  diminished  in  size  from  exostoses,  fractures,  or  other  causes. 

The  state  of  the  soft  parts  will  likewise  engage  his  attention,  and 
he  must  learn  whether  the  vulvo-uterine  canal  is  dry,  or  contains  suffi- 
cient mucus  to  facilitate  manipulation  or  delivery,  as  well  as  its  tempera- 
ture. Having  satisfied  himself  on  these  points,  the  fingers  are  again 
brought  together,  and  their  extremity  pushed  as  far  as  the  cervix  uteri, 
the  condition  of  which  is  carefully  studied.  The  chief  points  to  be  noted 
are  :  whether  it  still  projects  into  the  vagina,  or  if  it  is  completely 
effaced  ;  whether  the  uterus  has  descended  on  the  floor  of  the  abdomen, 
or  is  yet  in  its  ordinary  position  ;  whether  the  os  is  closed  or  open, 
and  the  extent  of  its  dilatation  ;  whether  the  texture  of  the  cervix  is  hard 
or  soft,  healthy  or  altered  by  morbid  degeneration,  and  if  it  lies  in 
the  axis  of  the  vagina  or  deviates  therefrom,  or  is  more  or  less  twisted. 
Passing  the  hand  into  the  uterine  cavity,  if  necessary  and  possible,  and 
with  all  care  and  gentleness,  the  explorer  will  meet  with  the  "  water- 
bag,"  if  it  is  not  already  ruptured,  and  the  foetus,  if  he  has  not  already 
encountered  it;  at  the  same  time  the  energy  and  frequency  of  the  labor 
pains  can  be  ascertained.  If  the  membranes  are  ruptured,  the  hand  must 
be  passed  into  them  in  order  to  discover  the  situation  of  the  foetus — the 
kind  of  presentation  and  position,  the  manner  in  which  the  limbs  are  dis- 
posed, and  any  complications  which  may  be  present.  If  the  membranes 
are  not  ruptured,  and  it  is  deemed  necessary  to  open  them — which  not 
unfrequently  happens  when  an  exploration  has  to  be  made,  and  labor  is 
advanced,  the  pains  being  well  marked,  the  os  dilated,  and  the  water-bag 
in  the  vagina — the  hand  may  be  passed  between  them  and  the  uterus, 
the  palm  being  towards  the  foetus  j  or  it  may  not  be  required  to  pass  so 
deeply. 

When  the  membranes  are  tense,  pressure  against  them  with  the  end  of 
the  index  finger  during  a  throe  is  usually  sufficient  to  open  them  ;  if,  how- 
ever, they  are  flaccid,  a  portion  is  seized  between  ^he  thumb  and  middle 
finger  and  torn  by  their  nails,  or  by  the  nail  of  the  first  finger  against 
that  of  the  thumb.  Sometimes  the  fingers  alone  are  not  sufficient, 
as  when  the  envelopes  contain  but  little  fluid  ;  then  a  pair  of  scissors,  a 
small  trocar,  or  even  an  ordinary  pen  will  effect  this  object. 

In  examining  for  presentation  and  position,  each  region  of  the  body  of 
the  foetus  should  be  familiar  to  the  touch,  as  it  can  be  distinguished  by 
its  own  proper  characters.  Under  ordinary  circumstances,  the  hand  of 
the  operator  first  meets  with  the  limbs  of  the  foetus  ;  if  they  are  the  ante- 
rior limbs,  and  the  plantar  surface  of  the  feet  is  turned  downwards,  then 
the  foetus  is  in  the  natural  or  vertebro-sacral  position,  anterior  presenta- 
tion ;  but  if  the  plantar  surface  of  the  feet  is  inclined  upwards,  and  they 
really  belong  to  the  fore  limbs,  then  it  is  in  the  vertebro-pubic  position. 
To  distinguish  the  fore  from  the  hind  limb,  the  shape  of  the  joints  and 
their  mode  of  flexion  must  be  taken  into  account — the  fetlock  and  knee 
of  the  former  bend  in  the  same  direction,  while  in  the  latter  the  fetlock 
and  hock  flex  in  opposite  directions  ;  the  knee,  in  addition,  is  large, 
round,  and  rather  flattened  in  front,  while  the  hock  is  flattened  on  each 
side,  and  offers  the  calcis  as  an  unmistakable  guide.  There  is  also  a 
difference  in  the  shape  of  the  feet. 

The  explorer  should  take  time  to  assure  himself  of  the  real  state 
of  affairs,  and  conduct  his  examination  with  all  the  care,  attention,  and 


i68  DVSTOKTA, 

gentleness  possible.  The  foetus  may  present  in  a  variety  of  positions,  in 
which  hind  and  fore  limbs  may  offer  first,  either  alone  or  together ;  and 
in  the  case  of  twins  or  monstrosities,  the  limbs  of  different  creatures  may 
be  encountered  at  the  same  time.  If  the  presentation  is  anterior,  the  heacl 
will  be  met  with,  and  this  is  distinguished  by  the  presence  of  the  mouth, 
eyes,  and  ears  ;  if  it  is  a  posterior  presentation,  then  we  have  the  rounded 
croup,  tail,  hocks,  and  external  genital  organs.  In  other  presenta- 
tions, the  neck  is  recognized  by  the  mane,  if  it  be  a  foal,  in  addition  to 
its  shape,  whether  foal  or  calf  ;  the  shoulders  by  the  acromion  processes 
and  withers;  the  chest,  by  the  ribs  and  intercostal  spaces  ;  and  so  on. 
In  addition  to  all  this,  the  obstetrist  should  judge  at  the  same  time  of 
the  volume  of  the  foetus  and  its  proportions.  This  is  particularly 
necessary  in  the  case  of  monstrosities ;  and  in  some  instances  it 
is  most  difficult  to  decide  what  the  hand  may  light  upon  in  such  an 
examination.  Kopp  alludes  to  the  case  of  a  Mare  which  he  examined 
during  parturition,  when  he  found  a  foetus  affected  with  hydroceusphal 
to  such  a  degree  that  for  a  long  time  he  thought  its  head  was  the  thorax. 

It  cannot  be  too  strongly  impressed  upon  the  minds  of  those  who  are 
commencing  obstetric  practice,  that  such  an  examination  should  be  so 
complete  as  to  furnish  all  the  requirements  of  a  sound  diagnosis,  on 
which  the  indications  for  affording  assistance  can  be  readily  based  ;  and 
this  exploration  can  only  be  said  to  be  complete  when  the  obstetrist  is  as 
well  acquainted  with  the  position  of  the  foetus  and  the  obstacles  to  its 
birth,  as  if  he  had  scrutinized  the  whole  with  his  eyes. 

Then  he  can  decide  as  to  the  measures  which  are  indicated  by  his 
diagnosis,  in  order  to  bring  the  young  creature  into  one  of  the  best  posi- 
tions for  delivery — either  natural  or  artificial — so  that  this  may  be  effected 
with  certainty  and  rapidity. 

These  measures  being  decided  upon,  a  methodical  procedure  is  as 
necessary  in  carrying  them  out,  as  in  exploring  the  vagina  and  uterus. 
The  required  assistants  should  be  selected,  and  to  each  should  be  allotted 
his  share  in  the  operation,  in  which  he  ought  to  be  instructed  briefly  and 
clearly;  the  instruments,  cords,  and  other  apparatus  ought  next  to  be 
placed  in  readiness  ;  and  then  the  task  may  be  begun.  When  this  is 
once  commenced,  it  should  be  conducted  with  prudence,  and  yet  with 
decision,  all  irrational  and  unnecessary  manoeuvres  being  avoided  ;  while 
every  precaution  being  at  the  same  time  observed,  there  should  be  no 
fear  of  irritating  the  organs  or  textures  by  manipulation,  as  they  appear 
to  be  endowed  with  a  greater  amount  of  tolerance  at  this  than  any  other 
time. 

In  such  cases,  the  operator  should  bear  in  mind  that  his  task  consists 
in. removing  or  overcoming  every  thing  which  suspends,  hinders,  or  inter- 
feres with  the  natural  course  of  parturition,  and  to  bring  this  as  near  as 
possible  to  a  normal  termination.  He  should  understand  and  appreciate 
the  part  Nature  plays  in  this  act ;  only  seeking  to  second  her  efforts  so 
long  as  she  is  competent  to  attain  the  desired  end,  by  removing  any 
obstacles  in  the  way.  When  Nature's  efforts  cease  to  be  effective,  they 
should  be  imitated  as  closely  as  possible  ;  and  no  more  ought  to  be 
attempted  than  Nature  herself  would  have  accomplished  under  more 
favorable  circumstances.  Art  should  never  undertake  what  Nature  can 
effect ;  and  remembering  this,  the  obstetrist  will  not  only  seek  to  learn  and 
appreciate  the  powers  of  Nature,  but  will  be  in  a  better  position  to  calcu- 
late how  far  he  should  himself  interfere. 


GENERAL  CONSIDERATIONS.  269 

Whatever  is  necessary  to  be  done  should  be  accomplished  without  de- 
lay, so  as  to  spare  the  animal  pain  and  exhaustion.  Sometimes  parturition 
is  difficult  because  of  the  insufficiency  of  the  expelling  forces,  as  we  have 
already  noticed,  and  this  may  be  remedied  by  hygienic  and  therapeutic 
means  ;  but  more  frequently,  while  the  expulsive  efforts  are  normal,  there 
is  undue  resistance.  To  increase  the  expelling  forces  in  the  latter  in- 
stances would  evidently  be  unwarrantable  and  injurious,  and  we  must 
attack  the  resistance  by  various  means,  according  to  its  character. 
Obstacles  in  the  genital  passages  must  be  overcome  either  by  altering  the 
position  of  the  foetus  by  manipulation,  in  changing  the  position  of  the 
mother,  or  by  other  means  ;  and  it  often  happens  that  we  must  combine 
extraneous  force  with  the  expulsive  efforts  of  the  mother,  in  order  to  ex- 
tract the  foetus  artificially.  At  other  times  the  size  of  the  foetus  must  be  re- 
duced by  embr3^otomy,  and  in  extreme  cases  an  artificial  passage  has  to  be 
made  for  it  by  hysterotomy  ;  though  these  dangerous  operations  may  be 
occasionally  averted  by  causing  artificial  abortion,  at  a  period  when  the 
foetus  is  sufficiently  small  to  be  safely  expelled  through  a  contracted 
pelvis. 

There  is  no  occasion,  in  veterinary  obstetrics,  to  hesitate  in  sacrificing 
the  life  of  the  foetus  in  serious  cases  ;  and  in  this  respect  the  practitioner 
is  in  a  different  position  to  \\\^  accoucheur  oi  woman-kind.  With  animals 
there  is  only  a  material  loss  to  be  looked  at,  and  the  foetus  must  always  be 
greatly  inferior  in  value  to  the  mother  ;  therefore,  in  order  to  save  the 
latter,  it  is  more  profitable  to  sacrifice  the  former. 

Such  are  the  general  principles  which  we  believe  to  be  applicable  to 
all  cases  of  dystokia.  These  cases,  as  Saint-Cyr  observes,  are  numerous 
and  various — more  varied  even  in  animals  than  in  woman  ;  and  in  order 
to  study  them  beneficially,  it  is  advisable  to  classify  them  in  a  methodical 
manner.  We  will  follow  that  authority  in  arranging  and  studying  them  in 
the  order  given  below. 

Synoptic  Table  of  Causes  of  Dystokia  in  the  Principal  Domesticated 

Animals. 


Dystokia 


Maternal 


Foetal. 


Pelvic  Constriction. 

Displacement  and  altered  relations  of  the  Uterus. 

Morbid  alterations  of  the  Maternal  Organs. 

T   J         A     ^     c{  Excess  in  Volume.  ^ 
Independent  of  |  r):_„„e„ 

.he  Presenta..!  ^'o'^-^.i,,.  ^Of  the  Foetus. 

t,ons,by:        [  Multiparity. 
Dependent    on  f  interior. 

tSePre^enta.     P-^J-bar. 
tions :  Sterno-abdominal. 


270  MATERNAL  DYSTOKIA. 

BOOK  L 

MATERNAL  DYSTOKIA, 

The  pathology  of  parturition,  as  has  been  mentioned,  includes  disturb- 
ances produced  by  excessive  or  tumultuous  pains  and  too  feeble  pains,  and 
derangement  caused  by  too  great  an  obstacle  to  birth.  We  have  sufficient- 
ly described  the  first ;  and  \Ve  have  now  to  deal  with  the  second,  in  so  far 
as  the  mother  is  concerned-  The  maternal  obstacles  to  parturition  are 
related  to  the  too  great  resistance  offered  by  the  parturient  passages, 
either  in  their  hard  or  soft  parts.  These  obstacles  have  been  grouped  in 
the  preceding  table  under  the  head  of  pelvic  constriction^  displacement  or 
change  in  relations  of  the  uterus,  and  morbid  alterations  of  the  maternal 
organs. 


CHAPTER  L 

Dystokia  by  Pelvic  Constrictionu 

Dystokia  from  constriction  of  the  pelvis  is  sometimes  observed  in  ani- 
mals ;*  though  less  frequently,  perhaps,  than  in  woman,  in  whom  con- 
stitutional causes  and  the  different  position  (vertical)  of  this  region, 
operate  largely  in  producing  diminished  dimensions  of  its  cavity.  Any 
alteration  in  the  dimensions  or  shape  of  the  pelvis,  whether  general  or 
partial,  is  a  more  or  less  serious  cause  of  dystokia,  and  in  some  cases  may 
render  delivery  absolutely  impossible,  A  pelvis  generally  reduced  in  all 
its  dimensions  is  sometimes  noticed  in  the  large,  as  well  as  the  small  do- 
mesticated animals. 

On  the  Continent  of  Europe,  this  has  been  observed  more  particularly 
among  some  of  the  small  common  breeds  of  cattle — such  as  the  Bretonne, 
and  certain  of  the  grey  Swiss  breeds,  as  the  J^ribourgeoise.  These  cattle 
have  the  ischia  pointed  and  the  tail  attached  high  above  them.  Leconte 
has  observed  this  conformation  in  animalslhe  produce  of  a  cross  between 
large  Norman  Mares  and  pure-bred  Horses — animals  with  a  sharp  croup. 
There  is  often  a  relative  narrowness  of  the  pelvis  in  animals  of  small  size 
which  have  been  put  to  larger  males.  This  has  been  witnessed  in  the 
Mare  and  Bitch  ;  and  as  the  young  are  proportionately  larger  than  the 
pelvis  can  accommodate  in  parturition,  we  have  here  a  cause  of  dystokia. 
An  abnormal  inclination  of  the  pelvis  has  been  supposed  by  some  writ- 
ers to  exercise  an  unfavorable  influence  on  parturition,  but  this  has  been 
denied  by  others.  Provided  the  other  conditions  of  normal  parturition 
are  present,  no  difficulty  should  be  experienced  in  delivery  ;  but  if,  added 
to  this  state,  there  is  a  narrow  pelvis,  then  obstetrical  operations  would 
certainly  be  rendered  more  serious- 
Deformities  which  occasion  irregular  constriction  of  the  pelvic  cavity, 

*  A  naturally  wide  pelvis— or  rather  an  esecess  in  width— observed  more  particularly  in  animals  of  a 
lymphatic  temperament,  and  especially  in  Cows,  along  with  an  extraordinary  suppleness  and  laxity  ot  the 
soft  parts  in  this  region,  has  the  inconvenience  of  rendering  parturition  too  easy,  it  would  appear.  Por 
this  facility  is  supposed,  and  not  without  reason,  to  bring  about  such  complications  as  eyersion  ot  the 
vagina  and  uterus,  placental  retention,  and  even  predisposes,  according  to  some  authorities,  to  vituiary 
fever  in  the  Cow  and  metritis  in  the  other  animals- 


DYSTOKIA  BY  PELVIC  CONSTRICTION. 


271 


are  various.  They  may  belong  to  the  bones  of  this  region,  or  to  its  con- 
nective tissue  ;  and  they  always  more  or  less  diminish  one  or  more  of  the 
dimensions  of  the  parturient  canal,  and  offer  an  obstacle  to  the  passage 
of  the  fcEtus.  These  cases,  however,  are  somewhat  rare  ;  they  are  gen- 
erally found  to  be  due  to  complete  deformity  of  the  pelvis.,  exostoses.,  fractures  ^ 
or  tumors. 

Complete  Deformity  of  the  Pelvis. 

As  has  been  observed,  complete  deformity  of  the  pelvis  is  very  rare 
among  animals.  When  due  to  rachitism,  it  is  most  frequently  noted  in 
the  Pig.  In  this  animal  the  pelvis  is  sometimes  greatly  distorted,  and 
not  unfrequently  there  is  accompanying  deviation  in  the  vertebral  spine. 
This  condition  is  seldom  seen  in  other  creatures. 

Saint-Cyr  informs  us  that  in  the  Museum  of  the  Lyons  Veterinary 
School,  there  is  the  pelvis  of  a  Mare  and  another  of  a  She-Ass,  which 


Fig.  64. 
Completely  Defok.med  Pelvis:  Mare.. 

present  a  very  remarkable  degree  of  general  constriction,  and  which  must 
have  offered  a  very  serious  obstacle  to  parturition  if  the  animals  had  ever 
been  pregnant.  That  of  the  Mare  (Fig.  64)  is  singularly  depressed  on 
both  sides,  the  ischia,  and  especially  the  pubis,  being  atrophied  with  re- 
spect to  size.  The  oval  foramina  and  cotyloid  cavities  are  close  together, 
the  floor  of  the  pelvis  is  extremely  contracted  and  angular,  and  the  pu- 
bic arch  is  hypertrophied.  In  this  specimen  there  is  a  very  notable 
diminution  in  the  different  diameters  of  the  pelvic  cavity  ;  the  supero-in- 
ferior,  instead  of  being  about  8^'^  inches  is  only  about  6,  and  the  bi-iliac 
diameter  is  but  dt%  instead  of  being  7^  to  8  inches. 

According  to  Saint-Cyr,  the  diagnosis  of  this  deformity  should  not  be 
difficult,  especially  when  it  is  so  marked  as  in  this  instance.  Vaginal  ex- 
plorations should  soon  discover  it,  and  the  diminution  in  size  may  be  ap- 
proximately determined  by  spreading  the  fingers,  and  in  this  way  measur- 
ing the  two  diameters.  The  diagnosis  may  not  be  so  easy,  however, 
when  the  canal  is  partly  or  wholly  occupied  by  the  foetus. 


272  MATERNAL  DYSTOKIA. 

Denoc  gives  the  following  case  of  a  Cow,  which  had  been  four  days  making  fruitless 
attempts  at  delivery  [Recueil  de  Med.  Veteriuaire,  1845,  p.  9).  The  os  was  dilated  and 
the  fcetus  in  a  good  position;  the  head  and  feet  could  be  brought  into  the  passage,  but 
the  creature  could  not  be  extracted.  In  exploring  the  cavity,  after  pushing  back  the 
foetus,  it  was  discovered  that  there  was  liypertrophy  of  the  symphysis  pubis,  and  an  ab- 
normal rugged  production  thereon,  forming  a  kind  of  ossified  ridge  which  extended 
beneath  the  bladder.  Forceps  proved  useless,  as  this  ossific  deposit  was  an  insurmount- 
able obstacle  ;  so  the  animal  was  killed  for  food.  On  examining  it  afterwards,  in  addi- 
tion to  the  bony  alterations,  there  was  a  double  twist  of  the  uterus. 

Gelle  has  published  a  case  in  which  the  narrowness  of  the  pelvis  appears  to  have 
been  the  sole  cause  of  difficulty  in  parturition  ;  there  did  not  seem  to  be  any  appreciable 
deformity,  and  probably  the  youth  of  the  animal — two  years  old,  and  a  pri'mapara — and 
a  large  calf,  occasioned  the  non-delivery,  as  the  fcetus  was  extracted  by  embryotomy. 
The  Cow  did  well  afterwards. 

Another  kind  of  deformity  which  has  been  described  by  several  author- 
ities, consists  in  a  depression  of  the  sacrum  (lordosis),  which  is  recognized 
externally  by  an  abrupt  hollow  existing  towards  the  posterior  third  of  the 
croup.  By  rectal  exploration,  the  sacrum  is  found  to  constitute  a  pro- 
jection in  the  roof  of  the  pelvis,  at  the  lower  face  of  the  bone,  and  this 
diminishes  the  supero-inferior  diameter  of  the  cavity  to  an  extent  corre- 
sponding to  the  protuberance. 

Schaack  gives  an  account  of  two  cases  of  dystokia  in  Cows,  arising  from  this  defor- 
mity. In  one,  the  fcetus  was  of  ordinary  size  and  making  a  good  anterior  presentation, 
but  it  was  wedged  between  the  floor  of  the  pelvis  and  the  exostosis  above.  It  required 
the  united  efforts  of  four  men  for  half  an  hour  to  extract  the  calf,  and  at  the  moment 
when  the  most  voluminous  part  of  its  body  was  being  dragged  through  the  depressed 
point  of  the  sacrum,  a  noise  was  heard  similar  to  that  produced  by  breaking  a  bit  of 
dried  wood.  When  the  calf  had  been  got  through,  it  was  then  perceived,  by  the  mobil- 
ity of  the  end  of  the  sacrum  and  the  root  of  the  tail,  that  the  Cow  had  sustained  a  frac- 
ture at  this  part.  The  Cow  recovered,  and  was  again  sent  to  the  bull  at  the  ordinary 
period.  Wlien  next  it  calved,  Schaack  had  to  assist  it  in  a  laborious  parturition,  but  a 
living  calf  was  pro(Juced.  In  the  second  case  the  calf  perished,  and  the  Cow  was  sent 
to  the  butcher. 

Canu  {Recueil  de  Med.  Veieritmire,  1837)  reports  that  in  May,  1831,  he  was  sent  for 
to  see  a  Mare  which,  for  seven  nr  eight  hours,  had  been  vainly  attempting  to  foal.  The 
fore  limbs  were  properly  presented,  but  when  it  was  observed  that  the  head  did  not  fol- 
low, those  who  had  been  endeavoring  to  assist  the  animal  ceased  to  pull  at  them. 

The  animal  was  seven  years  old ;  it  was  continually  straining,  was  covered  with  per- 
spiration, and  appeared  to  be  much  distressed.  Canu  introduced  his  arm,  but  could  not 
find  the  head  of  the  foetus,  as  a  hard  round  mass  closed  the  pelvic  inlet,  and  compelled 
him  to  withdraw  his  hand.  Shortly  afterwards,  however,  he  made  another  attempt,  and 
with  more  success.  Having  contrived  to  insert  the  whole  of  his  arm  in  the  direction  of 
the  obstructing  mass,  he  at  length  touched  the  tip  of  the  ears  of  the  foetus  with  the 
extremity  of  his  fingers.  It  was  in  vain,  however,  that  he  attempted  to  change  the  po- 
sition of  the  head  or  to  turn  the  neck  in  the  slightest  degree,  as  the  fingers  could  not  be 
introduced  between  the  latter  and  the  shoulder.  The  owner  was  then  informed  that  he 
must  not  reckon  upon  the  foal  being  extracted  alive,  and  that  the  Mare  itself  was  in  im- 
minent danger. 

Not  seeing  any  way  of  saving  the  mother  but  by  extracting  the  foal  by  force,  the 
owner's  consent  was  obtained  to  this ;  a  cord  was  placed  on  the  fore  limbs  that  were 
presented,  and  three  assistants  were  posted  at  this,  while  two  others,  with  a  girth  placed 
between  the  thighs,  held  the  Mare,  which  was  in  the  recumbent  position.  The  assist- 
ants at  the  cord  were  then  ordered  to  pull,  and  by  exerting  all  their  strength  the  foetus 
was  extracted  dead,  with  the  neck  bent  to  one  side  on  the  ribs.  All  attempts  to  have 
brought  the  head  into  the  natural  position  must  have  proved  unavailing,  according  to 
Canu,  as  the  right  side  of  it,  flattened,  and  even  crushed,  perfectly  fitted  a  concavity  in 
the  right  flank. 

The  vulva  was  a  little  torn  at  its  upper  part;  it  was  much  swollen,  and  its  lining 
membrane  was  extremely  congested. 

The  Mare  lay  during  three  days  before  attempting  to  get  up ;  but  by  appropriate 
treatment  it  eventually  recovered. 

It  was  subsequently  ascertained  that,  although  only  seven  years  old,  the  animal's 


D  YSTOKIA  B  V  PEL  VIC  CONSTRICTION.  273 

croup  had  become  altered  in  form;  it  was  depressed,  and  the  attachment  of  the  tail 
was  low,  while  the  ligamento-cartilaginous  substance  which  united  the  sacrum  to  the 
ossa  innominata  had  been  partially  torn,  causing  the  croup  to  approach  almost  two 
inches  nearer  to  a  horizontal  position. 

Exostoses. 

Exostoses  on  the  pelvic  bones,  and  particularly  when  they  project  into 
the  pelvic  cavity,  or  encroach  on  its  openings,  may  become  a  more  or  less 
serious  obstacle  to  the  passage  of  the  fcetus. 

Favre,  of  Geneva,  states  that  bony  tumors  situated  beneath  the  croup, 
at  the  inner  and  upper  surface  of  the  pelvis,  render  parturition  difficult, 
even  if  they  are  not  large  and  near  the  root  of  the  tail.  He  adds  that 
such  cases  are  not  rare  in  old  Mares. 

Fractures. 

Like  the  exostoses,  more  or  less  completely  consolidated  fractures  of 


Fig.  65. 
Pelvic  Exostosis. 

the  sacrum  or  coxae,  which  have  been  united  by  an  irregular  callus,  may, 
for  the  same  reason,  prove  an  obstacle  to  birth.  As  animals  suffering 
from  a  fracture  of  any  of  the  bones  of  this  region  are  often  destroyed, 
laborious  parturition  from  such  a  deformity  is  not  so  frequent  as  from 
some  other  causes  ;  nevertheless,  it  does  occur  now  and  again. 

It  must  be  remembered  that  fractures  of  the  pelvic  bones  are  some- 
what frequent  in  animals,  and  may  occur  at  any  part.  The  most  common 
seat  of  fracture  is  perhaps  the  external  angle  of  the  ilium  ;  and  the  least 
frequent,  the  posterior  part  of  the  ischium  and  the  pubis.  Fracture  of 
the  sacrum  and  the  internal  angle  of  the  ilium  is  also  very  rare.  Simul- 
taneous compound  fracture  of  the  two  coxal  bones  has  been  observed 
in  two  cases  by  Lafosse  ;  in  one  case  by  Crepin,  and  in  another  by 
Philippe. 

18 


274 


MATERNAL  DYSTOKIA. 


D'Arboval  has  witnessed  a  fracture  of  the  pubis  in  a  Dog  ;  and  Carsten 
Harms  alludes  to  fractures  of  the  ischium  occurring  in  the  Mare  and 
Cow.  The  latter  authority  has  likewise  found  the  two  iliums  of  a  Goat 
united  at  their  posterior  angle  by  a  mass  of  bone  as  thick  as  a  finger. 
Professor  Ercolani  has  well  described  twelve  important  cases  of  pelvic 
fracture  exhibited  in  the  Pathological  Museum  of  the  Bologna  Univer- 
sity.* The  first  of  these  is  a  compound  fracture  of  the  ossa  innominata, 
the  solution  of  continuity  involving  all  the  border  of  the  foramina  ovale 
in  the  pelvis  of  a  Mare  j  the  second  is  a  fracture  of  the  left  ilium  near  its 
neck,  and  extending  to  the  cotyloid  cavity,  also  in  the  pelvis  of  a  Mare  ; 
the  third  is  a  compound  comminuted  fracture  of  the  left  innominate  bone 
in  a  Mare,  the  piece  being  div-ided  into  six  principal  portions  ;  the  fourth 
is  a  compound  fracture  of  the  right  ilium  of  a  Mare,  extending  to  the 
arch  of  the  pubis  on  the  left  side  ;  the  fifth  is  a  longitudinal  fracture  of 
the  right  ilium  of  a  Filly  ;  the  sixth,  a  fracture  of  the  external  angle  of 
the  right  ilium  and  the  left  ischiatic  tuberosity  of  a  Mare  ;  the  seventh 
is  a  slightly  oblique  fracture  of  the  ilium  extending  to  the  cotyloid  cavity 
of  a  Mare  ;  the  eighth  is  a  compound  fracture  of  the  pelvis  of  a  Mare, 
involving  the  internal  angle  of  the  ilium,  the  external  part  of  the  ischial 
tuberosity,  the  arch  of  the  pubis,  and  the  union  of  the  pubis  with  the 


Fig.  66. 
Fracture  of  the  Pelvis. 

ischium  ;  the  ninth  is  a  fracture  of  the  superior  and  posterior  crest  of  the 
ilium  of  a  Mare  ;  the  tenth  is  an  oblique  fracture  of  the  neck  of  the  left 
ilium  of  a  Mare  ;  the  eleventh  is  a  compound  fracture  of  the  right  coxa 
of  a  Mare,  the  cotyloid  portion  being  completely  isolated  from  the  is- 
chium, ilium,  and  pubis  ;  the  twelfth  is  a  fracture  of  the  external  angle  of 
the  ilium.  Lanzillotti-Buonsanti  states  that  the  Pathological  Museum  of 
the  Milan  Veterinary  School  contains  a  coxa,  which  shows  a  fracture  of 
the  neck  of  the  ilium,  with  overlapping  of  the  disunited  portions;  and 
also  a  pelvis  in  which  the  pubic  portion  of  the  symphysis  has  sustained 
a  comminuted  fracture. 

*  Descrizione  Metodica  dei  Preparati  del  Museo  di  Anatomia  Patologica  Comparata  della  R.  Universita 
di  Bologna.     Meraoria  I.  Bologna,  1867,  p.  38: — Fratture  della  Pelvi. 


D  YSTOKIA  B  Y  PEL  VIC  CONSTRICTION.  275 

Much  will  depend,  of  course,  upon  the  nature  and  the  seat  of  the  frac- 
ture. When  it  is  only  the  outer  angle  of  the  ilium  (point  of  haunch), 
and  even  when  the  fractured  bone  is  displaced  by  the  action  of  the  small 
oblique  muscles  of  the  abdomen  and  the  fascia  lata,  producing  great 
external  deformity,  no  great  effect  can  be  produced  on  the  act  of  partu- 
rition, as  this  part  has  nothing  to  do  with  the  pelvic  cavity.  But  when 
the  whole  of  one  side  of  the  haunch  is  lower  than  the  other,  delivery  is 
then  undoubtedly  interfered  with,  and  perhaps  to  a  most  serious  extent; 
inasmuch  as  some  one  of  the  parts  which  concur  in  forming  the  pelvic 
cavity  is  implicated  in  the  fracture,  and  consequently  the  external  defor- 
mity corresponds  to  an  internal  diminution  and  irregularity  in  its  diame-: 
ters,  from  displaced  fragments  of  bone,  overlapping  of  fractured  ends,* 
the  approach  of  the  sacrum  to  the  pubis,  and  consequent  lessening  of 
the  inlet  of  this  cavity,  as  well  as  to  the  more  or  less  voluminous  deposit 
of  bone  around  the  fractured  portions.  Many  cases  are  on  record  of 
difficulty  in  parturition  from  this  deformity. 

Gohier  {Mem.  stir  la  Chiriirgie  et  la  Med.  Vetirinaire)  mentions  a  Ewe  which  was 
I^rought  to  him,  and  which  for  twelve  hours  had  been  making  ineffectual  attempts  to 
give  birth  ;  the  cause  of  delay  appeared  to  be  narrowness  of  the  pelvis.  Traction  on 
the  fore  limbs  of  the  foetus  only  resulted  in  tearing  them  away  from  the  thorax.  De- 
livery  being  impossible  by  the  natural  way,  Gohier  performed  the  abdominal  Caesarean 
operation,  but  the  animal  died  next  day.  On  examination,  it  was  di'scovered  that  the 
pelvis  was  very  narrow  and  irregular,  in  consequence  of  an  old  fracture  of  the  ilium. 
The  coxa  of  that  side  was  at  least  half  an  inch  shorter  than  the  other  from  the  cotyloid 
cavity  to  the  sacrum,  which  gave  a  very  marked  obliquity  to  this  part ;  and  it  was  this, 
as  well  as  the,  slight  exostosis  protruding  there,  which  prevented  the  top  of  the  lamb's 
head  from  passing  through. 

Chretien  {Journal  Prat,  de  Med.  Veterinaire,  1826,  p.  225)  was  called  to  attend  a  Cow 
which  could  not  calve.  Two  legs  of  the  foetus  protruded,  but  nothing  more  could  be 
extracted.  By  exploration  it  was  found  that  there  was  a  hard  tumor  between  the  vagina 
and  uterus,  which  filled  up  one-third  of  the  pelvic  cavity.  On  inquiry  it  was  ascertained 
that  the  animal  had  been  treated,  a  year  previously,  for  a  fracture  of  the  ilium,  near  the 
coxo-femoral  articulation,  and  that  the  fracture  had  united,  though  the  Cow  remained 
lame,  and  rested  this  side  of  the  body  more  than  the  other.  Delivery  being  impossible, 
the  calf  was  removed  by  Csesarean  operation.  The  Cow  recovered,  and  on  being  killed 
by  the  butcher  some  time  after,  Chretien  examined  the  pelvis,  when  he  found  a  very 
voluminous  bony  tumor  or  callus,  and  noted  that  the  inierior  part  of  the  ili^um  had  not 
united  fairly,  but  projected  a  good  deal  inwards. 

Rainard  speaks  of  a  large  Anglo-Chinese  Sow  which  died  during  parturition,  its 
owner  being  unable  to  extract  any  of  the  young.  Two  months  previously  it  had  sus- 
tained a  fracture  of  the  ascending  branch  of  the  ilium,  near  the  cotyloid  cavity,  from 
which  it  had  always  been  lame.  When  Rainard  examined  the  pelvis,  the  callus  was  not 
yet  solidified ;  it  formed  a  considerable  prominence  within  the  pelvis. 

Fractures  of  the  pelvis  are  by  no  means  unfrequent  with  animals,  and 
are  due  to  falls,  crushing,  blow.s,  or  other  causes  ;  and,  as  the  above  in- 
stances testify,  they  may  prove  insurmountable  obstacles  in  parturition. 
Female  animals  which  have  sustained  an  injury  of  this  kind,  should  not 
be  employed  for  breeding  purposes,  unless  a  careful  examination  has 
shown  that  it  has  not  altered  the  pelvic  diameters  in  such  a  way  as  ren- 
der delivery  difficult. 

Such  an  alteration  may  be  diagnosed  by  depression  of  the  haunch  or 
croup,  and  lameness  to  a  more  or  less  appreciable  extent  ;  while  rectal 
or  vaginal  exploration  will  discover  the  presence  of  a  variable-sized  hard 
tumor  forming  part  of  the  bone,  and  projecting  into  the  cavity.  The 
previous  history  of  the  animal   may  also  aid  in  confirming  the  diagnosis; 

Fractures  of  the  pelvis  may  also  take  place  during  parturition,  and 


2^6  MATERNAL  DYSTOKIA. 

Rueff  mentions  two  instances  in  which  they  have  occurred  spontaneously 
during  very  violent  labor  pains. 

In  the  latter  instances,  there  may  have  existed  a  predisposition  due  to 
a  diseased  condition  of  the  bones — a  predisposition  not  uncommon  in 
breeding  animals. 

Tumors  in  the  Pelvic  Cavity. 

Tumors  of  various  kinds,  in  addition  to  those  of  a  bony  character  due 
to  injury — such  as  fibromata,  melanotic,  and  cancerous  tumors — may 
prove  a  cause  of  dystokia  \  abscess  may  also  co-exist  with  pregnancy,  and 
be  a  source  of  difficulty  in  parturition.  But  that  form  of  melanosis  which 
appears  in  grey  animals,  and  particularly  manifests  itself  in  the  form  of 
tumors  at  the  root  of  the  tail,  around  the  anus,  and  in  the  connective 
tissue  of  the  pelvis,  should  offer  the  most  frequent  obstacle  to  delivery. 

One  case  has  occurred  in  my  own  experience,  in  which  an  aged  Mare,  nearly  white, 
belonging  to  a  friend,  was,  on  my  recommendation,  taken  by  a  farmer,  who  attempted  to 
breed  from  it ;  but  at  the  termination  of  pregnancy,  and  during  parturition,  it  died  with- 
out giving  birth  to  a  foal. 

When  opened,  it  was  found  that  delivery  could  not  take  place,  owing  to  great  masses 
of  melanotic  deposit  in  the  pelvic  cavity.  When  given  to  the  farmer  there  were  only  a 
few  small  nodular  masses  observed  about  the  tail  and  vulva. 

Leconte  [Mem.  de  la  Societe  Ccntrale  de  Med.  Veterinaire,  vol.  v.,  p.  i8o),  was  con- 
sulted with  regard  to  a  Mare,  about  twelve  years  old,  and  about  five  months  pregnant, 
which  had  such  a  large  melanotic  deposit  around  the  anus  that  defecation  was  impossi- 
ble without  assistance.  Rectal  exploration  discovered  a  very  voluminous  tumor  sit- 
uated at  the  left  side  of  the  pelvis,  in  the  centre  of  which  a  slight  fluctuation  could  be 
perceived.  With  a  view  to  accelerate  the  maturation  of  the  tumor,  vesicatory  agents 
were  applied  to  the  left  flank  and  croup ;  five  days  later  the  tumor  was  larger  and  more 
fluctuating,  and  it  was  punctured,  when  about  two  pints  of  a  dark,  purulent,  but  almost 
odorless  fluid  escaped.  On  the  hand  being  introduced  into  the  softening  mass,  a  por- 
tion was  found  about  the  size  of  two  fists,  and  partially  detached  ;  this  was  removed, 
and  weighed  nearly  seven  pounds.  In  twelve  days  the  wound  had  cicatrized  ;  and  in 
five  and  a  half  months,  gestation  being  nearly  completed,  another  melanotic  tumor,  sit- 
iiated  somewhat  deeply  towards  the  right  side  of  the  pelvic  cavity,  was  also  removed. 
Cicatrization  took  place  rapidly,  and  delivery  occurred  without  any  difficulty. 

Indications  for  Surgical  Treatment. 

The  surgical  treatment  of  those  cases  in  which  dystokia  is  due  to  any 
of  the  causes  just  enumerated,  will  greatly  depend  upon  circumstances, 
not  only  with  regard  to  the  kind  of  treatment,  but  also  as  to  its  expediency 
at  all. 

For  instance,  if  total  or  partial  deformity  of  the  pelvis  is  present  to 
such  a  degree  as  to  endanger  the  life  of  the  animal  during  parturition,  or 
if  there  exist  obstacles  due  to  fractures  oi  tumors,  and  which  cannot  be 
removed,  then  it  may  be  advisable,  if  the  animal  be  fit  for  food  and  in 
good  condition,  to  send  it  to  the  butcher  ;  or  if  it  be  pregnant  and  in  in- 
ferior condition,  to  produce  abortion  at  a  sufficiently  early  period.  But 
if  parturition  has  already  commenced,  then,  of  course,  surgical  or  obstet- 
rical treatment  must  be  had  recourse  to ;  and  the  nature  of  this  will  de- 
pend upon  the  constriction  of  the  pelvic  cavity,  and  the  kind  of  obstacle 
which  causes  the  diminished  space.  The  indications  are  :  to  forcibly  ex- 
tract the  foetus  through  the  narrowed  passage  ;  to  7mden  the  passage ;  to  dimin- 
ish the  size  of  the  fxtus  ;  or  to  make  an  artificial  passage.  But  as  artificial 
abortion  may  be  necessary  during  pregnancy,  should  the  veterinarian  be 


D  YSTOKIA  B  Y  PEL  VIC  CONSTRICTION.  z'j'j 

consulted,  and  from  examination  be  led  to  conclude  that  parturition  will 
be  dangerous  or  impossible,  we  shall  include  this  as  one  of  the  indica-- 
tions,  and  commence  with  it. 

1.  Artificial  Abortion. — Artificial  abortion  may  be  rendered  neces- 
sary not  only  during  pregnancy,  when  the  condition  of  the  pelvic  cavity 
leads  to  the  supposition  that  delivery  at  full  term  is  dangerous  or  impos- 
sible, but  also  in  metrorrhagia,  serious  inversion  of  the  vagina,  hydram- 
nios,  debility,  or  exhaustion,  etc. 

Artificial  abortion  may  be  produced  in  several  ways,  and  is  generally 
more  successful  with  the  Mare  than  the  Cow,  because  of  the  greater  ex- 
citability of  the  cervix  uteri,  and  the  readiness,  with  which  it  can  be  di- 
lated in  that  animal.  Three  modes  of  procedure  have  been  adopted  with 
the  domesticated  animals,  each  being  attended  with  success,  and  each 
offering  special  advantages  in  particular  cases.  These  are  :  irritatiofi  of 
the  cervix  uteri  by  the  hand ;  puncture  of  the  envelopes  ;  and  vaginal  irrita- 
tions. 

Digital  Irritation  of  the  Cervix  Uteri. — This  is  accomplished  in  the  fol- 
lowing manner  :  The  hand  is  introduced  into  the  vagina,  and  first  one 
finger,  then  two  are  insinuated  into  the  os  by  a  semi-rotatory  movement, 
and  finally  the  whole  hand  is  inserted,  as  the  part  dilates.  If  the  opera- 
tion is  repeated  several  times,  labor  pains  soon  ensue.  As  the  manual 
exertion  is  rather  fatiguing,  the  sponge  tent,  elastic  bags,  or  other  dilators 
of  the  OS  uteri  may  be  employed.  A  better  and  more  successful  mode  is 
the  introduction  of  a  long  elastic  catheter,  strong  pieces  of  catgut,  or  even 
a  quill,  between  the  foetal  membranes  and  the  uterus.  Labor  maybe 
promoted  by  passing  the  hand  through  the  os,  and  separating  the  mem- 
branes from  the  uterus. 

This  procedure  is  to  be  recommended  for  Mares,  the  uterus  of  which 
is  so  irritable  that  abortion  sometimes  occurs  after  manipulations  in  the 
rectum  for  some  time.  In  ordinary  cases,  the  expulsion  of  the  foetus  oc- 
curs in  from  six  to  twelve  hours.  It  is  not  applicable  to  cattle,  Harms 
having  once  manipulated  a  Cow  in  this  manner  for  a  whole  night  without 
producing  any  result  ;  neither  is  it  to  be  recommended  for  smaller  ani- 
mals. 

Puncture  of  the  Foetal  Envelopes. — The  envelopes  are  punctured  by 
pushing  a  long,  and  more  or  less  pointed,  sound  through  the  os  uteri, 
into  the  "  water-bag ; "  the  liquor  amnii  soon  escapes,  and  the  uterine 
contractions  begin.  Expulsion  of  the  foetus  follows  in  from  twelve  to 
forty-eight  hours.     This  method  is  particularly  efficacious  with  cattle. 

Vaginal  Irrigations. — Irrigation  of  the  vagina  with  cold  water  (or  water 
at  a  temperature  of  about  90^  Fahr.),-  made  by  means  of  a  syringe  or  in- 
jection-tube, and  continued  for  a  quarter  of  an  hour  every  three  hours, 
will  induce  labor  pains  about  the  fourth  injection,  and  effect  the  expul- 
sion of  the  foetus  towards  the  second,  third,  or  fourth  day.  This  method 
is  more  particularly  adapted  for  the  smaller  animals  ;  though  it  will  also 
succeed  with  the  larger.  The  only  danger  to  be  apprehended  from  it  is 
an  attack  of  metro-peritonitis. 

2.  Forcible  Extraction. — As  Saint-Cyr  well  remarks,  the  first'  im- 
pulse which  presents  itself  when  the  foetus  meets  with  any  obstacle  to  its 
passage  through  the  pelvis,  is  to  "  force  it  through  ;  "  and  it  is  this  im- 
pulse which  is  carried  into  execution  by  unscientific  people.     Too  fre- 


278  MATERNAL  DYSTOKIA. 

quently,  however,  it  happens  that  by  this  procedure  some  portion  of  the 
foetus  is  so  tightly  wedged  in  the  pelvis  that  no  amount  of  force  is  capa- 
ble of  moving  it  farther,  and  renders  absolutely  impossible  those  other 
operations  which  might  be  the  means  of  savisg  at  least  the  mother  or 
offspring,  or  perhaps  both.  For  this  reason  it  is,  that  the  owner  of  an 
animal  in  this  condition  should  not  himself,  nor  suffer  others  to,  pull  at 
the  foetus,  or  attempt  any  similar  manoeuvre,  until  the  arrival  of  the  veter- 
inarian. And  the  latter  has  a  difhcult  task  before  him  iji  solving  the 
problem,  as  to  whether  he  ought  to  extract  the  fcetus  forcibly,  or  resort 
immediately  to  the  other  measures  prescribed.  This  will  render  a  care- 
ful examination  necessary,  in  order  to  ascertain  the  nature,  seat,  and  de- 
gree of  constriction. 

The  animal  is  making  excessive,  nay  violent,  efforts,  and  the  foetus  may 
be  in  a  favorable  position,  but  it  does  not  advance  through  the  pelvis. 
The  creature  is  restless  and  sighs  deeply  ;  the  flanks  are  covered  with 
perspiration,  and  sometimes,  through  sheer  exhaustion,  it  falls,  utterly 
prostrated  by  its  efforts.  As  the  uterine  contractions  generally  increase 
in  violence  in  the  presence  of  obstacles  to  birth,  there  is  the  gravest 
danger  to  mother  and  offspring. 

In  such  a  case,  the  veterinarian,  having  introduced  his  hand  into  the 
pelvis  in  the  ordinary  way,  endeavors  to  discover  if  the  obstacle  is  there. 
With  this  object  in  view,  he  closes  his  hand  to  try  if  he  can  move  his 
shut  fist  about  in  every  direction,  and  with  ease.  Then  stretching  out 
the  thumb,  he  can  approximately  judge  the  distance  which  intervenes 
between  opposite  points  of  the  pelvic  circumference,  and  in  this  way 
appreciate  to  a  certain  degree  whether  a  moderate-sized  foetus  could 
pass  through.  For  if  the  pelvis  is  so  contracted  that  the  closed  hand 
can  scarcely  move  about  in  it,  it.  will  be  needless  to  attempt  forcible 
extraction,  as  the  foetus  cannot  be  brought  through. 

Saint-Cyr  has  calculated  that  the  closed  hand  of  an  adult  man  repre- 
sents an  irregular  mass  measuring  between  three  and  four  and  a  half  inches 
in  diameter;  but  the  head  of  a  calf,  in  its  supero-inferior  diameter, 
measures  from  seven  to  ten  inches,  and  four  to  five  inches  in  transverse 
diameter.  It  is  therefore  obvious  that  the  head  of  a  calf  could  not  pass 
through  an  aperture  in  which  the  hand  cannot  move  freely  ;  and  much 
less  the  chest  of  a  foal,  which  is  at  least  twelve  to  thirteen  inches  in 
depth. 

It  is  also  necessary  to  take  into  consideration  the  cause  of  dystokia. 
If  this  is  due  to  a  complete  deformity  of  the  pelvis,  then  the  case  is 
serious,  and  there  is  little  hope  of  traction  alone  overcoming  the  diffi- 
culty. If  it  is  due  to  a  tumor,  and  localized,  then  it  must  be  ascertained 
if  this  is  of  a  bony  character,  arising  from  an  exostosis  or  fracture  ;  or  if  it 
is  movable  and  independent.  If  the  latter,  the  case  is  not  so  serious, 
and  especially  if  the  tumor  is  connected  with  the  sacro-sciatic  ligament; 
as  it  may  be  pushed  out  of  the  way  of  the  foetus  and  birth  take  place. 

As  Saint-Cyr  insists,  all  these  considerations  should  be  weighed  before 
deciding  to  terminate  parturition  by  mechanical  traction  ;  for  if  the  impos- 
sibility of  accomplishing  it  by  this  means  is  discovered  when  too  late, 
the  other  operations  are  rendered  more  difficult  and  dangerous,  in  conse- 
quence of  the  ineffectual  attempts  at  forced  extraction. 

If  extraction  of  the  entire  foetus  is  discovered  to  be  practicable,  and 
the  position  is  favorable,  then  there  should  not  be  much  difficulty  in  effect- 
ing delivery,  which  may  be  achieved  as  in   ordinary  circumstances.     It 


1 


D  YSTOKIA  B  Y  DISPLA  CEMENT. 


279 


will  be  much  facilitated,  should  the  foetus   and  the  passage   be  dry  and 
tenacious,  if  these  are  smeared  with  oil  or  soapy  fluid. 

If,  however,  the  foetus  has  become  wedged  in  the  passage  and  cannot 
be  pulled  through,  it  may  be  useful  to  push  it  back  a  little  into  the  uterine 
cavity,  and  then  lubricate  it  and  the  vagina  with  some  oily  matter  to  assist 
movement,  before  another  attempt  is  made. 

3.  Enlargement  of  the  Passage. — This  is  nearly  always  impossible 
in  practice,  unless  the  cause  be  a  tumor  which  can  either  be  excised,  or 
moved  temporarily  out  of  the  way  so  as  to  effect  delivery. 

4.  Diminution  of  the  Size  of  the  Fcetus. — With  the  domesticated 
animals,  as  we  have  repeatedly  said,  there  are  no  moral  considerations  to 
oppose  us  when  it  comes  to  a  question  of  sacrificing  the  foetus  to  save 
the  life  of  the  parent.  And  with  the  Mare  there  should  be  no  hesitation 
in  this  direction,  when  a  careful  examination  has  proved  delivery  of  the 
living  or  entire  foetus  to  be  impossible  ;  and  particularly  when  we  remem- 
ber that  the  young  creature  soon  perishes. 

With  the  Cow,  however,  the  case  is  somewhat  different,  as  when  delivery 
is  unsuccessful  this  animal  may  be  killed  and  utilized  as  food.  Embry- 
otomy is,  nevertheless,  often  resorted  to  before  the  case  is  considered 
hopeless  ;  and  not  at  all  unfrequently  with  good  results,  so  far  as  the 
Cow  is  concerned. 

We  shall  treat  of  embryotomy  hereafter  ;  but  it  may  be  useful  to  men- 
tion here  that,  in  an  anterior  presentation,  removal  of  one  or  both  of  the 
fore  limbs  at  the  scapula  of  the  foetus  will  often  allow  the  remaining 
portions  to  be  removed  by  traction.  With  a-  posterior  presentation,  exci- 
sion of  one  hind  legis  frequently  sufficient  to  permit  the  body  of  the  foetus 
to  be  drawn  through  the  passage. 

5.  Establish  an  Artificial  Passage  for  the  Fcetus. — When  all  the 
preceding  means  have  been  recognized  as  impracticable  or  too  danger- 
ous, there  yet  remains  another,  which,  though  it  ma}'^  place  the  life  of  the 
mother  in  great  jeopardy,  and  should  be  considered  only  as  a  last  and 
a  most  serious  expedient,  may  be  resorted  to  :  this  is  the  C^esarean  sec- 
tion, or  gastro-hysterotomy — an  operation  to  be  described  hereafter.  It 
may  only  be  noted  in  this  place,  that  a  formidable  operation,  such  as  this 
is,  should  be  resorted  to  early,  and  before  the  female  is  much  exhausted 
by  inefficacious  manipulations  and  impotent  labor  pains. 


CHAPTER  II 

Dystokia  by  Displacement  or  Changed  Relations  of  the  Uterus. 

Delivery  may  be  rendered  difficult  by  displacement  or  altered  relations 
of  the  organ  containing  the  foetus — the  uterus,  either  from  heriiia  of  that 
organ  through  a  natural  or  accidental  opening  in  the  abdominal  parietes  ; 
from  deviations  in  the  direction  of  the  uterus,  whereby  the  os  is  no  longer 
in  the  axis  of  the  pelvis  ;  and  torsion  of  the  organ,  which  is  due  to  its 
having  made  a  revolution  or  become  twisted  on  its  own  axis — a  singular 
displacement  that  well  merits  attention. 


28o 


MATERNAL  DYSTOKIA. 
Hernia  of  the  Uterus — Hysterocele. 


Every  description  of  ventral  hernia  may  be  viewed  as  more  or  less 
tending  to  dystokia,  from  the  important  share  the  abdominal  muscles 
assume  in  the  act  of  parturition  ;  and  when  there  is  a  tendency  to  hernia 
of  any  of  the  organs  in  this  cavity,  or  when  a  hernia  really  exists,  this  is 
likely  to  be  increased  during  labor,  and  may  complicate  delivery.  But  the 
case  is  generally  all  the  more  serious  if  the  displaced  organ  is  the  gravid 
uterus  itself. 

Hernia  of  the  uterus  is  certainly  not  a  very  common  accident ;  never- 
theless, it  is  far  from  being  rare,  if  we  are  to  judge  by  the  instances 
recorded  in  veterinary  literature,  and  it  has  been  observed  in  the  Mare, 
Cow,  Sheep,  Sow,  Goat,  and  Bitch — in  all  the  more  important  domesti- 
cated animals,  in  fact,  and  has  often  proved  a  very  serious  obstacle  to 
parturition. 


Fig.  67. 

Uterine  Hernia:    Mare. 

A  B,  Hernial  Tumor ;  C,  Teat  carried  down  by  the  Tumor. 

Origin  and  Symptoms  in    Ufiiparoiis  Animals. 

The  symptoms  and  other  features  of  this  accident  rather  differ  in  uni- 
parous  and  multiparous  animals.  In  such  uniparous  creatures  as  the 
Mare  and  Cow,  hernia  of  the  uterus  is  generally  not  observed  until  preg- 
nancy is  pretty  well  advanced — towards  the  eighth  or  ninth  month,  or 
even  later  in  the  Mare,  and  the  seventh  or  eighth  month  in  the  Cow. 
This  delay  is  evidently  due  to  the  circumstance,  that  in  the  non-pregnant 
animal  the  uterus  is  small,  and  closely  fixed  by  its  ligaments  to  the  sub- 
lumbar  region  ;  so  that  if  there  is  a  breach  in  the  abdominal  walls,  it  is 
either  the  intestine  or  omentum  which  passes  through  it.     When,  how- 


DYSTOKIA  BY  DISPLACEMENT.  281 

ever,  pregnancy  is  advanced,  the  great  size  of  the  organ,  together  with  its 
weight,  brings  it  in  contact  with  the  parietes  of  the  peritoneal  cavity,  and 
if  there  happens  to  be  a  weak  part  or  a  rupture,  however  slight,  the  heavy 
uterus  gradually  forces  itself  through,  and  may  in  time  escape  altogether 
from  the  abdomen,  along  with  other  viscera. 

It  would  appear  that  laceration  of  the  abdominal  walls  may  occur  in 
other  ways  than  through  external  traumatic  influences,  or  any  appreciable 
occasional  cause  ;  and  it  would  also  appear  that,  in  some  animals,  there 
is  a  kind  of  predisposing  relaxation  or  softening  of  the  abdominal  muscles, 
which  leads  to  their  being  unable  to  support  the  gradually  increasing 
strain  thrown  upon  them  by  the  heavy  uterus,  and  its  oftentimes  very 
lively  and  energetic  inmate.  The  muscles  are  stretched  and  attenu- 
ated, their  fibres  are  separated  and  some  of  them  may  rupture,  and  in 
this  way  is  formed  a  rent,  which  gradually  enlarges  from  the  increasing 
pressure.  Then  a  tumor  appears  externally  and  towards  the  lower  part 
of  the  abdomen,  though  always  a  little  to  one  side — usually  the  left  in' 
the  Mare,  the  right  in  the  Cow,  and  not  unfrequently  in  front  of  the  pubis 
in  the  mammary  region.  This  tumor,  when  first  noticed,  is  about  the 
size  of  a  child's  head,  and  not  clearly  defined ;  but  it  rapidly  enlarges, 
and  in  a  few  days  may  acquire  prodigious  dimensions  :  descending  as  low 
as  the  hocks,  or  even  nearly  to  the  ground,  pushing  the  mammae  to  one 
side  or  carrying  them  with  it,  and  extending  almost  as  far  forward  as  the 
sternum,  giving  to  the  abdomen  a  singular  appearance  (Fig.  67). 

These  extraordinary  herniae  are  most  frequently  witnessed  in  Cows, 
though  several  veterinarians — among  others,  Lecoq,  Binz,  Leconte,  Serres, 
Lafosse — have  seen  them  in  Mares.  In  very  many  instances  they  are  due 
to  violent  efforts,  kicks,  blows,  and  other  external  injuries. 

When  the  hernia  is  recent,  and  especially  if  it  occurs  in  the  mammary 
region,  it  is  generally  surrounded  by  a  considerable  cedematous  swelling. 
This  swelling  disappears  after  parturition,  though  the  hernial  tumor 
itself  does  not  diminish  in  volume,  the  digestive  organs  having  occupied 
the  space  previously  held  by  the  foetus.  Then  the  animal  has  a  still  more 
singular  appearance,  perhaps  ;  for  owing  to  this  emptying  of  the  abdom- 
inal cavity,  the  belly  is  wonderfully  retracted,  and  the  flanks  are  so 
drawn  together  that  the  fingers  may  be  made  to  touch  through  them  on 
each  side. 

Before  parturition,  palpation  of  the  tumor  enables  the  foetus  to  be 
distinguished,  the  head,  limbs,  and  body  being  felt,  while  its  movements 
are  perceptible  to  the  eye  or  hand. 

As  a  rule,  and  contrary  to  what  might  be  surmised,  this  uterine  hernia 
does  not  appear  to  cause  any  loss  of  condition  or  inconvenience  except  in 
progression,  which  it  interferes  with,  and  causes  the  animal  to  move  with 
its  hind  legs  wide  apart.  Aptitude  for  labor  is  also  somewhat  impaired, 
as  may  be  imagined. 

Origin  and  Symptoms  in  Multiparous  Animals. 

As  has  been  mentioned,  uterine  hernia  is  observed  in  multiparous  ani- 
mals, but  its  manner  of  production,  according  to  Saint-Cyr,  would  appear 
to  be  different  to  what  it  is  in  uniparous  creatures,  this  taking  place  in 
the  intervals  between  gestations.  The  length  and  mobility  of  the  cornua 
in  such  an  animal  as  the  Bitch,  together  with  their  close  proximity  to  the 
abdominal  walls,  sufficiently  explain  how  they  may  pass  into  an  opening  in 


282  MATERNAL  DYSTOKIA. 

these.  There  is  formed,  at  first,  a  small  tumor,  the  size  of  a  pigeon's  or 
hen's  Qgg  ;  this  tumor  is  soft,  indolent,  more  or  less  easily  reduced,  and 
which,  attracting  perhaps  little  or  no  attention  while  the  animal  is  unim- 
pregnated,  remains  stationary.  After  impregnation,  however,  it  daily 
acquires  larger  dimensions  ;  one  or  more  ovules  have  descended  into  the 
hernied  portion,  localized  themselves  there,  and  become  developed  into 
foetuses  without  the  Bitch  showing  much,  if  any,  disturbance. 

The  usual  seat  of  the  hernia  is  in  the  mammary  region,  to  the  right  or 
left  of  the  linea  alba,  though  it  may  be  also  inguinal,  or  even  vulvular. 
An  example  of  inguinal  uterine  hernia  will  be  given  hereafter  ;  we  will 
now  briefly  allude  to  a  case  of  vulvular  uterine  hernia  described  by  Rain- 
ard.  In  this  instance,  the  uterus,  which  had  been  apparently  carried 
through  the  inguinal  ring,  was  pushed  backwards  through  the  connective 
tissue,  and  appeared  as  a  tumor  at  the  vulva.  The  owner  of  the  animal, 
not  knowing  what  the  swelling  contained,  opened  it  by  means  of  a  pen- 
knife ;  in  this  way  there  was  formed  a  fistulous  wound  from  which  a  viscid 
fluid  escaped.  Rainard  incised  this  fistula,  and  found  beneath  the  skin 
a  second  membrane  having  some  analogy  to  it,  and  which  afterwards 
proved  to  be  the  uterus;  to  the  inner  face  of  this  there  adhered  a  reddish- 
brown  vascular  network,  which  was  the  placenta,  and  which  was  easily 
detached  by  the  finger,  and  within  it  appeared  a  transparent  bladder — the 
amnion — already  slightly  perforated,  and  looking  like  the  envelope  of  a 
kyst.  Having  opened  this,  there  escaped  a  quantity  of  fluid,  and  a  foetus 
apparently  three  or  four  weeks  old.     The  Bitch  died  next  day. 

When  the  hernia  occurs  in*the  abdominal  region,  it  usually  appears  as 
an  indolent  tumor,  the  skin  covering  it  being  destitute  of  redness  and  not 
attenuated  in  any  way  ;  the  tumor  itself  being  soft  and  fluctuating  at  dif- 
ferent points  where  the  liquor  unmii  \'i,  but  firm  and  resisting  at  others 
where  the  foetus  chances  to  be. 

It  may  be  noted  here,  that  we  may  have  other  herniae  of  the  uterus 
than  ventral.  For  instance,  Gelle  describes  a  case  of  hernia  of  one  of  the 
uterine  cornua,  which  contained  a  calf,  and  which  had  passed  through  a 
rent  in  the  mesentery.  And  Rainard  has  observed  several  cases  of  this 
kind  in  the  Bitch. 

Diagnosis. 

The  diagnosis  of  uterine  hernia  in  the  larger  animals  is  not  difficult  in 
the  great  majority  of  instances,  and  especially  if  labor  has  commenced. 
In  the  first  place,  it  is  usually  known  to  the  owner  that  the  animal  is 
pregnant  ;  and  in  the  second  place,  if  parturition  has  begun  there  can 
scarcely  be  any  mistake  made  as  to  the  nature  of  the  expulsive  efforts. 
Besides,  there  is  the  abdominal  tumor  with  its  peculiar  characteristics, 
and  by  manipulating  which  the  foetus  can  be  detected.  It  will  also  be 
discovered  that  the  tumor  does  not  adhere  to  the  abdominal  parietes,  and 
that  it  may  be  reduced  by  taxis. 

But  it  may  be  necessary  to  ascertain  the  presentation  and  position  of 
the  foetus,  and  if  it  cannot  be  born,  what  the  nature  of  the  obstacle  is 
which  prevents  delivery.  In  such  a  case  vaginal  exploration  must  be 
resorted  to  ;  and  from  it  we  may  learn  that  the  os  is  not  dilated  from  one 
of  several  causes  to  be  hereafter  discussed  ;  or  the  non -dilatation  may 
be  due  to  the  uterine  contractions  not  pressing  the  foetal  mass  directly 
against  the  cervix,  in  consequence  of  the  altered  direction  of  the  uterus, 


DYSTOKIA  BY  DISPLACEMENT.  283 

or  the  margin  of  the  hernial  opening  strangulating  the  foetus  and 
hindering  its  advance.  These  obstacles  must  be  combated  by  appropri- 
ate measures. 

In  consequence  of  the  foetus  lying  so  far  below  the  pubis,  the  hand 
introduced  through  the  os  cannot  feel  it,  even  when  the  whole  length  of 
the  arm  is  inserted  ;  in  which  case,  if  the  animalis standing,  the  abdomen 
may  be  raised  by  means  of  a  sheet  or  blanket,  so  as  to  bring  the  foetus 
within  reach.  If  the  animal  is  recumbent  and  cannot  rise,  then  it  should 
be  placed  on  its  back  and  secured  in  that  position,  the  croup  being 
raised  by  bundles  of  straw.  The  tumor  may  then  be  examined  by 
external  palpation,  as  well  as  by  rectal  and  vaginal  exploration,  and  the 
position  of  the  foetus  determined. 

As  a  rule,  the  position  is  never  completely  normal.  In  the  most  favor- 
able cases,  the  head  is  found  to  be  directed  backwards  and  near  to  the 
pubis — sometimes  partly  in  the  pelvis,  with  the  face  upwards  and  slightly 
forwards  ;  the  fore  feet  being  more  or  less  doubled  back  against  the  body, 
which  lies  deep  in  the  tumor,  the  buttocks  resting  on  the  mammae  of  the 
mother — the  foetus  being  altogether  in  the  recumbent  female  in  the  posi- 
tion of  a  sitting  dog. 

The  state  of  the  borders  of  the  hernial  orifice  should  be  carefully 
ascertained,  and  their  rigidity  and  tension,  together  with  the  degree  of 
constriction  they  exercise  on  the  body  of  the  foetus,  noted.  This  impor- 
tant examination  should  be  made  before  any  traction  is  exercised  on  the 
foetus ;  for  on  the  information  gained  by  it  will  depend  the  choice  of 
means  to  effect  delivery. 

With  the  Bitch  uterine  hernia  is  frequently  most  difficult  to  diagnose, 
and  errors  are  far  from  unfrequent :  the  most  common  mistake  is  fixing 
on  jthe  tumor  as  a  cancerous  mass.  But  mammary  tumors  are  very  dif- 
ferent to  that  of  hernia  ;  they  are  generally  nodulated,  very  hard,  and  the 
skin  is  closely  adherent  to  them  ;  whereas  the  uterine  hernia  has  not  the 
fluctuation  of  a  kyst  or  abscess,  neither  has  it  the  resistance  of  a  carci- 
noma, fibroma,  or  adenoma,  while  the  skin  covering  it  is  smooth,  supple, 
perfectly  natural,  without  ulcerations,  discolorations,  and  other  signs 
which  mark  the  presence  of  mammary  enlargements.  The  uterine 
tumor  can  also  be  reduced  by  taxis  or  manipulation,  while  the  fissure  in 
the  abdominal  wall  can  be  felt.  This,  together  with  the  fact  that  it  is 
only  developed  rapidly  after  impregnation,  and  without  any  local  or  gen- 
eral inflammatory  symptoms,  or  disturbance  of  the  general  health,  should 
settle  the  question. 

However,  should  any  doubt  yet  remain,  or  if  it  is  desired  to  ascertain 
the  exact  state  of  affairs,  a  more  careful  examination  will  be  necessary, 
it  being  always  born  in  remembrance  that  his  hernia  in  the  Bitch  appears 
in  different  regions.  Vaginal  exploration  cannot  be  resorted  to  with  this 
animal  because  of  the  smallness  of  the  pelvis — unless  the  Bitch  is  a  large 
one,  and  then  the  fingers  are  too  short  to  explore  to  any  depth. 

An  external  examination  must,  therefore,  be  relied  upon,  and  this  is 
easier  and  more  certain  than  with  the  larger  creatures.  By  it  the  size  of 
the  abdominal  rent  will  be  ascertained,  and  also  whether  the  foetus  can 
be  passed  through  it  into  the  abdomen  ;  though  this  is  rarely  possible, 
owing  to  the  hernia  occurring  when  the  uterus  was  empty,  and  when  it 
could  pass  through  an  opening  which  will  not  be  sufficient  for  a  foetus 
when  fully  developed. 

All  manipulatory  operations  on  the  Bitch  should  be    practised  with  as 


284  MATERNAL  DYSTOKIA. 

much  tact  and  gentleness  as  possible,  as  the  young  are  readily  killed, 
whil§  the  female  itself  is  very  liable  to  metritis. 

Indications. 

Animals  suffering  from  uterine  hernia  sometimes  bring  forth  their 
young  spontaneously,  and  without  any  bad  results  to  themselves  or  their 
progeny  ;  thus  proving  that  the  uterine  contractions  alone  will  expel  the 
foetus,  and  that  the  aid  of  the  abdominal  muscles  is  not  absolutely 
necessary.  And  more  especially  is  this  the  case  with  the  larger  animals. 
Leconte  mentions  a  Mare  whose  career  he  traced  for  five  years,  and 
which,  notwithstanding  the  existence  of  this  condition,  brought  forth  four 
living  foals;  three  without  assistance,  the  forth  being  in  a  wrong  position. 
Cows  which  had  most  alarming  herniae,  have  even  brought  forth  twin 
calves  spontaneously. 

But,  as  a  rule,  with  these  larger  uniparous  animals,  parturition  is  always 
more  protracted  and  difficult  than  in  ordinary  circumstances,  and  the 
assistance  of  the  veterinary  obstetrist  is  needed  to  effect  delivery  ;  and 
this,  after  all,  is  in  some  instances  impossible,  and  the  mother  and  off- 
spring are  lost.  This  is  more  particularly  the  case  with  multiparous  ani- 
mals, and  especially  the  Bitch,  in  which  it  is  generally  all  but  impossible 
to  reduce  the  hernia  or  remove  the  foetuses  by  the  natural  passage.  Roll 
has,  nevertheless,  described  the  case  of  a  Bitch  suffering  from  uterine 
hernia,  which  brought  forth  its  progeny  in  a  natural  manner ;  and 
Prange,  in  1844,  published  the  history  of  another  Bitch  that,  unaided, 
gave  birth  to  three  puppies  which  had  been  lodged  in  a  hernia  of  this 
kind.  Kopp,  as  we  will  see  presently,  removed  three  puppies  by  gastro- 
hysterotomy  from  a  uterine  hernia,  which  he  afterwards  reduced,  when 
another  puppy  was  borne  naturally.  And  Chanel  reports  that  a  sow 
brought  forth  young  after  a  portion  of  one  of  the  uterine  cornua  contain- 
ing two  foetuses,  and  which  had  been  hernied,  was  amputated. 

Notwithstanding  these  instances,  however,  the  assistance  of  the  obstet- 
rist is  necessary  to  effect  delivery,  for  which  a  careful  examination,  as  in 
diagnosis,  will  indicate  the  means. 

Previous  to  parturition,  the  hernia  should  be  supported,  when  possible, 
by  a  truss  or  retaining  bandage,  and  care  should  be  taken  to  prevent 
over-exertion  or  straining. 

With  the  larger  animals,  delivery  by  the  natural  passages  is,  of  course, 
the  chief  object  to  be  attained.  In  certain  cases,  the  simplest  measure, 
and  which  is  sometimes  all  that  is  necessary,  is  to  elevate  the  hernia  by 
means  of  a  sheet  or  blanket  passed  under  it,  and  raised  by  an  assistant 
at  each  side  of  the  animal.  Manipulation  per  vaginam  may  supplement 
this  support,  and  in  the  majority  of  such  cases  may  even  be  absolutely 
necessary  to  complete  delivery. 

In  other  instances,  however,  the  foetus  cannot  be  removed  from  the 
hernial  sac  without  placing  the  female  in  a  recumbent  posture.  Either 
lateral  or  dorsal  decubitus  maybe  resorted  to,  according  to  circumstances  ; 
but  the  preference  is  usually  given  to  the  latter  position  \  though  when 
lateral  decubitus  is  tried,  the  animal  should  be  placed  on  the  side  oppo- 
site to  that  in  which  the  hernia  exists. 

In  the  dorsal  position,  the  weight  of  the  foetus  and  uterus  is  removed 
from  the  floor  of  the  abdomen  ;  consequently,  the  abdominal  muscles  are 
relaxed,  and  the  borders  of  the  hernial  opening  are  not  so  tense ;  while 


DYSTOKIA  BY  DISPLACEMENT.  285 

the  uterus  'and  its  contents,  by  their  own  weight,  have  a  tendency  to 
escape  from  the  hernia  and  fall  into  the  abdomen ;  at  the  same  time  the 
foetus  is  more  accessible  to  the  hand  of  the  obstetrist. 

Should  the  os  be  contracted,  it  must  then  be  dilated  by  the  hand  ;  if 
the  membranes  are  intact,  they  are  to  be  ruptured  ;  should  the  foetus 
make  an  unfavorable  presentation,  which  is  not  very  frequent  in  these 
cases,  this  can  be  rectified ;  and  if  the  creature  is  dead,  which  is  nearly 
alwavs  the  case  when  assistance  has  not  been  rendered  sufficiently  early, 
and  the  membranes  are  ruptured,  it  can  be  all  the  more  easily  removed. 

When  the  foetus  presents  anteriorly  and  the  head  can  be  seized,  this 
should  be  brought  into  the  pelvic  inlet,  and  cords  attached  to  the  lower 
jaw,  or  Schaack's  head-collar  forceps  (to  be  hereafter  described)  may  be 
employed  ;  then  having  secured  the  head,  the  fore  limbs  are  sought  for, 
and  brought  into  the  passage  one  after  the  other,  where  they  are  also 
secured  by  cords  around  the  pasterns.  Sometimes  these  limbs  cannot  be 
found,  owing  to  their  being  bent  back  against  the  body  of  the  foetus,  and 
this  will  certainly  render  delivery  more  difficult. 

Should  the  foetus  present  posteriorly,  the  case  is  more  unfavorable  ; 
though  if  the  hind  limbs  can  be  found  and  brought  into  the  vagina,  then 
delivery  may  soon  be  effected  if  there  are  no  other  complications. 

Cords  being  fastened  to  the  pasterns,  sufficient  and  well-directed  trac- 
tion should  be  employed  on  them,  the  hand  of  the  operator  remaining  in 
the  pelvis  if  necessary,  in  order  to  guide  the  passage  of  the  foetus.  Saint- 
Cyr  suggests  that  an  intelligent  assistant  may  at  the  same  time  be  directed 
to  make  methodical  pressure  on  the  hernia,  in  order  to  complete  its 
reduction,  which  is  effected  when  the  contents  of  the  hernia  are  returned 
to  the  abdomen. 

At  times  this  reduction  is  easy,  and  at  other  times  it  is  extremely  diffi- 
cult. In  the  latter  instances,  all  the  more  care  is  necessary  that  the  ex- 
ternal manipulations  are  not  too  forcible,  if  it  is  desired  to  have  a  living 
foetus.  Should  the  resistance  prove  greater  than  the  means  which  may 
safely  be  employed  to  overcome  it,  then  a  surgical  operation  must  be 
determined  on.  When  the  muscles  of  the  abdomen  prove  an  obstacle  to 
the  escape  of  the  foetus  from  the  hernial  sac,  and  produce  a  kind  of 
strangulation,  an  incision  may  be  made  through  them  in  the  most  con- 
venient part,  as  in  the  operation  for  strangulated  hernia  of  the  intestine. 

In  other  cases  the  Csesarean  operation  may  have  to  be  resorted  to, 
and  speedily,  if  the  mother  or  progeny,  or  even  both,  are  to  be  saved. 
Recourse  to  this  formidable  measure  will  only  be  had  in  particular 
instances :  as  when  the  mother  or  foetus  are  valuable,  and  other  means 
have  failed  or  are  not  likely  to  succeed. 

And  in  uterine  hernia  this  operation  is  undertaken  in  far  more  favor- 
able condition,  than  in  some  other  circumstances  which  necessitate  its 
adoption.  In  this  accident  only  the  skin,  and  perhaps  also  occasionally 
the  tunica  abdominaiis,  has  to  be  cut  through  to  expose  the  uterus, 
which  has  not  to  be  sought  for  among  the  mass  of  intestines  and  labo- 
riously withdrawn  from  their  midst ;  indeed,  it  generally  occupies  the 
whole  of  the  hernial  tumor,  and  so  closely,  that  there  is  no  danger  of 
the  intestines  escaping  during  the  operation.  A  simple  incision — no 
larger  than  is  necessary — through  the  organ,  a  larger  one  through  the 
foetal  membranes,  and  the  prompt  extraction  of  the  foetus  therefrom, 
pretty  nearly  complete  the  task. 

If  the  Caesarean  operation  is  timeously  resorted  to,  the  chances  are 


286  MATERNAL  DYSTOKIA. 

greatly  in  favor  of  delivering  a  living  foetus  ;  with  the  Cow,  as  Saint-Cyr 
has  stated,  a  living  and  perfectly  viable  calf  is  almost  certain  to  be 
obtained,  even  a  long  time  after  labor  is  commenced  and  the  "  water- 
bag"  has  ruptured.  And  even  with  the  Mare  it  is  not  at  all  impossible 
to  rescue  a  living  foal,  if  the  operation  is  resorted  to  before  rupture  of 
the  membranes. 

The  chances  in  favor  of  the  mother  are,  of  course,  fewer  than  with  the 
foetus  ;  for  under  the  most  favorable  conditions,  after  removal  of  the 
progeny,  there  will  still  remain  the  great  hernial  sac,  which  it  will  be 
most  difficult  to  keep  the  intestines  from  occupying,  and  still  more  diffi- 
cult to  cure  in  a  radical  manner  :  judicious  trussing  and  bandaging  being 
nearly  all  that  can  be  done  to  palliate  the  effects  of  the  accident. 

All  these  considerations  should,  of  course,  be  duly  estimated  by  the 
veterinary  surgeon  in  undertaking  the  treatment  of  such  a  case  ;  and  it  is 
scarcely  necessary  to  say  that,  with  the  Cow  more  especially,  the  butcher 
will  frequently  have  to  be  called  in  when  the  question  of  risk  and  ex- 
pense has  been  fairly  discussed. 

It  need  hardly  be  pointed  out  that  it  is  generally  very  injudicious  to 
attempt  to  breed  from  an  animal  affected  with  hysterocele,  or  an  abdom- 
inal hernia  of  any  description,  notwithstanding  the  fact  that  this  condition 
may  not  militate  against  gestation  and  parturition  in  every  case. 

With  the  smaller  animals,  and  especially  the  Bitch,  the  Caesarean  ope- 
ration has  usually  to  be  resorted  to  for  various  reasons,  the  chief  of 
which  are  the  small  size  of  the  creature,  the  difficulty  in  reaching  the 
foetus  or  foetuses  and  extracting  them  by  the  natural  passages,  as  well  as 
the  irreducible  nature  of  the  hernia,  which  is  often  extremely  constricted 
at  the  neck,  and  attempts  at  reduction  are  often  followed  by  death. 
Besides,  the  Bitch  withstands  very  serious  operations  in  the  abdominal 
region  better  almost  than  any  other  animal,  the  entire  uterus  having  been 
frequently  removed  by  abdominal  section  without  a  fatal  termination. 
In  this  animal  the  operation  is  also  very  simple,  and  demands  only 
ordinary  care  and  manipulative  skill. 

Every  thing  is  therefore  in  favor  of  gastro-hysterotomy  in  the  uterine 
hernia  of  the  pregnant  Bitch ;  but  in  order  to  ensure  whatever  success 
may  be  possible,  it  must  be  performed  early,  and  before  serious  injury 
has  been  done  by  attempts  at  reduction  or  delivery  in  other  ways.  It  has 
been  argued  that  it  might  be  preferable  to  open  the  sac,  divide  the  con- 
striction which  prevents  reduction,  and  return  the  gravid  uterus  to  the 
abdomen,  when  delivery  might  be  effected  in  a  natural  and  spontaneous 
manner.  And  it  has  been  shown  that  this  mode  of  operating  is  rational 
and  possible,  and  may  be  followed  by  success  should  there  be  no  adhesions 
between  the  misplaced  uterine  cornu  and  the  hernial  pouch.  The  expe- 
rience gained  in  such  cases,  however,  does  not  testify  very  markedly  in 
favor  of  this  procedure,  and  the  evidence  is  certainly  in  favor  of  the  Cae- 
sarean operation,  and  particularly  when  adhesions  exist. 

The  dangers  to  be  apprehended  from  gastro-hysterotomy  are  inflamma- 
tion and  strangulation  of  the  imprisoned  cornu  and  of  the  uterus,  which 
at  this  time  is  so  vascular,  impressionable,  and  particularly  susceptible  to 
the  influence  of  the  air  on  its  internal  surface.  To  avert  these  dangers, 
it  has  been  proposed  to  remove  the  uterine  horn  altogether ;  'and  we  are 
certainly  of  opinion  that,  in  certain  cases,  the  proposal  is  worthy  of  a 
trial. 

We  will  describe  the  Caesarean  operation  in  another  place. 


DYSTOKIA  BY  DISPLACEMENT.  287 

At  a  recent  meeting  of  the  Medical  Society  of  Strasburg,  M.  Kopp  {Gazette  Medicale 
de  Strasbourg,  1875)  exhibited  the  uterus  and  its  appendages  belonging  to  a  Bitch  upon 
which  he  had  operated  in  order  to  extract  a  foetus  which  was  lodged  in  one  of  the  uterine 
cornua.  The  animal  had  been  restless  for  some  twenty-four  hours  when  Kopp  was 
called  in  to  examine  it ;  he  found  every  indication  of  approaching  pafturition,  but  not- 
withstanding these,  and  the  considerable  volume  of  the  abdomeji,  tne  os  uteri  was  almost 
closed — a  circumstance  which  decided  him  to  wait.  During  the  night  the  Bitch  gave 
birth  to  a  dead  puppy,  and  on  the  following  day  the  diminished  distention  of  the  abdo- 
men enabled  him  to  discover,  beneath  the  skin,  the  presence  of  three  fa-tuses.  On  inquiry, 
he  ascertained  that  for  some  time  the  animal  had  been  suffering  from  an  inguinal  hernia 
on  the  left  side,  and  this  information  led  him  to  adopt  active  measures.  The  skin  was 
incised  over  the  isolated  hernial  sac,  as  far  as  the  inguinal  canal ;  then,  after  largely 
opening  the  tumor,  as  well  as  the  uterine  cornu  it  contained,  he  was  able  to  remove  the 
three  dead  foetuses  and  their  membranes.  The  prolapsed  uterine  portion  having  been 
carefully  cleansed,  was  closed  by  suture  and  returned  to  the  abdominal  cavity,  and  a 
strong  ligature  placed  round  the  sac.  The  inguinal  canal  had  been  widely  incised  ;  but 
notwithstanding  this,  the  reduction  of  the  uterus  and  its  annexes  offered  some  difficulties, 
in  consequence  of  the  great  mass  of  fat  in  and  upon  the  broad  ligaments  surrounding 
them.  Every  thing  appeared  to  be  going  on  favorably  until  the  ninth  day,  when  the  ani- 
mal suddenly  succumbed.  Death  was  attributed  to  purulent  absorption,  produced 
through  the  agency  of  a  small  abscess  on  the  broad  ligament,  which  had  been  abraded 
during  the  operation  of  reduction.  There  were  no  traces  of  metro-peritonitis,  and  the 
wound  in  the  uterus,  as  well  as  in  that  portion  of  the  sac  which  had  been  ligatured,  was 
cicatrizing  most  satisfactorily.  According  to  Kopp,  this  was  an  instance  of  intra  and 
extra-abdominal  pregnancy  at  the  same  time ;  and  in  proof  of  this,  he  pointed  to  the 
narrowness  of  the  inguinal  canal,  and  the  presence  of  the  uterine  hernia  previous  to  im- 
pregnation. 

Three  of  the  foetuses  were  developed  in  the  cornual  hernia,  and  the  fourth  in  the  body 
of  the  uterus. 

Pathological  Anatomy. 

The  pathological  anatomy  of  uterine  hernia  is  not  without  interest  to 
the  obstetrist ;  and  as  it  has  been  studied  in  animals  which  have  died  during 
attempts  at  parturition,  or  have  been  slaughtered  after  that  act,  the  evi- 
dence is  as  plentiful  as  it  is  reliable. 

According  to  Saint-Cyr^  the  chief  and  essential  lesion  is  of  course  to  be 
found  in  the  abdominal  parietes.  The  fleshy  or  tendinous  fibres  of  the 
oblique  muscles  may  be  merely  separated,  especially  at  the  commence- 
ment ;  though  most  frequently  some  of  them  are  ruptured.  The  great 
rectus  muscle  always  shows  a  solution  of  continuity,  the  rupture  being 
sometimes  as  clean  and  sharp  as  if  it  had  been  made  by  a  knife  ;  though 
at  other  times  it  is  irregular  and  lacerated.  In  every  case  there  results  a 
variable-sized  opening,  more  or  less  circular,  oval,  or  triangular,  its  larger 
diameter  corresponding  to  the  axis  of  the  animal's  body  \  Rodet  has  seen 
an  opening  of  this  kind  measure  nearly  twenty  inches. 

The  seat  of  the  rupture  varies  ;  sometimes  the  rectus  muscle  is  perfor- 
ated at  its  pubic  insertion,  as  Favre  has  seen  it ;  in  other  cases  it  is  else- 
where, but  in  every  instance  it  is  inferior,  posterior  to  the  umbilicus,  and 
to  the  right  or  left  of  the  linea  alba.  The  latter  structure  is  at  first  never 
involved  ;  but  when  the  hernia  increases  largely  in  size,  it  may  in  its  turn 
give  way  ;  so  long  as  it  remains  intact  it  forms  a  kind  of  cord  extending 
from  the  pubis  to  the  sternum,  and  by  partially  dividing  the  tumor^  gives 
it  a  bi-lobular  appearance. 

In  a  few  cases  the  tunica  abdominalis  resists  the  strain  imposed  on  it, 
being  only  extended,  and  in  this  way  the  hernia  has  another  covering,  in 
addition  to  the  skin  ;  but  in  many  instances  it  tears  like  the  muscles. 
Delplanque  has  shown  that  the  peritoneum  may  escape  rupture,  stretch 
and,  accompanying  the  descending  viscera,  constitute  a  serous  tunic  to 


288  MATERNAL  DYSTOKIA. 

the  hernia ;  most  frequently,  however,  it  gives  way,  the  uterus  passes 
through  it,  and  then  there  is  no  hernial  sac. 

In  a  recent  hernia,  the  connective  tissue  surrounding  it  is  greatly  ecchy- 
mosed  and  infiltrated,  and  the  muscular  fibres  broken-up  and  separated  ; 
the  tendinous  fibres  are  also  separated  and  torn,  and  numerous  red  and 
partly  discolorized  blood-clots  lie  among  their  interstices.  At  a  later 
period  no  extravasated  blood  is  found  between  the  skin  and  the  uterus, 
but  the  parts  are  uniformly  red  ;  and,  later  still,  attempts  at  repair  are  evi- 
denced by  cicatrization  of  the  borders  of  the  rupture,  which  have  then  a 
rounded,  thickened,  and  fibro-tendinous  aspect,  and  are  dense  and  resist- 
ing. The  connective  tissue  beneath  the  skin  is  condensed  into  a  kind  of 
smooth  membrane,  continuous  with  the  margin  of  the  rent,  and  forms  a 
second  tunic  to  the  hernia. 

Before  parturition  the  hernia  is  occupied  exclusively,  or  nearly  so,  by 
the  gravid  uterus,  which  is  wholly  or  in  part  lodged  in  this  accidental  di- 
verticulum. After  delivery,  however,  the  uterus  often,  though  not  always, 
ascends  into  the  abdominal  cavity  ;  but  whether  it  does  so  or  not,  other 
viscera — such  as  the  rumen  with  the  Cow,  and  the  colon  and  small  intes- 
tine with  the  Mare — find  their  way  into  the  pouch  ;  Rodet  has  even  found 
the  uterus  and  the  entire  intestinal  mass  included  in  it. 

Deviation  of  the  Uterus. 

By  the  term  deviation^  when  applied  to  the  uterus,  is  meant  a  change  in 
the  direction  of  the  organ,  by  which  the  cervix  and  os  no  longer  corre- 
spond to  the  axis  of  the  vagina.  This  change  of  direction  in  the  vaginal 
opening  of  the  uterus  may  be  productive  of  more  or  less  difficulty  in 
parturition. 

Changes  in  the  position  of  the  uterus  are  somewhat  common  in  woman, 
whose  vertical  uterus  may  easily  deviate  in  any  direction,  producing  those 
flexions  and  versions  which  not  unfrequently  offer  serious  obstacles  to  de- 
livery. With  quadrupeds,  however,  in  which  the  uterus  is  horizontal,  the 
veterinary  obstetrist  has  but  to  deal  with  one  kind  of  deviation  of  the 
uterus,  the  only  one  possible — that  of  inferior  obliquity^  which  appears  to 
be  extremely  rare,  and  corresponds  to  the  anteversion  of  the  human  fe- 
male. 

According  to  Schaack  and  Garreau,  who  have  more  particularly  studied 
it,  this  change  of  position  may,  in  certain  circumstances,  become  a  very 
serious  cause  of  dystokia. 

The  accident  has,  up  to  the  present  time,  only  been  observed  in  the 
Cow  \  and  this  circumstance  is  believed  to  be  explained  by  an  interest- 
ing feature  in  the  anatomy  of  this  animal,  which  has  been  recently  brought 
under  notice  by  Professor  Goubaux,  of  the  Alfort  Veterinary  School. 

It  would  appear  that,  in  bovines,  the  abdominal  muscles  are  not  at- 
tached to  the  anterior  border  of  the  pubis  as  in  solipeds,  but  are  inserted 
into  a  thick  ligament  found  at  the  external  and  inferior  part  of  the  pubic 
bones,  and  which  strengthens  the  symphysis  pubis.  It  consequently  hap- 
pens that,  at  this  border  of  these  bones,  the  floor  of  the  abdomen  is  on  a 
lower  plane  than  that  of  the  pelvic  cavity ;  so  that  there  is  a  kind  of  step 
between  the  two  cavities,  the  height  of  which  varies  in  different  animals, 
but  has  been  found  to  be  as  much  as  three,  four,  and  even  five  inches. 
Dissection  has  demonstrated  that  the  peritoneum  lining  the  lower  sur- 
face of  the  abdominal  cavity,  on  arriving  at  the  pubis  ascends  this  step, 


DYSTOKIA  BY  DISPLACEMENT. 


289 


in  covering  it  like  a  carpet,  to  line  the  upper  surface  of  the  pubic  bones 
and  the  pelvic  cavity. 

From  this  anatomical  peculiarity,  it  may  happen  that  the  fundus  of  the 
gravid  uterus,  instead  of  being  directed  forward,  will  incline  directly 
downwards  and  lie  on  this  pelvic  step,  not  passing  beyond  the  umbilicus, 
behind  which  it  may  even  rest  sometimes.  At  the  same  time,  and  as  a 
consequence  of  this  arrangement,  the  other  end — the  cervix — is  tilted 
upwards  in  the  direction  of  the  sacro-vertebral  angle,  and  it  may  even 
compress  the  rectum  against  that  part.  It  will  be  obvious  that,  through 
this  great  deviation  in  the  direction  of  the  cervix,  the  os  no  longer  cor- 
responds to  the  axis  of  the  vagina,  the  canal  following,  of  course,  the 
same  oblique  ascending  line  as  the  cervix.  Such  an  alteration  in  the 
position  of  the  uterus  entails  a  similar  change  in  the  attitude  of  the 
foetus,  which,  instead  of  being  placed  almost  horizontally,  is  now  more 
or  less  vertical — the  head  towards  the  sacrum,  and  the  buttocks  resting 
on  the  pubic  step. 

During  parturition,  as  Saint-Cyr  points  out,  we  may  easily  understand 
how  affairs  are  changed  with  regard  to  the  performance  of  this  act.  The 
uterine  contractions  are  no  longer  directed  towards  the  cervix  ;  the  os 
only  dilates  slowly  or  not  at  all,  according  to  the  degree  of  uterine  ob- 
liquity ;  the  animal  is  exhausted  with  ineffectual  attempts  to  expel  the 
foetus  ;  and  if  assistance  is  not  rendered,  it  may  succumb  without  being 
delivered,  or  the  uterus  may  rupture.  Garreau  has  observed  that  labor 
may  be  suspended  altogether- ;  the  foetus  dies,  becomes  mummified,  and 
is  retained  for  perhaps  a  very  long  time. 

Diagnosis. 

The  diagnosis  of  this  deviation  does  not  appear  to  be  attended  with 
much  difficulty.  The  long  duration  of  labor,  and  the  inutility  of  the 
expulsive  efforts,  prove  that  some  obstacle  to  delivery  must  be  present. 
Consequently,  vaginal  exploration  is  resorted  to,  and  when  the  hand  is 
passed  into  that  canal  it  reaches  a  kind  of  imperforate  cul-de-sac,  at  the 
bottom  of  which  is  a  large  round  tumor  into  which  no  opening  can  be 
found.  This  tumor  is  the  lower  face  of  the  uterus  which,  pressed  against 
the  corresponding  wall  of  the  vagina,  projects  into  the  pelvic  inlet. 
Raising  the  hand  towards  the  sacrum,  the  os  will  be  discovered  much 
removed  from  its  normal  position,  and  situated  above  in  front  of  the 
uterine  tumor  just  alluded  to. 

Sometimes  the  os  is  completely  closed,  in  other  cases  it  may  be  more 
or  less  dilated.  When  in  the  latter  condition,  there  is  frequently  formed 
at  this  point  a  kind  of  membraneous  transverse  fold,  raised  in  the  form 
of  a  valve  which  has  been  compared  to  a  fleshy  band  analogous  to 
that  which  forms  the  sacculations  of  the  large  intestine  ;  this  band  is 
stretched  across  the  lower  part  of  the  os,  and  it  has  to  be  surmounted 
before  the  hand  can  touch  the  foetus.  The  latter  is  lodged  in  a  kind  of 
pouch  or  excavation  situated  beneath  the  band,  and  constitutes  the  tu- 
mor met  with  at  first  at  the  bottom  of  the  vagina. 

Complicatio7is. 

To  Saint-Cyr,  Garreau,  and  Schaack,  we  are  indebted  for  our  descrip- 
tion of  the  condition  we  have  been  describing,  and  to  the  two  latter  are 
also  due  the  knowledge  we  possess  of  certain  complications  which  are 
worthy  of  notice.  19 


290 


MATERNAL  DYSTOKIA. 


Garreau  has  found  the  cervix  in  this  uterine  deviation,  thickened^,  indu- 
rated, and  the  os  closed.  Delivery  was  impossible,  and  the  foetus  re- 
mained for  three  months  in  the  uterus  without  causing  any  great  incon- 
venience to  the  Cow.  At  the  end  of  this  period  the  calf  was  extracted 
by  Caesarean  section,  and  with  perfect  success  ;  as  the  Cow  quite  recov- 
ered, and  was  sold  at  a  good  price  eight  months  afterwards. 

In  one  of  the  cases  described  by  Schaack,  the  foetus  was  in  the  verte- 
bro-sacral  position,  and  the  limbs  and  head  having  been  secured  by  cords, 
delivery  was  accomplished  by  strong  traction.  In  a  quarter  of  an  hour 
afterwards,  however,  the  Cow  lay  down,  trembled  all  over,  the  muscles  of 
the  limbs  and  the  eyes  contracted  in  a  convulsive  manner,  and  death 
rapidly  ensued. 

At  the  autopsy,  which  was  made  six  hours  after  death,  a  quantity  of 
blood,  in  the  form  of  a  large  clot,  was  found  in  the  abdomen,  and  the 
textures  about  the  pubis  were  infiltrated  with  that  fluid.  The  uterus  had 
resumed  its  ordinary  form,  and  its  mucous  membrane  was  intact ;  but  at 
the  inferior  part  of  the  organ,  there  was  a  large  triangular  tear,  about 
six  inches  long  and  four  wide  ;  and  it  was  noted  that  this  laceration  had 
caused  the  rupture  of  two  good-sized  arteries,  which  of  course  led  to  the 
haemorrhage  that  caused  death  so  rapidly. 

Indications. 

The  indications  for  treatment  in  this  deviation  are  simple  :  raise  the 
fundus  of  the  uterus,  lower  the  cervix,  and  bring  the  os  on  a  line  with 
the  vagina.  When  this  is  accomplished,  the  uterine  contractions  will  act 
directly  on  the  cervix,  and  if  this  is  healthy,  dilatation  of  .the  os  will  soon 
take  place  ;  then  the  foetus,  pushed  towards  the  vagina,  instead  of  against 
the  sacrum,  will  enter  the  passage,  from  which  a  little  judicious  manipu- 
lation will  in  all  probability  remove  it,  and  thus  complete  delivery. 

Several  modes  of  procedure  have  been  recommended  for  adoption  in 
carrying  out  these  indications.  Indeed,  Saint-Cyr  states  that  when  the 
deviation  is  inconsiderable^  and  the  valvular  band  we  have  mentioned  as 
obstructing  the  os  is  not  present,  reduction  is  often  spontaneously  effect- 
ed by  mere  decubitus.  This,  in  pushing  upwards  the  fundus  of  the 
uterus,  brings  down  the  cervix  to  its  normal  position  by  an  easily  under- 
stood tilting  movement.  Schaack  has  noticed  this  to  happen  in  two  in- 
stances. 

In  such  cases,  says  Rainard,  if  the  animal  persists  in  standing,  it  naay 
suffice  to  raise  the  belly  by  means  of  a  folded  sheet  or  blanket,  or  even  a 
plank  held  by  an  assistant  on  each  side  of  the  Cow ;  or  the  creature  may 
be  gently  thrown  down  on  a  thick  bed  of  straw. 

In  difficult  cases,  however,  these  measures  will  not  be  sufficient,  and 
Garreau  recommends  the  following  procedure  to  be  adopted.  Introduce 
the  right  hand  into  the  rectum  and  the  left  into  the  vagina  ;  with  the 
first  press  on  the  head  of  the  foetus,  and  push  back  its  body  (the  vaginal 
tumor)  with  the  second,  tilting,  as  it  were,  the  young  creature  into  its 
natural  position.  This  will  bring  the  uterus  into  its  normal  situation,  and 
consequently  the  os  opposite  the  vagina. 

Saint-Cyr,  nevertheless,  gives  the  preference  to  the  method  recom- 
mended and  practised  by  Schaack  in  these  troublesome  cases,  inasmuch 
as  it  is  more  simple,  and  experience  has  demonstrated  its  efficacy.  This 
method  consists  merely  in  throwing  down  the  Cow  most  carefully,  plac- 


D  YSTOKIA  B  Y  D  ISP  LA  CEMENT. 


291 


ing  the  animal  on  its  back,  and  keeping  it  in  that  position  by  bundles  of 
straw.  The  weight  of  the  foetus  carries  the  uterus  down  towards  the 
spine  (inferior)  ;  the  fundus  of  the  organ  is  depressed,  and  the  cervix 
raised  towards  the  pubis  (now  superior)  \  the  obliquity  of  the  uterus  is 
thus  got  rid  of. 

Schaack  has  on  two  occasions  resorted  to  this  mode  of  reduction,  and 
in  each  case  the  abnormal  valve  disappeared,  and  parturition  was  ren- 
dered easy. 

Professor  Peuch,  of  the  Lyons  Veterinary  School,  states  that  in  a  case 
of  this  description,  he  employed  Schaack's  method  ;  when  the  Cow  was 
placed  on  its  back  the  obliquity  disappeared  spontaneously,  and  with  the 
greatest  facility. 

Torsion  of  the  Uterus:  Contorsio  Uteri. 

Torsion,  or  "  twisting  "  of  the  gravid  uterus  on  itself — and  which  often 
involves  not  only  the  cervix  of  the  organ,  but  also  the  vagina — is  an  ac- 
cident unknown  to  the  pregnant  human  female,  but  for  anatomical  rea^ 
sons  may  occur  in  animals,  and  particularly  in  the  Cow,  in  which  it  has 
been  most  frequently  observed.  This  accident  is  rare  in  the  Mare  ;  it 
has  been  observed  in  the  Sheep  and  Goat,  as  well  as  i«  the  Cat ;  but 
though  in  the  Sow  and  Bitch  the  uterine  cornua  may  become  displaced 
and  twisted  on  each  other,  and  even  become  hernied  by  the  broad  liga- 
ments, yet  torsion  of  the  uterus  has  not  been  noted  in  them,  so  far  as 
can  be  ascertained. 

We  will  first  study  the  accident  in  the  Cow,  and  afterwards  in  the 
Mare  and  other  animals. 

History. 

Though  torsion  of  the  uterus  is  now  recognized  as  a  serious,  but  not 
insurmountable,  obstacle  to  parturition,  yet  its  existence  may  be  said  to 
be  of  recent  discovery ;  for  though  it  was  clearly  and  explicitly  indicated 
in  the  last  century  by  Boutrolle  {Far/ait  Bouvier,  2d  edition,  1766),  yet 
it  was  not  until  after  much  observation  and  discussion  in  this  century 
that  such  a  condition  was  proved  to  be  possible.  Boutrolle  wrote:  "If 
it  is  possible  to  pass  two  or  three  fingers  into  the  os  {veliere),  the  hand 
and  arm  may  be  forced  through ;  but  if,  on  the  contrary,  a  finger  cannot 
be  passed  into  it,  and  the  opening  is  found  to  be  turning,  it  is  a  sign  that 
the  OS  is  twisted — thai  it  has  fnade  a  half-turn  on  itself- — and  it  is  impos- 
sible to  enter  it." 

Though  Veterinary  Science  had  gained  a  sound  footing  in  France  soon 
after  the  publication  of  Boutrolle's  "  Perfect  Cawherd,"  yet  its  students 
do  not  appear  to  have  paid  any  heed  to  the  amateur's  description  of  the 
spiral  twist  of  the  cervix  uteri,  the  difficulty  in  penetrating  the  os,  and  the 
impossibility  of  birth  taking  place  through  it.  Indifference  or  incredulity 
may  have  prevailed  ;  and  it  was  not  until  painful  experience  had  awak- 
ened attention  to  the  existence  of  the  accident,  that  the  veterinarians  of 
this  century  began  to  notice  it. 

Nevertheless,  in  France  Boutrolle's  "  Cowherd  "  appears  to  have  been 
carefully  read  and  usefully  studied  by  those  for  whom  it  was  written — 
the  countr}^- folks  or  cowmen,  or  he  may  have  gained  his  knowledge  from 
these  ;  for,  according  to  Saint-Cyr,  one  of  their  great  problems  in   cases 


292 


MA  TERN  A  L  D  YSTOKIA . 


of  difficult  parturition — a  problem  not  confined  to  the  cowherds  of  France 
only — was  to  discover  if  the  calving  Cow  was  not  "  barre'e  "  (obstructed), 
if  it  had  not  the  torche^  veliere,  or  portiere  torse,  torte,  or  tordue  (cervix 
twisted),  terms  employed  according  to  the  localities  and  dialects,  and 
which  signify  what  Boutrolle  has  distinctly  described. 

At  the  commencement  of  this  century,  however,  we  are  informed  by 
Rainard  that  Maurin  of  Cantal,  and  Vieillard  of  Brioude,  two  of  his  pu- 
pils, had  witnessed  this  form  of  dystokia. 

"  On  January  13,  1823,"  says  Maurin,  "  I  was  called  upon  to  attend  on  an  eight  years 
old  Cow  which  was  calving.  This  animal,  which  had  an  enormous  belly,  had  remained 
lying  for  four  or  five  days,  without  appetite,  and  the  pulse  quick.  It  should  have  calved 
towards  the  end  of  the  previous  December ;  and  indeed  on  the  26th  and  27th  of  that 
month,  it  exhibited  symptoms  of  pain  similar  to  those  of  labor,  though  the  '  waters '  did 
not  escape. 

"  These  symptoms  having  disappeared,  and  every  thing  being  tranquil,  the  proprietor 
of  the  Cow  thought  that  he  had  been  deceived  as  to  the  precise  period  at  which  the 
animal  should  have  calved,  and  believed  that  the  pains  were  merely  due  to  accidental 
colic,  and  had  no  relation  to  parturition.  I  endeavored  to  assure  myself  as  to  whether 
the  foetus  was  alive  or  dead,  by  strong  pressure  on  the  abdomen,  in  order  to  excite  it  to 
movement  if  it  chanced  to  be  living ;  but  not  succeeding  in  this,  I  was  convinced  that  it 
was  dead.  On  trying  to  introduce  my  hand,  I  experienced  my  first  difficulty  in  passing 
the  bulb  of  the  vagina,  which  was  so  constricted  that  I  was  compelled  to  dilate  it.  Hav- 
ing reached  the  e«d  of  the  canal,  I  was  able  to  assure  myself  that  the  cervix  uteri 
offered  salient  folds;  as  the  index  finger,  with  which  I  endeavored  to  penetrate  the  os, 
found  it  contracted  and  plicated.  As  it  appeared  to  me  that  the  Cow  must  die,  I  recom- 
mended the  owner  to  sell  it  to  the  butcher. 

"  On  opening  it,  I  found  the  small  intestines  in  the  vicinity  of  the  uterus  reddened  for 
a  considerable  extent.  The  uterus  itself  was  turned  round  from  right  to  left,  and  the 
suspensory  ligaments  of  the  cornua  were  interlaced  in  one  another.  When  the  uterus 
was  opened,  the  calf  was  found  with  its  back  towards  the  right  flank  of  the  Cow.  its 
limbs  being  towards  the  left  flank  ;  the  cervix  formed  two  very  salient  spiral  turns, 
which  undoubtedly  prevented  its  dilatation  The  body  of  the  foetus  did  not  present  any 
traces  of  putrefaction,  although  the  '  waters  '  had  a  foetid  odor." 

Vieillard  was  able  to  distinguish  this  accident  in  a  more  evident  manner  than  Maurin, 
and  during  the  life-time  of  the  two  Cows  he  was  called  in  to  see.  These  animals  had 
the  uterus  prolapsed,  the  cervix  being  external  to  the  vulva,  and  the  posterior  part  of 
the  organ  showed  three  markedly-spiral  folds. 

In  Frarjce,  other  veterinary  observers  afterwards  published  similar  cases, 
the  first  in  order  being  Lecoq,  of  Bayeux,  who  in  1837  '^^*^  occasion  to 
note  this  accident.  In  a  Alemoire  sur  le part  laborieiix  {Comptes  Rejidus 
de  la  Societe  Veterinaire  du  Calvados  et  de  la  Manc/ie,  1838),  he  expresses 
his  surprise  at  the  silence  prevailing  among  veterinary  authorities  with 
regard  to  this  condition,  which  was  met  with  from  time  to  time,  and  was 
well  enough  known  to  breeders.  In  describing  the  symptoms  he  had 
noted,  Lecoq  says  :  "  The  hand  having  been  introduced  into  the  vagina, 
and  pushed  as  far  as  the  neck  of  the  uterus,  encountered  a  kind  of  valve 
obstructing  the  entrance  to  the  latter.  I  was  beyond  the  part  I  had 
taken  for  a  valve,  and  had  got  into  a  narrow  canal  which  had  the  form  of 
a  screw  {ayant  la  forme  d'une  vis).  The  Cow  died  on  the  following  day 
without  having  been  delivered,  and  at  the  autopsy  it  was  found  that  the 
uterus  was  completely  turned  upside-down — the  superior  face  having  be- 
come the  inferior — and  that  this  version  had  taken  place  from  right  to 
left." 

The  first  Veterinarian,  we  believe,  who  observed — or,  rather,  who  de- 
scribed— a  complete  rotation  of  the  uterus  (the  previous  cases  recorded 
were  only  those  of  half-rotation),  was  Mazure,  whose  description  is  one 
of  the  best  we  possess.     It  is  published  in  the  same  periodical  which 


DYSTOKIA  BY  DISPLACEMENT.  293 

contains  Lecoq's  account.  From  his  narrative,  it  appears  that  he  was 
consulted  by  one  of  his  colleagues  with  regard  to  a  Cow,  the  cervix  of 
whose  uterus  was  so  twisted  that  a  finger  could  not  enter  the  os.  Mazure 
gave  an  unfavorable  prognosis  ;  but,  notwithstanding,  it  was  attempted  to 
reduce  the  torsion  by  making  an  opening  in  the  right  flank  in  order  to 
reach  the  uterus.  The  attempt  failed,  though  it  demonstrated  that  there 
was  a  quantity  of  foetid  serosity  and  fibrinous  flakes  in  the  peritoneal 
cavity  ;  that  the  uterus  had  a  rupture  in  its  left  posterior  border,  the  rent 
being  rounded  in  form  and  had  a  diameter  of  from  twenty  to  twenty-four 
centimetres  ;  and  that  the  foetus  was  dead,  as  had  been  suspected. 

As  nothing  more  could  be  done  with  the  Cow,  it  was  destroyed,  and  it 
was  then  discovered  that  the  uterus  had  made  a  complete  revolution 
on  its  axis  j  while  towards  the  part  adjoining  the  cervix,  there  were 
found  five  spiral  twists,  two  of  which,  more  voluminous  than  the  others, 
were  of  a  greyish  color  and  hard  in  texture.  Throughout  the  whole 
extent  of  these  twists  in  the  uterus,  the  connective  tissue,  infiltrated  with 
serosity,  formed  a  swelling  which  rendered  the  dilatation  of  the  posterior 
part,  and  the  passage  of  the  calf  through  it,  most  difficult.  The  foetus 
was  perfectly  developed  and  intact,  and  did  not  appear  to  have  been  dead 
more  than  two  or  three  days. 

Another  Norman  Veterinarian,  Pouchy,  describes  four  cases,  about  the 
same  period.  These  Cows  merely  suffered  from  loss  of  appetite,  great 
distention  of  the  abdomen,  unhealthy-looking  coat,  a  foetid  and  sanguino- 
lent  vaginal  discharge,  and  suppression  of  milk,  for  six  to  eight  weeks  ; 
when  submitted  to  treatment,  and  turned  out  to  pasture,  they  recovered 
sufficiently  to  become  fit  for  the  butcher. 

In  Germany,  about  the  same  time,  torsion  of  the  uterus  had  been  the 
subject  of  investigation  and  treatment  by  Dieterichs  and  Schmidt  of 
Bavaria,  Vix  of  Giessen,  Fricke  of  Hanover,  and  Irminger  and  Schenker 
of  Switzerland.  Fricke  cured  a  case  by  fastening  the  feet  together,  two 
by  two,  and  rolling  the  animal  in  a  contrary  direction  to  that  in  which  the 
uterus  was  twisted. 

In  Britain  nothing  appears  to  have  been  noticed  of  this  accident  until 
1840,  when  Mr.  Carlisle,  of  Wigton,  under  the  head  of  "  Csesarean  Opera- 
tion "  ( Veterinarian^  vol.  xiii.,  p.  407),  describes  an  undoubted  case  of 
torsion.  The  circumstance  which  rendered  the  operation  necessary,  was 
a  severe  injury  the  animal  had  received  two  days  previously,  since  when 
it  had  manifested  symptoms  of  parturition  ;  but  though  several  attempts 
had  been  made  to  extract  the  foetus,  delivery  could  not  be  accomplished 
owing  to  the  uterus  being  twisted.  Caesarean  section  having  delivered 
the  calf  and  its  membranes,  the  Cow  only  lived  a  short  time.  The  uterus 
was  found  to  be  "  completely  rotated,  even  to  the  termination  of  the 
vagina." 

After  this  period,  torsion  of  the  uterus  attracted  a  large  share  of  at- 
tention among  the  most  accomplished  Continental  Veterinarians,  and 
particularly  after  the  observations  published  by  Denoc,  in  France,  in 
1845.  It  formed  the  subject  of  animated  and  interesting  discussions  at 
the  Belgian  Socie'te  de  Medicine,  the  Socie'te'  Central  de  Med.  Ve'terinaire 
of  Paris  in  1853  and  i860,  the  Veterinary  Society  of  Wurtemberg  in  1854, 
and  that  of  Denmark  in  1855  ;  and  memoirs  on  it  have  b.een  published 
by  Bordonnat,  Rossignol,  Gaven,  Bouley,  Canu,  Lemaire,  Chambon, 
Goubaux,  Chauveau,  Weber,  Liautard,  Dagoureau,  Lessona,  Ollivero, 
Ercolani,  Lafosse,  Chuchu,  Goron,  Obig,   Heu,  Rocco,   Marlot,  Gourcy, 


294 


MATERNAL  DYSTOKIA. 


Coquet,  and  many  other  foreign  Veterinarians  ;  while  it  is  alluded  to 
with  more  or  less  detail  in  the  treaties  of  Rainard,  Baumeister  and  Rueff, 
Ziirn,  Harms,  Lanzillotti-Buonsanti,  Cruzel,  Saint-Cyr,  etc. 

In  this  country  it  has  not  received  much  attention,  if  we  are  to  judge 
from  the  paucity  of  allusions  to  it ;  though  there  can  be  no  doubt  that  the 
accident  frequently  occurs.  Beyond  a  few  notices  from  the  pen  of  Car- 
lisle, Cartwright  (of  Whitchurch),  Woods  (Wigan),  Bennet,  and  Captain 
Russell,  little  more  is  recorded.  These  observations  only  refer  to  torsion 
of  the  uterus  in  the  Cow.  No  observer  in  this  country  has  noticed  its 
occurrence  in  other  animals,  except  Cox. 

With  the  Mare,  in  which  the  accident  is  nearly  always  fatal,  it  has  been 
witnessed  by  Belhomme,  Elsen,  Delwart,  Hamon,  Noll,  Devaux,  Canu, 
Leconte,  Schmidt,  and  Cox. 

In  the  Cat,  it  has  been  observed  by  Vivier. 

Nature  and  Freqiieficy. 

Before  proceeding  to  describe  the  symptoms  and  other  features  of  this 
curious  accident,  it  may  be  well  to  inquire  into  its  nature  and  frequency. 

As  the  designation  indicates,  the  accident  consists  in  a  rotation  of  the 
uterus  on  its  axis,  by  which  its  upper  surface  may  successively  become 
lateral  and  inferior  ;  and  lateral  on  the  opposite  side  and  superior,  when 
the  revolution  is  complete.  This  revolution  may  take  place  in  two 
opposite  directions  ;  the  upper  face  may  at  first  be  left  lateral  or  I'ight 
lateral — the  first  constituting  left  torsion,  the  second  right  torsion. 

I'orsion  may  be  incomplete  or  cofnplete.  There  may  be  quarter-torsion^ 
half -torsion,  three-quarter  torsion,  or  complete  torsion,  according  to  the  degree 
of  rotation  the  uterus  has  experienced.  In  those  instances  in  which  the 
organ  has  made  two  complete  turns,  we  have  a  double  torsion. 

The  consequences  of  this  rotation  are  easily  seen.  The  vagina  and  its 
prolongation — the  cervix  uteri — because  of  their  attachments,  cannot 
follow  the  uterus,  and  therefore  become  twisted  in  a  cord-like  manner  ; 
whence  arises  stricture  of  the  os — the  constriction  being  all  the  greater  as 
the  rotation  is  complete — and  utter  impossibility  to  effect  delivery  of  the 
foetus  unless  the  uterus  is  replaced  in  its  normal  position,  or  its  contents 
are  removed  otherwise  than  through  the  os. 

Incomplete  torsion  is  by  far-  the  most  frequent  form  encountered  in 
practice.  It  is  often  so  slight  that  it  might  rather  be  classed  among  the 
deviations  of  the  uterus  already  alluded  to.  For  instance,  very  frequently 
there  is  only  a  trifling  displacement  of  the  cornu  containing  the  foetus, 
and  this  may  carry  the  uterus  with  it,  giving  rise  to  a  condition  which  bears 
a  certain  analogy  to  the  uterine  obliquity  met  with  in  woman,  in  which 
the  organ  is  inclined  laterally.  Schaack,  Rainard^  Weiss,  and  Zundel 
have  often  noted  these  cases  in  animals ;  and  the  latter  states  that  they 
occur  in  largest  proportion  among  the  larger  lymphatic  Cows.  In  other 
instances,  the  torsion  consists  in  a  quarter  or  half-turn,  the  upper  face  of 
the  uterus  having  become  lateral  or  inferior ;  sometimes  the  gravid  cornu 
comes  to  occupy  the  inferior  region  of  the  abdomen  ;  and  at  other  times, 
making  a  ,wider  rotation,  it  is  lodged  in  the  opposite  flank. 

There  are  scarcely  any  means  in  practice  by  which  we  can  estimate, 
with  mathematical  exactness,  the  degree  of  torsion  to  which  the  uterus 
may  have  been  submitted  ;  as  what  we  have  designated  a  quarter-turn  or 
revolution  only  signifies  that  the  organ  has  made  a  rotation  of  90°,  while 


D  YSTOKIA  B  Y  DISPL  A  CEMENT. 


29s 


the  half-turn   is   scarcely   180^.     Nevertheless,   an   approximation  is  all 
that  can  be  looked  for,  and,  indeed,  is  all  that  is  necessary. 

As  we  have  already  mentioned,  Mazure,  in  1842,  had  a  case  of  com- 
plete rotation  of  the  uterus  on  its  axis  ;  this  was  remedied  by  causing  the 
organ  to  turn  completely  round  in  the  opposite  direction.  Other  writers 
have  spoken  of  a  complete  rotation  in  some  cases,  but  it  may  be  sur- 
mised that  it  was  only  a  half-turn.  Double,  triple,  and  even  quadruple 
twists  have  been  described  ;  because  there  have  been  found  two,  three, 
or  more  spiral  ridges  or  doubles,  close  together,  hard,  and  resisting,  and 
usually  parallel  to  each  other.  But,  as  Zundel  points  out,  these  multiple 
plies  are  only  what  a  somewhat  long  and  supple  cylinder  makes  when 
it  is  twisted. 


Fig.  68. 

Incomplete  Torsion  of  the  Uterus. 

I,  Body  of  the  Uterus  ;  2,  3,  4,  Spiral  Twists  directed  from  left  to  right ;  5,  Cervix  Uteri  and 
Vagina;  6,  Suspensory  Ligament;  7,  Pelvis. 

To  account  for  these  multiple ///V«,  which  have  erroneously  been  taken 
for  so  many  complete  turns  of  the  uterus,  we  have  only  to  accept  the 
illustration  offered  us  by  Delafond,  who,  comparing  that  organ  to  a  long 
stocking,  puts  a  weight  in  the  foot  of  the  latter,  and  gives  it  a  turn  in  the 
middle,  keeping  the  open  or  upper  end  fixed.  Or  a  small  body,  to  repre- 
sent the  fcetus,  may  be  enclosed  in  the  middle  of  a  handkerchief — the 
uterus — so  as  to  make  a  sac.  If  the  end  containing  the  body  be  turned 
or  twisted  on  itself,  the  neck  of  the  sac  will  have  a  first  ply,  representing 
one-fourth  of  a  complete  twist ;  a  second  ply  will  represent  the  half  of  a 
complete  twist  or  turn,  and  will  cross  the  other  ;  so  that  when  a  complete 
turn  has  been  made,  it  will  be  found  that  there  are  at  least  four  plies  or 
strands. 

Notwithstanding  this  illusion,  however,  jt  is  certain  that  double  and 
even  multiple  tol-sion  of  the  uterus  may  ex'ist ;  but  then  the  body  of  the 
organ  and  the  vagina  are  close  twisted  like  a  cord.  This  multiple  tor- 
sion is  discovered  on  making  the  autopsy  of  an  animal  which  has  died  or 
been  killed   because  of  non-delivery.     In  such  a  case,  it  requires   two 


296 


MATERNAL  DVSTOKIA. 


or  more  turns  of  the  uterus  to  bring  it  to  its  normal  position.  Such  a 
complicated  condition  would  appear,  however,  to  be  very  rare. 

An  important  question  is  that  relating  to  the  possibility  of  such  an 
accident  occurring  to  an  organ  like  this,  which  is  attached  to  the  pelvis 
by  its  continuation — the  vagina — suspended  to  the  vertebrae  in  the  lum- 
bar region  by  broad  ligaments,  and  maintained  in  situ,  in  addition,  by  the 
neighboring  viscera,  and  more  especially  by  the  rumen  in  the  Cow — the 
animal  in  which  uterine  torsion  is  observed  by  far  the  most  frequently. 

This  question  can  be  answered  by  a  reference  to  what  we  have  stated 
with  regard  to  the  anatomy  of  this  portion  of  the  generative  apparatus,  at 


Fig.  69. 

Multiple  Torsion  of  the  Uterus. 

. I,  Body  of  the  Uterus;  2,  2,  2,  Torsion,  involving  the  Body  of  the  Organ  ;   3,  Rectum;  4, 
Bladder  ;  5,  Vagkia  ;  6,  Symphysis  Pubis. 

pages  38,  40,  and  44.  We  have  seen  that,  in  the  Cow,  the  concave 
curvatures  of  the  uterine  cornua  look  downwards,  and  that  it  is  to  these 
concavities  the  broad  ligaments  are  attached  ;  so  that  if  the  uterus  be 
considered  as  freely  suspended  in  the  abdomen,  the  extremity  of  each 
corml  is  turned  outwards  and  upwards,  while  its  base,  near  the  body  of 
the  organ,  although  drawn  in  the  same  direction  by  the  ligaments,  yet 
retains  its  position,  being  firmly  maintained  in  it  by  the  body  of  the  uterus, 
which  also  receives  the  insertion  of  the  broad  ligaments  on  its  lower 
face.  This  insertion  causes  the  uterus  to  project  above  the  ligaments, 
which  are  very  broad,  particularly  at  their  anterior  border,  and  widely 
separated  from  one  another  in  front,  near  their  lumbar  attachment.  The 
ligaments  suspend  the  uterus  loosely  in  the  abdomen,  and  allow  it  to 
become  fully  developed   during   pregnancy.     At   this   period,  too,  they 


DYSTOKIA  BY  DISPLACEMENT.       •  297 

become  greatly  increased  in  substance  and  length.  As  gestation  ad- 
vances, nearly  the  whole  of  the  great  size  of  the  uterus  is  due  to  the 
development  of  the  one  horn  in  which  the  foetus  is  situated  ;  and  as  the 
other  horn  retains  its  normal  size,  the  twisting  of  this  around  its 
ligament,  and  consequent  torsion  of  the  cervix,  can  be  readily  understood. 

Such  in  the  explanation  of  the  accident  given  by  Chauveau ;  but  Gou- 
baux  does  not  quite  assent  to  it.  According  to  him,  it  is  not  because 
one  horn  of  the  uterus  is  developed  more  than  another,  neither  is  it  owing 
to  one  of  the  broad  ligaments  being  longer  than  its  fellow  ;  it  is  in  con- 
sequence^of  the  development  of  the  cornua  during  gestation,  and  their 
projecting  greatly  beyond  their  means  of  attachment  or  suspension,' the 
broad  ligaments  being  thrown  altogether  back.  During  pregnancy  the 
cornua  are  considerably  lengthened,  while  the  ligaments  do  not  increase 
in  breadth,  their  points  of  attachment  to  the  inner  face  of  the  flank  or  the 
ilium  remaining  invariably  the  same.  This  projection  of  the  gravid  cornu 
beyond  the  broad  ligament  supporting  it — and  which  may  be  as  much  as 
nearly  two  feet — must  render  the  production  of  the  torsion  remarkably 
easy.  We  have  shown  that  the  uterus  is  suspended  in  its  ligaments  as  in 
a  hammock,  and  if  these  ligaments  increased  in  width  as  the  gravid  organ 
is  developed  in  size,  so  as  not  to  be  overlapped  by  the  cornua,  then  it 
might  to  a  certain  extent  roll  about  in  the  hammock,  but  could  not  twist 
around  it.  Even  if  the  uterus  was  suspended  at  the  extremity  of  the 
ligaments,  as  in  the  Mare,  it  would  be  far  less  liable  to  torsion,  and  would 
swing  in  the  abdomen  like  a  kind  of  pendulum. 

As  it  is,  the  projection  of  the  gravid  uterus  beyond  its  means  of  suspen- 
sion, the  peculiar  attachment  of  the  broad  ligaments  to  the  lower  face  and 
concave  border  of  the  cornua,  and  a  large  proportion  of  the  weight  being 
situated  high  above  and  in  front  of  these  ligaments — all  this  makes  us 
comprehend  how  a  shock  of  any  kind  may  throw  the  organ  off  its  ham- 
mock, and  produce  incomplete,  or  even  complete,  torsion  in  the  pregnant 
Cow  without  rupturing  the  hammock  itself.       , 

Rueff  and  Ercolani  have  witnessed  cases  in  which  the  torsion  was  con- 
fined to  the  gravid  cornu ;  and  Stockfleth  mentions  its  occurrence  in  the 
body  of  the  uterus,  in  front  of  the  cervix.  Most  frequently,  however,  it 
involves  the  vagina,  as  well  as  the  cervix  and  body  of  the  organ. 

In  certain  cases,  alluded  to  by  Zundel,  the  accident  has  been  accom- 
panied by  rupture  of  the  ligaments  ;  and  instances  are  recorded  by  Dense 
and  Albrecht  in  which  the  rupture  has  extended  to  the  uterus  itself. 
Rueff  alludes  to  a  case  in  which  the  foetus  had  even  escaped  into  the 
abdominal  cavity  from  a  uterus  thus  ruptured,  and,  developing  in  the 
peritoneal  sac,  constituted  an  extra-uterine  pregnancy. 

With  regard  to  the  direction  of  the  torsion,  several  authorities  have 
maintained  that  it  takes  place  from  left  to  right.  Others,  however,  have 
found  it  to  be  in  the  contrary  direction,  and  there  appears  to  be  no  reason 
why  it  should  occur  in  one  way  more  than  another,  as  the  foetus  is  devel- 
oped in  either  cornu  irrespectiveh'.  Reynal,  however,  believes  that  the 
obliquity  of  the  inner  face  of  the  rumen  might  dispose  the  uterus  to 
torsion  towards  the  right.  Chauveau  is,  we  think,  justified  in  asserting 
that  torsion  always  takes  place  inwards  and  upwards — the  foetus  slipping 
off  its  hammock  causes  this  to  swing  round  either  to  the  right  or  left. 

The  relative  unfrequency  of  this  occurrence  in  the  other  domesticated 
animals,  is  undoubtedly  owing  to  the  different  arrangement  of  the  uterus 
and  its  suspensory  ligaments. 


298  MATERNAL  DYSTOKIA 

With  regard  to  \h.Q:  frequency  of  the  accident,  this  depends  upon  several 
circumstances,  the  chief  of  which,  perhaps,  are  related  to  the  nature  of  the 
country  in  which  the  animals  are  reared,  as  well  as  to  the  manner  of 
rearing  them.  This  will  explain,  partly  or  wholly,  why  veterinarians  in 
one  locality  are  familiar  with  the  accident,  while  others  with  as  extensive 
experience  never  witness  it. 

Leconte  states  that  he  has  observed  it  about  a  dozen  times,  in  between 
three  and  four  hundred  cases  of  difficult  parturition.  Lemaire  has  met  with 
it  seven  times  in  four  years  ;  and  Rocco  speaks  of  having  witnessed  about 
thirty  cases  of  uterine  torsion  during  forty  years'  practice. 

Etiology. 

Torsion  of  the  uterus  ordinarily  occurs  towards  the  termination  of  preg- 
nancy— about  the  eighth  or  ninth  month,  and  its  causes  appear  to  be  very 
diverse,  if  we  are  to  accept  the  numerous  opinions  which  have  been  offered 
on  this  point. 

The  cause  which,  of  all  others,  appears  to  operate  most  frequently  in 
producing  this  condition,  is  a  slip  ox  fall,  and  particularly  on  the  hind 
quarters — croup  or  hocks. 

For  this  reason,  uterine  torsion  is  oftenest  witnessed  among  Cows  at 
liberty  in  pastoral  countries,  where  the  ground  is  broken,  intersected,  or 
hilly.  Therefore  it  is,  also,  that  the  accident  is  not  at  all  uncommon  in 
Switzerland  and  the  hilly  parts  of  South  Germany;  while  it  is  almost  un- 
known on  the  plains,  and  is  ve^y  rare  indeed  among  Cows  kept  in  sheds. 

Sometimes  the  Cow  has  slipped  upon  its  hind-quarters  and  tumbled  over, 
through  coming  in  contact  with  another.  Marlot  and  Liautard  have  seen 
it  arise'from  a  horn  thrust  in  the  flank  by  a  companion  Cow,  the  blow 
throwing  the  foetus  and  the  uterus  round  to  the  opposite  side.  It  has 
occurred  in  a  Cow  which  was  often  butting  with  others,  Chambon  has 
noted  it  in  a  Cow  which  was  in  the  habit  of  rolling  like  a  horse  ;  Dagou- 
reau  reports  it  occurring  in  a  pregnant  Cow  which  leapt  on  others  like  a 
bull,  and  Liautard  in  another  that  used  to  get  its  fore  feet  in  the  manger. 
Rocco  states  that  it  is  produced  in  shoeing  at  the  forge,  when  pregnant 
Cows  are  either  thrown  down  or  put  in  the  travis  to  be  shod  ;  and  Rueff 
mentions  a  case  in  which  it  happened  through  casting  a  Cow  for  the  pur- 
pose of  performing  an  operation  on  it.  In  other  instances  it  has  been 
ascribed  to  falling  when  jumping  a  ditch,  or  slipping  up  when  descending 
a  steep  hill. 

Reynal,  Mignon,  Chambon,  Weber,  and  others,  appear  to  consider 
meteorism  as  one  of  the  most  certain  and  most  frequent  causes  of  uterine 
torsion,  through  the  displacement  of  the  viscera  which  the  distension 
occasions.  Either  the  expansion  of  the  rumen  induces  unusual  and 
inordinate  movements  on  the  part  of  the  foetus  ;  or  it  acts  directly  on  the 
uterus,  and  produces  displacement  of  the  organ  through  the  changes  in 
situation  and  relations  imposed  on  the  other .  abdominal  organs.  Mr. 
Cartwright,  of  Whitchurch,  is  of  opinion  that  great  distension  of  the 
stomach  may,  either  of  itself,  or  especially  in  connection  with  a  fall,  cause 
the  uterus  to  be  forced  on  one  side,  or  twisted. 

Other  authorities,  among  whom  we  find  Ercolani,  attribute  the  accident 
to  severe  toil  when  Cows  are  worked — as  in  draught ;  others,  to  deformity 
or  malposition  of  the  foetus  ;  and  others,  again,  think  it  may  be  mainly, 
if  not  exclusively,  due  to  the  spontaneous  and  energetic  movements  of 


DYSTOKIA  BY  DISPLACEMENT.  299 

the  foetus  in  utero,  towards  the  termination  of  pregnancy.  It  is  well 
known  that  these  movements  are  sometimes  very  lively  and  powerful, 
and  especially  when  induced  by  sudden  jerks  or  blows  inflicted  on  the 
pregnant  animal,  or  when  the  abdomen  is  compressed,  after  the  ingestion 
of  cold  water,  etc.  There  can  be  no  doubt  that  the  movements  which 
the  foetus  executes  in  order  to  get  rid  of  uncomfortable  sensations  or  avoid 
unpleasant  positions,  gives  rise  to  those  various  attitudes  and  mal-presen- 
tations  which  so  frequently  render  birth  difficult,  if  not  impossible  ;  and 
their  occurrence  may  also  explain  how  the  young  creature  may  be  the 
means  of  causing  the  cornu  in  which  it  is  contained,  to  roll  and  twist 
around  the  vacant  cornu  on  the  opposite  side.  In  this  way  Colin 
endeavors  to  account  for  those  cases  in  which  the  uterus  has  made 
several  revolutions  on  itself  when  the  movements  persist — a  very  rare 
accident,  it  is  true ;  while  he  admits  that  the  quarter  or  half  revolutions 
— which  are,  after  all,  most  frequent — may  occur  without  the  active 
intervention  of  the  foetus,  or  even  of  the  uterus,  and  may  take  place 
through  falls  or  slips. 

Torsion  from  the  above  cause,  Colin  thinks,  is  all  the  more  feasible,  as 
at  the  end  of  gestation  the  amniotic  and  allantoic  fluids  are  diminished 
in  quantity,  and  the  membranes  and  uterus  are  therefore  applied  closer 
to  the  foetus,  and  may  follow  its  movements  more  readily. 

Chambon  and  other  veterinarians  are  of  opinion  that  the  irregular  and 
often  violent  movements  which  the  pregnant  animals — and  especially 
primiparae — manifest  when  the  labor  pains  commence  :  lying  down  and 
getting  up  again,  throwing  themselves  first  down  on  one  side,  then  on 
another,  and  sometimes  even  rolling,  are  the  most  frequent  cause  of 
torsion  which,  according  to  them,  only  takes  place  at  parturition.  The 
latter  opinion  is  supported  by  a  case  described  by  Landel,  in  which, 
when  he  made  a  first  exploration  of  the  genital  passages  at  the  com- 
mencement of  birtii,  there  was  no  obstruction ;  but  soon  after,  on  again 
exploring,  he  found  that  torsion  of  the  cervix  uteri  had  occurred  in  the 
interval. 

Lessona  and  a  few  others  believe  that  the  accident  may  be  due  to   the 
thabit  that  certain  Cows  have  of  rolling  themselves  alternately  from  right 
|to  left  when   they  are   lying.     On  the  sternum   they  may  do   this;  but 
though  among  solipeds  and  other  animals  rolling  on  the   back  is    a  per- 
fectly natural  movement,  yet  it  is  rarely  if  ever  witnessed  in   the  bovine 
species.     Sternal  or  abdominal  rolling  could   scarcely  produce  displace- 
lent  of  the  uterus. 

Rupture  of  one  or  both  of  the  broad  ligaments  has  been  indicated  by 
^econte  as  always  present  in  torsion  ;  but  this  is  an  error,  as  such  a 
lesion  is  found  to  be  exceedingly  rare  after  death.  But  rupture  of  either 
)r  both  of  these  important  suspensory  bands  may  take  place  when 
)regnancy  has  well  advanced,  and  there  is  a  severe  strain  upon  them, 
'hen  it  can  be  readily  understood  how  the  uterus,  rolling  about  among 
the  digestive  viscera  and  mainly  retained  by  the  cervix  and  vagina,  may 
twist  and  twine  on  itself,  and  thus  effectually  occlude  the  os. 

Torsion  of  the  uterus  has  been  witnessed  by  Pouchy,  subsequent  to  a 
)irth,  in  which  there  was  eversion  of  the  vagina  and  this  organ. 
In  all  likelihood,  the   stretching  of  the   broad  ligaments,  through  re- 
sated  pregnancies,  predisposes  to  it ;  though  this   cannot  be  the  sole 
:ause,  as  torsion  is  often  met  with  in  primiparae. 
Displacement  of  the  uterus  by  the  pressure  of   a  diseased  kidney,  has 


300  MATERNAL  DYSTOKIA. 

been  recorded  by  Rueff.     The  kidney  was  of  great  size,  and  weighed 
more  than  thirty-three  pounds. 

Symptoms. 

We  have  stated  that  this  accident  always  takes  place  towards  the 
termination  of  pregnancy — from  the  eighth  to  the  ninth  month.  But 
Wegerer,  Benzie,  and  other  veterinarians,  assert  that  they  have  witnessed 
it  so  early  as  the  fifth  month.  Without  disputing  the  correctness  of 
their  observations,  it  must  be  admitted  that,  during  the  early  periods  of 
gestation,  the  means  by  which  the  uterus  is  retained  in  its  situation  are 
sufficiently  powerful  to  prevent  any  displacement  of  this  kind  ;  and  that  it 
can  only  be  at  a  late  period,  when  the  foetus  is  fully  developed,  and,  with 
its  membranes,  has  attained  its  maximum  size  and  weight — so  far  as 
uterine  life  is  concerned,  that  such  an  occurrence  is  likely.  And  the 
existence  of  torsion  is  generally  only  discovered  when  the  time  for  the 
expulsion  of  the  foetus  has  arrived  ;  though  it  has  been  said  that  partu- 
rition takes  place  earlier  when  torsion  is  present. 

As  a  rule,  there  is  no  particular  indication  of  inconvenience  or  suffering 
at  the  moment  when  torsion  of  the  uterus  has  taken  place,  if  it  has 
occurred  before  parturition  ;  and  it  would  appear  that  gestation  may  go 
on  to  its  termination  without  any  appreciable  symptoms  being  noted,  or 
any  thing  like  functional  disturbance  observed. 

Even  in  the  initial  stage  of  parturition,  when  enlargement  of  the  udder, 
sinking  of  the  croup,  swelling  and  dilatation  of  the  vulva,  etc.,  have 
become  manifest,  there  is  no  sign  which  can  be  relied  upon  to  prove  the 
existence  of  torsion.  Only  in  some  instances  it  has  been  remarked  that 
the  tumefaction  of  the  vulva  is  not  so  great  as  in  ordinary  cases,  and  that 
it  remains  dry,  and  appears  to  be  buried  more  deeply  between  the  ischial 
tuberosities. 

Occasionally  some  difficulty  in  micturition  is  observed  before  parturi- 
tion, should  torsion  have  occurred  :  the  urine  escaping  only  in  small 
quantity  at  a  time  \  or  there  may  be  total  suppression.  This  interference 
with  the  discharge  of  the  urine  is  due  to  the  compression  the  bladder 
experiences  from  one  of  the  twists  in  the  uterus. 

The  first  labor  pains,  which  soon  appear,  are  usually  feeble  and 
separated  by  a  comparatively  long  interval  of  quiet,  during  which  the 
animal  appears  to  be  nothing  amiss.  Nevertheless,  as  time  goes  on, 
symptoms  of  colic  are  evinced  now  and  again,  and  though  the  labor 
pains  succeed  each  other  more  rapidly,  and  become  more  energetic,  yet 
birth  does  not  seem  to  advance;  the  "water-bag"  does  not  show  itself, 
and  nothing  appears  externally.  This  condition  may  persist  for  six, 
twelve,  twent3'-four,  or  even  forty-eight  hours ;  when,  if  not  before,  the 
veterinarian  is  perhaps  requested  to  attend. 

In  other  instances,  however,  the  symptoms  are  more  marked  and 
severe  during  this  first  period.  The  animal  appears  to  suffer  from  the 
pain  of  intense  uterine  and  abdominal  spasms,  marked  by  violent 
straining,  which  comes  on  at  longer  or  shorter. intervals  ;  it  moves  about 
anxiously ;  paws  energetically  now  and  again  ;  attempts  to  lie  down ; 
rests  on  its  chest  or  sits  like  a  dog  on  its  hind-quarters  ;  springs  up 
suddenly,  and  often  with  a  bound.  The  pulse  is  quickened,  the  skin 
becomes  alternately  hot  and  cold,  moist  and  dry;  and  the  expulsive 
efforts,  though  so  violent,  are  of  course  futile. 


D  YSTOKIA  B  Y  D  ISP  LA  CEMENT. 


301 


In  many  instances,  after  a  period  varying  from  twelve  to  lorty-eight 
hours,  these  symptoms  may  disappear,  and  the  animal  seems  to  have 
recovered,  for  the  time  at  least,  its  ordinary  health.  To  such  an  extent 
does  this  occur,  that  it  might  be  believed  the  period  of  birth  had  not  ar- 
rived, and  that  the  symptoms  were  only  those  of  "false  pains." 

In  the  course  of  from  one  to  six  days,  however,  this  normal  quietude  is 
interrupted  by  the  recurrence  of  the  labor  pains,  and  in  so  urgent  a  form 
that  there  can  no  longer  be  any  doubt  as  to  real  attempts  at  delivery. 
But  still  the  efforts  are  not  succeeded  by  any  tangible  evidence  that  birth 
is  making  progress.  As  some  obstacle  to  the  expulsion  of  the  foetus  now 
evidently  intervenes,  a  manual  examination  will  probably  be  made  by  the 
veterinarian,  if  he  has  chanced  to  be  called  in,  and  after  he  has  heard  the 
history  of  the  case  and  noted  the  general  symptoms. 

The  oiled  hand,  on  being  introduced  into  the  vagina,  meets  at  first  with 
no  obstacle  in  that  canal  ;  but  on  advancing  into  it,  the  fingers  soon  en- 
counter one  or  more  folds  or  rugae,  which  render  the  passage  more  and 
more  constricted  towards  the  cervix  uteri.  Towards  the  termination  of 
the  vagina,  the  fingers  reach  a  kind  of  cul-de-sac,  formed  by  the  mucous 
folds,  and  which  at  this  part  converge  in  a  spiral  manner,  their  direction 
being  either  to  the  right  or  left.  Although  at  first  there  appears  to  be 
no  passage,  yet  it  will  be  found  that  by  turning  the  hand  in  the  same 
spiral  direction  as  the  cavity  winds,  or  rather  the  rugae  incline,  the  fingers 
will  be  able  to  penetrate  to  a  certain  depth  ;  and  if  one  of  the  most  prom- 
inent ridges  be  followed  in  this  way,  it  will  be  discovered  that  it  has  a 
cork-screw-like  course. 

This  is  the  pathognomonic  or  distinctive  symptom  of  torsion  of  the 
uterus,  and  it  is  not  found  in  simple  deviation  or  obliquity  of  the  organ. 
In  the  latter  condition  there  is  no  spiral  twisting  or  rugae,  but  merely  a 
fold  of  mucous  membrane  passing  from  behind  forward,  in  an  oblique 
manner ;  while  the  hand  can  be  passed  with  little  difficulty  to  the  cervix, 
the  OS  of  which  is  usually  found  dilated.  It  is  only  this  fold  of  membrane, 
in  uterine  deviation,  which  prevents  the  passage  of  the  foetus  through  the 
OS,  by  hindering  uniform  pressure  on  the  cervix. 

The  kind  of  spiral  infundibulum  into  which  the  hand   penetrates   in 

torsion  of  the   uterus,  varies  in  dimensions  according  to  the  amount  of 

torsion.     In  the  quarter-turn  or  revolution,  it  may  be  possible  to  get  the 

hand  into  the  constriction,  though  with  difiiculty,  and  to  reach  so  far  as 

^to  touch  the  neck  of  the  uterus,  which  may  be  more   or  less  dilated,  and 

How  the  position  of  the  foetus  to  be  ascertained.     In  accomplishing  this 

lanoeuvre,  the  fingers  can  feel  a  large   salient  spiral  ring  which  becomes 

rider  as  the  hand  enters  deeper  into  the  organ,  and  which  terminates  in 

le  cavity  of  the  latter  in  a  wide   membranous,  fan-like   manner.     If  the 

torsion  is  to  the  left,  this  ring  inclines  to  the  right,  and  the  membranous 

Jxpansion  in  the   uterus  is   directed  obliquely  from  right  to   left  towards 

Hhe  fundus  of  the  organ.     The   spiral  twist  is   in  the  direction  of  the  tor- 

iion,  and  the  uterus  is  carried  towards  the  left  flank.     In  torsion  to   the 

ight,  the  arrangement  is  the  reverse  of  this. 

In  the  half-turn  or  revolution,  occlusion  is  so  marked  that  the   fingers 

in  scarcely  be.  made  to  enter  the  obstacle,  and  the  cervix  cannot  be 
Reached  unless  the  torsion  is  beyond  it.  There  are  always  two  prominent 
rings — two  mucous  folds  which  cross  each  other,  but  which,  as  they  recede 
Erom  the  torsion,  become  wider  apart  and  spread  like  a  fan.  We  shall 
investigate  the  character  of  this  twist  hereafter. 


302 


MATERNAL  DYSTOKIA. 


In  the  complete  turn,  the  occlusion  is  such  that  only  one  finger  can 
penetrate  to  a  very  slight  depth  in  the  spiral  stricture,  and  the  direction 
of  the  rugse  is  very  baffling,  as  they  seem  to  intersect  each  other,  and  to 
run  in  opposite  directions. 

In  some  instances,  when  the  mucous  membrane  of  the  vagina  is  in- 
volved, the  spiral  ridge  may  be  distinguished  in  the  roof  of  that  canal, 
and  even  near  to  its  commencement. 

When  the  hand  can  be  introduced  into  the  uterus,  it  is  generally  found 
that  the  foetal  membranes,  as  well  as  the  foetus,  are  intact,  and  particularly 
in  the  half  and  complete  degrees  of  torsion.  In  the  quarter  revolution, 
the  membranes  are  sometimes  ruptured  and  the  waters  discharged  for  a 
considerable  period. 

The  foetus  is  usually  alive  soon  after  the  first  labor  pains ;  but  it 
quickly  perishes,  and  its  death  is  almost  certain  to  have  taken  place  within 
forty-eight  hours  after  parturition  has  commenced.  The  period  of  its 
decease,  however,  will  greatly  depend  on  the  intensity  of  the  "  pains." 

The  position  of  the  foetus  varies,  according  to  circumstances.  Some- 
times when  the  twist  is  slight  and  the  passage  sufficiently  large,  it  partly 
enters  the  pelvis,  where  it  may  not  only  be  felt,  but  seized  by  the  parts 
first  presenting.  At  other  times  it  is  entirely  lodged  in  the  abdomen  ; 
and  at  others,  again,  it  may  be  felt  towards  the  pubis,  in  a  kind  of  pouch 
or  sub-vaginal  tumor,  formed  by  a  duplicature  of  the  uterus  beneath  the 
inner  opening  of  the  os.  In  the  latter  case,  torsion  is  complicated  with 
obliquity  of  the  organ,  and  the  tumor  not  unfrequently  considerably  ele- 
vates the  bladder  and  meatus  urinarius. 

The  form  of  the  abdomen  is  sometimes  characteristic.  The  foetus  can 
generally.be  found  higher  in  it,  towards  the  flank,  on  the  right  or  left  side. 
This  change  in  the  position  of  the  foetus  may  also  be  recognized  by  ex- 
ploration/^r  rectum,  which  may  also  possibly  allow  the  torsion  of  the  uterus 
to  be  distinguished,  as  well  as  its  direction.  The  uterus  can  be  felt 
through  the  wall  of  the  rectum  as  a  tense  hard  mass,  while  the  broad 
ligaments  may  be  discovered  as  hard  funicular  bands.  It  may  be  noted, 
also,  that  occasionally  the  rectum  itself  is  displaced  and  drawn  towards 
the  entangled  uterus. 

If  the  animal  is  not  relieved,  the  symptoms  above  indicated  persist  with 
variable  intensity,  according  to  circumstances.  The  straining  and  at- 
tempts at  spontaneous  delivery  continue  either  feebly,  and  with  long 
intervals  between,  or  they  are  violent  and  almost  incessant.  The  animal 
soon  ceases  to  eat  and  ruminate  ;  it  becomes  dull  and  dispirited  ;  fever 
sets  in,  and  the  pulse  and  respiration  are  hurried ;  rigors  and  grinding  of 
the  teeth  are  remarked  from  time  to  time  ;  the  lacteal  secretion  which  had 
commenced  is  now  suspended  ;  the  mammae  become  soft  and  small  ;  the 
eyes  sink  in  their  orbit ;  and  extreme  prostration  ensues.  The  creature, 
unable  to  get  up,  constantly  lies  ;  the  pulse  becomes  imperceptible,  while 
the  heart's  beats  are  loud  and  tumultuous  ;  and  death  generally  occurs 
from  the  third  to  the  tenth  day  after  the  earliest  symptoms  were  ex- 
hibited. 

Many  authorities  are  of  opinion  that  death  is  the  only  result  that  can 
be  looked  for  when  assistance  is  not  rendered,  and  the  animal  is  accord- 
ingly left  to  its  fate  ;  and,  contrary  to  what  Rainard  has  stated,  they  do 
not  admit  that  the  foetus  may  become  mummified  in  the  uterus  and  the 
Cow  live  and  thrive.  But  we  have  the  evidence  of  the  old  French  au- 
thority, BoutroUe,  as  well  as  that  of  Ercolani,  Lessona,   Rocco,  Gurlt, 


DYSTOKIA  BY  DISPLACEMENT.  303 

Liautard,  Pouchy  (already  quoted),  and  others,  that  this  happy  termina- 
tion is  quite  possible  ;  and  indisputable  cases  are  recorded  of  Cows  with 
unreduced  uterine  torsions,  which  have  perfectly  recovered  and  fattened, 
and  in  the  uterus  of  which,  after  slaughter,  the  dessicated  or  mummified 
foetus  has  been  found. 

But  yet  these  must  be  looked  upon  as  exceptional  cases  ;  and  while 
they  only  prove  that  spontaneous  recovery  is  possible,  it  must  be  admitted 
that,  in  the  great  majority  of  instances,  death  is  not  long  in  appearing  in 
torsion  of  the  uterus,  if  the  organ  is  not  restored  to  its  normal  position. 

Diagnosis. 

The  diagnosis  of  this  accident,  and  the  direction  and  extent  of  the 
torsion,  are  of  great  importance  in  an  obstetrical  point  of  view.  We 
will  therefore  consider  (i)  The  presence  of  torsion  ;  (2)  The  direction  of  the 
torsion;  and  (3)  The  degree  of  torsion. 

»  I.  The  Presence  of  Torsion. — To  recognize  the  existence  of  torsion  of 
the  uterus  is  not  attended  with  much  difficulty  ;  and  in  describing  the 
symptoms  we  have,  to  a  certain  extent,  shown  the  manner  in  which  the 
accident  manifests  itself  to  the  obstetrist. 

It  has  been  stated,  that  when  the  hand  is  introduced  into  the  vagina 
of  an  animal  the  subject  of  this  displacement,  it  is  soon  discovered  that 
there  is  something  in  the  way,  and  that  this  appears  to  be  a  narrowing  of 
the  passage.  Passing  on,  the  constriction  seems  to  be  increasing,  until 
at  the  end  of  the  canal  there  is  only  a  very  small  opening  into  which  the 
fingers  may  pass  w^ith  difficulty  ;  when  inserted  there,  it  is  found  that 
they  cannot  be  pushed  straight  forward,  but  have  a  tendency  to  deviate  to 
the  right  or  left,  and  finally  to  assume  a  spiral  course. 

We  have  also  stated  that  this  peculiarity  in  the  constriction  is  markedly 
characteristic  and  distinctive  of  uterine  torsion,  and  this  statement  holds 
good  in  the  large  majority  of  cases  ;  so  that  it  is  scarcely  possible  to 
make  a  mistake. 

In  very  exceptional  instances,  however,  the  torsion  may  have  occurred 
in  front  of  the  cervix — in  the  body  of  the  uterus  ;  and  then  the  cervix 
may  be  easily  reached,  while  the  os  may  even  be  penetrated,  without  dis- 
covering any  indications  of  the  accident.  Such  occurrences  have  been 
recorded  by  Stockfieth,  Ercolani,  and  Rueff ;  and  these  excellent  authori- 
ties have  also  witnessed  the  torsion  limited  to  the  cornu  containing  the 
foetus.  Here  we  have  neither  the  constriction  of  the  vagina,  nor  the 
spiral  involutions  of  its  lining  membrane,  to  guide  us  to  a  conclusion,  and 
we  must  mainly  rely  on  rectal  exploration. 

Fortunately,  such  cases  are  all  but  unknown  in  practice,  and  probably 
in  ninet3'-nine  per  cent,  it  will  be  found  that  the  twisting  has  taken  place 
at  the  cervix,  when  we  have  the  infallible  distinctive  sign — the  spiral 
rugae  in  the  vagina. 

2.  The  Direction  of  the  Torsion. — It  has  been  demonstrated  that  the 
uterus  may  revolve  on  itself  in  two  different  directions,  and  that  in  order 
to  make  a  complete  revolution,  its  upper  face  may  become  right  lateral,  then 
inferior^  then  left  lateral,  and  again  superior  ;  or  if  it  revolves  in  the  oppo- 
site direction,  it  will  become  successively  left  lateral,  inferior,  right  Literal^ 
and  once  more  superior. 

We  have  casually  indicated  how  the  direction  of  the  twist  may  be  dis- 
covered when  it  has  not  made  a  complete  revolution.     But  as  Sainl-Cyr 


304 


MATERNAL  DYSTOKIA. 


remarks,  the  manner  of  discovering  to  which  side  the  gravid  uterus  has 
inclined,  has  been  one  of  the  most  debatable  in  the  history  of  this  accident, 
and  has  occasioned  much  controversy  and  the  most  contradictory  interpre- 
tations ;  up  to  the  present  time,  in  fact,  the  problem  has  not  met  with  a 
satisfactory  solution.  The  confusion  prevailing  with  regard  to  what 
appears  such  a  simple  matter,  is  well  exemplified  in  the  discussion  which 
took  place  in  i860,  at  a  meeting  of  the  Central  Veterinary  Medical 
Society  of  Paris,  at  which  the  most  opposite  notions  were  promulgated. 
And  yet  next  to  assuring  one's  self  that  torsion  does  exist,  the  ascertaining 
of  the  direction  it  follows  is  of  supreme  importance,  as  on  this  alone 
depends  our  being  able  to  rectify  the  malposition  of  the  organ  without 
delay.  The  disputation  appears  to  have  arisen  solely  from  a  confusion 
of  terms — from  ne^ecting  to  define  what  was  meant  by  torsion  from  left 
to  right,  or  right  to  left ;  and  Saint-Cyr  praiseworthily  endeavors,  and 
with  success,  to  settle  the  question  by  repairing  the  omission. 

"When,"  he  says,  "in  its  revolution  the  left  cornu  of  the  uterus  passes 
above  the  right  cornu,  the  upper  face  of  the  organ  becomes  successively 
right  lateral,  then  inferior,  then  left  lateral  and  again  superior — thus  con- 
stituting a  complete  revolution  ;  the  torsion  is  then  from  left  to  right,  or 
simply  right  torsion." 

A  B 


Fig.  70. 
A,  Cord  Twisted  to  the  Right ;  B,  Cord  Twisted  to  the  Left. 

The  reverse  movement  constitutes  torsion  from  right  to  left,  or,  better, 
left  torsion. 

In  other  words,  the  passing  of  the  left  cornu  over  the  right  produces 
right  torsion  ;  that  of  the  right  over  the  left  cornu,  left  torsion. 

Hence  we  have  the  simple,  and  easily  remembered  and  understood 
terms,  of  right  torsion  and  left  torsion,  which  arc  synonymous  with  torsion 
from  left  to  right  and  torsion  from  right  to  left. 

This  being  decided  upon,  the  next  question  is  how  to  distinguish,  from 
a  purely  objective  point  of  view,  a  right  from  a  left  torsion  ;  and  this  also, 
it  appears,  has  been  a  source  of  difficulty  and  debate,  from  neglecting  to 
define  terms.  Saint-Cyr  again  has  come  to  the  rescue,  and  his  efforts 
to  put  the  matter  in  a  clear  light  must  be  looked  upon  as  eminently 
satisfactory. 


DYSTOKIA  BY  DISPLACEMENT 


305 


Glancing  at  Figure  70,  we  see  two  pieces  of  cord,  the  strands  of  which 
exactly,  but  more  clearly,  represent  the  spiral  plicae  of  the  twisted  vagina 
or  cervix  uteri.  It  will  be  observed  from  the  course  of  the  strands,  that 
the  pieces  are  twined  in  opposite  directions  :  cord  A  being  twined  to 
the  right,  and  cord  B  to  the  left.  This  disposition  of  the  strands  of  a 
rope  being  generally  recognized  as  exact  in  the  technical  language  of 
mechanics,  as  well  as  in  speaking  of  the  spiral  inclination  of  the  thread 
of  a  screw,  the  same-application  of  the  terms  should  hold  good  in  such  a 
mechanical  deviation  of  the  uterus  as  that  now  under  consideration. 

These  different  torsions  can  be  imitated  by  the  handkerchief,  as  has 
just  been  pointed  out ;  and  they  are  well  represented  in  Figures  68  (left 


Fig.  71. 

Left  Uterine  Torsion. 

.  Body  of  the  Uterus ;  2,  Cervix  Uteri 
Twisted  to  the  left ;  3,  Rectum  ;  4,  Blad- 
der ;  s,  Symphysis. 


Fig.  72. 

Right  Uterine  Torsion. 

,  Body  of  the  Uterus ;  2,  2,  2,  Torsion  of 
the  Cervix  Uteri  to  the  right,  involving  the 
Body  of  the  Organ  ;  3,  Rectum ;  4,  Blad- 
der ;  5,  Vagina  ;  6,  Symphysis. 


torsion),  71  (left  torsion,)  72  (right  multiple  torsion),  and  75  (left  tor- 
sion), which  illustrate  simple  and  multiple,  as  well  as  right  and  left  tor- 
sion. 

This  being  fully  understood,  we  have  now  to  demonstrate  how  the 
different  torsions  may  be  distinguished  in  the  living  animal,  by  vaginal 
exploration.  In  doing  so,  we  will  follow  the  remarkably  lucid  directions 
furnished  by  Saint-Cyr,  to  guide  obstetrists  in  forming  a  diagnosis. 

Supposing  the  right  hand  introduced  in  a  state  of  pronation  (palm  down- 
wards) into  the  vagina  of  a  Cow  supposed  to  be  suffering  from  uterine 
torsion,  it  is  evident  that,  in  order  to  follow  the  direction  of  the  spiral  folds 
met  with,  it  must  execute  a  kind  of  rotary  or  screw-like  movement  on  the 

20 


3o6 


MATERNAL  DYSTOKIA, 


wrist.  If  this  movement  is  such,  that  the  cubital  border  of  the  hand,  to 
the  right  at  first  (Fig.  73,  position  A),  becomes  inferior  (little  finger 
downwards — position  B),  then  internal,  so  as  to  arrive  at  a  state  of  supina- 
tion (palm  upwards — position  C),  then  the  torsion  is  to  the  right. 

On  the  contrary,  if  the  hand,  in  following  the  spiral  folds  in  the  vaginal 
canal,  rotates  in  the  opposite  direction,  of  course  the  torsion  is  to  the  left. 
For  instance,  as  in  the  other  case,- the  hand  is  introduced  in  a  state  of 


Right  Uterine  Torsion: 
Manipulation. 


Fig.  74. 

Left  Uterine  Torsion; 
Manipulation. 


pronation  (Fig.  74,  position  A),  but  instead  of  the  thumb  turning  upwards 
and  round  to  the  right,  it  inclines  downward  to  the  left  (position  B),  the 
little  finger  ascending  until  it  is  uppermost,  and  the  palm  of  the  hand 
is  turned  outwards  (position  C). 

This  is  a  very  simple  matter,  apparently  ;  and  yet  in  practice  it  may  be 
very  important.  It  may  be  sufficient,  then,  if  we  impress  upon  the  young 
obstetrist  the  fact,  that  when  the  palm  of  the  hand  turns  to  the  left,  or 
inwards,  the  torsion  is  to  the  right ;  and  when  it  inclines  outwards,  or  to 
the  right,  then  the  twist  is  to  the  left. 

3.  The  Degree  of  Torsion, — To  ascertain  the  degree  of  torsion  is  more 
difficult  than  to  discover  its  existence  or  direction  ;  though  every  endeavor 


\ 


DYSTOKIA  BY  DISPLACEMENT.  307 

should  be  made  to  satisfy  one's  self  in  this  respect,  as  the  "  detorsion  " 
will  be  easy  as  the  torsion  is  slight,  and  vice  versd. 

It  has  been  stated  that  it  may  exist  as  a  quarter,  half,  three-quarter,  or 
a  complete  revolution  ;  and  that  it  may  even  extend  to  a  double,  treble, 
or  quadruple  twist.  But  it  must  be  always  doubtful  whether  we  can 
diagnose  with  certainty  these  different  degrees  of  torsion  which  may  be 
met  with  in  obstetrical  practice. 

It  is  evident,  however,  that  the  greater  the  amount  of  torsion,  so  the 
more  will  the  vagina  be  constricted,  and  penetration  by  the  hand  ren- 
dered difficult.  We  have  already,  in  treating  of  the  symptoms,  drawn 
attention  to  the  condition  of  the  vagina  and  cervix  uteri  in  the  more  simple 
cases.  When,  for  instancy,  the  hand  can  be  pas§ed  without  very  much 
trouble  as  far  as  the  cervix,  and  the  os  can  be  penetrated  to  such  a  depth 
that  some  parts  of  the  foetus  are  felt,  then  it  may  be  presumed  that  the 
organ  has  only  made  about  one-fourth  of  a  revolution  on  itself.  But  if 
the  passage  is  more  constricted,  the  spiral  folds  closer  together,  and  the 
cervix  can  be  reached  with  much  difficulty,  perhaps  only  one  or  two 
fingers  entering  the  os,  we  may  expect  that  the  uterus  has  made  a  half 
or  three-quarter  revolution. 

In  a  complete  rotation  of  the  organ,  we  may  expect  to  find  the  vagina 
completely  occluded  not  far  from  the  vulva,  the  fingers  being  only  able  to 
pass  into  the  funnel-shaped  infundibuluni  but  a  very  short  distance,  and 
cannot  reach  the  cervix.  The  spiral  folds  will  also  be  close  and  numer- 
ous, and  for  this  reason  their  direction  will  be  all  the  more  difficult  to 
ascertain 

Frognosis. 

With  the  Cow,  torsion  of  the  uterus  must  be  looked  upon  as  a  serious 
accident ;  for  except  in  a  few  exceptional  cases,  when  assistance  is  not 
rendered,  the  foetus  and  mother  have  always  perished.  Nevertheless,  not- 
withstanding its  grave  character,  modern  veterinary  science  does  not 
consider  it  beyond  remedy ;  and  its  records  show  that,  by  judicious  inter- 
vention, mother  and  offspring  may  often  be  saved. 

But  in  order  to  attain  this  happy  result,  a  careful  disignosis  must  not 
only  be  made,  and  the  direction  and  extent  (if  possible)  of  the  torsioa 
clearly  ascertained,  but  the  proper  mode  of  restoring  the  uterus  to  its 
'lormal  position  must  also  be  observed  and  skilfully  carried  out> 

A  cautious  opinion  must  always  be  given,  but  its  favorableness  will  of 

course  depend  upon  the  brief   duration  of  the  pafturient  symptoms,  the 

legree  of  torsion,  the  condition  of  the  animal^  and  whether  it  has  been 

iubjected  to  unskilful  manipulation  before    the   veterinarian   has   beea 

tiled  in. 

Pathological  Anatomy^ 

When  the  animal  has  been  subjected  to  manipulatory  manoeuvres  to 
feet  delivery,  or  when  it  has  been  permitted  to  live  many  hours  after 
signs  of  parturition  have  appeared,  the  first  important  alteration  noted 
m  opening  the  abdomen  is  that  due  to  peritonitis.  There  is  a  quantity 
)f  blood-tinted  serum  effused  into  the  peritoneal  sac,  in  which  float  shreds 
)f  fibrin  ;  and  the  lining  membrane  is  reddened,  deeply  injected  with 
>lood  in  parts,  and  particularly  those  which  have  been  in  contact  with 
le  uterus  ;  not  unfrequently  there .  is  a  fibrinous  exudate  on  its  suface, 
md  this  may  cause  adhesion  between  it  and  the  different  orgams. 


3o8 


MATERNAL  DYSTOKIA. 


On  removing  the  intestines  and  the  floor  of  the  pelvis,  the  uterus  and 
vagina  are  exposed,  and  the  torsion  is  visible.  This  appears  as  a  large, 
hard  cord,  composed  apparently  of  a  number  of  spiral  strands  of  unequal 
size,  the  closest  twined  of  which  are  in  the  middle  of  the  strangulation  ; 
this  cord — formed  by  the  termination  of  the  vagina  and  the^  cervix  and 
body  of  the  uterus — opens  out  its  strands  as  it  recedes  from  the  densely- 
twined  portion  towards  the  fundus  of  the  uterus  on  one  side,  and  to  the 
vagina  on  the  other. 

The  broad  ligaments  are  sometimes  compressed  between  the  spiral 
folds,  which  they  concur  to  form,  and  with  which  they  are  so  intimately 
connected  that  very  often  they  cannot  be  recognized  until  the  uterus  has 


Body  of  the  Uterus  ; 


Fig-  75- 
Left  Uterine  Torsion  ht  situ. 
Twisted  cervix  uteri;  3,  Vagina  ;  4,  Left  Fallopian  Ligament. 


been  untwisted.  In  other  instances,  they  merely  envelop  the  twist  in 
crossing  it ;  so  that  the  extent  of  the  torsion  cannot  be  seen  until  the 
ligaments  are  detached  from  the  ilium  on  each  side. 

Rarely,  as  we  have  remarked,  are  these  ligaments  ruptured ;  and 
though  some  veterinary  authorities  have  maintained  that  torsion  is  impos- 
sible without  one  or  both  being  torn,  yet  we  know  that  this  lesion  is 
seldom  witnessed.  In  the  large  majority  of  cases,  they  are  tense  and 
greatly  stretched,  tightly  compressing  the  cervix  and  rendering  occlusion 
of  the  OS  all  the  more  rigid  ;  but  when  the  uterus  is  reinstated  in  its 
natural  relations,  they  are  found  to  be  intact. 

If  the  uterus  be  seized  at  its  fundus,  and  turned  in  a  direction  con- 
trary to  that  of  the  torsion,  the  strands  of  the  latter  gradually  open,  widen, 
and  are  effaced  ;  while  the  strangulation  disappears,  the  cervix  comes 


DYSTOKIA  BY  DISPLACEMENT.  309 

into  view,  and  the  vagina  assumes  its   normal  length  and  width,  as  well 
as  cylindrical  form. 

So  that  the  hand  introduced  into  the  vagina,  per  vulvam,  no  longer 
encounters  the  spiral  plicae  met  with  in  the  animal  while  alive  ;  but 
passes  through  the  canal,  and  even  into  the  uterus,  without  hindrance. 
The  number  of  turns  necessary  to  accomplish  this  will  indicate  the 
amount  of  torsion  which  had  taken  place.  Most  frequently  only  half  a 
turn  is  necessary,  showing  that  the  uterus  had  made  half  a  revolution  on 
its  axis — the  upper  surface  having  become  the  lower.  Sometimes  the 
quarter  of  a  turn  will  suffice  to  adjust  it  ;  while  in  other  instances  a  com- 
plete turn,  or  even  two,  three,  or  four  turns  in  the  opposite  direction  to 
the  torsion,  may  be  needed  before  the  obstruction  to  the  genital  passages 
disappears. 

At  times  the  uterus  and  vagina  exhibit  signs  of  inflimmation,  particularly 
towards  the  strangulation,  and  the  indications  of  acute  metro-peritonitis 
are  frequently  most  marked.  In  exceptional  instances  we  may  hav^e  gan- 
grene of  the  uterus,  probably  due  to  obstruction  of  the  blood-vessels  im- 
plicated in  the  torsion. 

As  a  complication,  a  more  or  less  extensive  rupture,  complete  or  incom- 
plete, of  the  uterus  may  exist :  possibly  having  been  produced  by  the 
severe  uterine  contractions  during  the  life  of  the  animal.  This  rupture 
implicating  the  walls  of  the  organ,  is  most  frequently  met  with  in  its  body, 
in  the  vicinity  of  the  twisted  portion,  or  at  the  junction  of  the  gravid  cornu 
with  the  uterus.  The  foetus  has  been  at  times  found  partly  fixed  in  the 
fissure. 

With  regard  to  the  foetus  itself,  its  condition  varies  with  the  length  of 
time  which  has  elapsed  since  it  perished,  and  also  whether  or  not  the 
external  air  has  had  access  to  it.  In  some  instances,  even  when  it  has 
been  dead  for  a  long  time,  it  will  be  found  in  a  state  of  perfect  preserva- 
tion ;  in  others  it  is  in  an  advanced  stage  of  putrefaction,  the  hair  and 
hoofs  coming  off  readily,  and  the  body  swollen  and  emphysematous, 
while  the  odor  emitted  is  disgustingly  powerful  and  foetid. 

In  rare  cases  the  foetus  is  mummified,  and  this  may  even  occur  when  it 
has  attained  its  full  development. 

Such  is  an  outline  of  the  pathological  anatomy  of  this  accident.  Nume- 
rous illustrations  of  the  various  lesions  met  with  after  death  might  be 
furnished,  but  we  will  content  ourselves  by  quoting  two  or  three  of  the 
very  few  cases  recorded  in  England,  in  addition  to  that  published  by 
Carlisle  and  already  referred  to. 

In  Carlisle's  case  the  following  lesions  were  noted  :  On  opening  the 
abdominal  cavity  to  its  full  extent  along  the  linea  alba,  the  pelvic  region 
was  found  to  be  "  completely  crammed  with  the  small  intestines  in  a  far 
advanced  state  of  putrefaction  ;  as  far  as  the  anterior  ridge  (brim)  of  the 
pelvis  at  this  place,  the  portion  of  intestine  was  completely  strangulated. 
Anterior  to  this  the  bowels  were  free  from  inflammation,  and  the  only 
abnormal  appearance  was  the  mesentery  which  attaches  the  small  intes- 
tines to  the  spine,  which  was  torn  from  the  spine  for  a  considerable 
length.  The  bladder  was  free  from  inflammation,  and  void  of  urine."  On 
examination  of  the  uterus,  there  was  discovered  an  extensive  rupture  of 
the  broad  ligaments,  near  to  the  cervix  uteri.  "  For  about  four  inches  there 
was  a  high  degree  of  inflammation,  clearly  pointing  out  thepl^ce  where  it 
had  been  twisted.  The  other  parts  of  the  uterus  were  healthy.  The 
vagina  appeared  inflamed  throughout  its  whole  length ; "  this  condition 


3IO 


MATERNAL  DYSTOKIA. 


v/as  supposed  to  be  due  to  the  frequent  and  long-continued  attempts  to  in- 
troduce the  hand  to  extract  the  calf. 

The  cause  of  all  these  lesions  was  "  the  Cow  tumbling  into  a  ditch,  and 
remaining  there  for  some  time  struggling  very  much."  "  The  calf  and 
uterus  were  turned  or  twisted  in  consequence  of  the  lateral  ligaments 
giving  way,  which  would  take  place  during  the  fall,  as  the  poor  animal 
completely  turned  over  before  she  fell  to  the  ground.  The  mesentery 
might  possibly  be  torn  at  the  same  time,  and  the  intestines  forced  into 
the  pelvic  cavity.  That  part  of  the  gut  which  rested  on  the  brim  of  the 
pelvis  was  strangulated,  from  the  weight  of  the  calf  resting  on  it ;  and  the 
other  portion,  which  was  forced  back,  was  continually  under  the  influence 
of  excessive  pressure,  from  the  poor  creature's  attempt  to  rid  herself  from 
pain." 

Mr.  Bennett  (  Veterinarian,  vol.  xlv.,  p.  925),  called  to  see  a  Cow  which  had  been  suffer- 
ing from  aphthous  fever,  but  which  on  recovery  began  to  exhibit  symptoms  of  abdom- 
inal pain,  found  on  examination  that  it  was  near  the  period  of  parturition :  the  pains, 
indicated  by  the  symptoms,  being  somewhat  allied  to  those  of  labor,  but  were  unac- 
companied by  any  dilatation  of  the  os  uteri.  The  pulse  was  quick  and  tremulous,  the 
breathing  rapid,  and  the  surface  of  the  body  bedewed  with  perspiration  ;  the  faeces  and 
urine  were  voided  during  the  painful  expulsory  efforts.  Supposing  the  foetus  to  be  dead, 
and  that  in  due  course  the  os  uteri  would  be  dilated,  diffusible  stimulants  were  adminis- 
tered with  the  view  of  sustaining  the  animal's  strength  and  assisting  in  the  expulsion  of 
the  calf.  Subsequently,  on  the  same  day,  the  pulse  was  rather  more  distinct  ;  though 
the  eyes  were  more  sunken  and  the  general  indications  of  suffering  more  marked.  On 
the  following  morning  it  was  much  worse,  being  almost  pulseless  and  evidently  dying, 
and  no  signs  of  delivery.     The  Cow  died  soon  after. 

On  making  -a  post-mortem  examination,  the  uterus  was  found  to  be  much  congested,  its 
vessels  being  turgid  with. blood,  and  its  walls  very  much  thickened.  But  what,  in  Mr. 
Bennett's  eyes,  was  a  very  singular  thing,  was  the  presence  of  a  "  complete  twist  in  the 
neck  of  the  uterus ;  so  that  the  uterus  must,  calf  and  all,  hav'e  turned  quite  over  in  the 
abdomen."  Whether  this  state  of  things  arose  from  the  Cow  rolling  or  from  any  other 
cause,  Mr.  Bennett  could  not  say ;  though,  from  the  appearance  of  the  uterus,  he  imag- 
ined the  accident  might  have  occurred  forty-eight  hours.  He  adds  that,  "  No  doubt  the 
strangulation  would  lead  very  quickly  to  the  complete  congestion  of  the  vessels  of  the 
womb  and  to  the  speedy  death  of  the  calf." 

At  a  meeting  of  the  Liverpool  Veterinary  Medical  Association,  held  in  1875,  M""* 
Woods  described  a  case  of  "  twisted  uterus  "  in  a  Cow,  the  organ  containing  a  fully  de- 
veloped foetus,  and  the  os  having  become  hermetically  sealed.  The  animal  had  been 
ill  for  some  time ;  but  it  gradually  recovered,  and  was  fed  for  the  butcher.  When  killed 
the  foetus  was  discovered  to  be  quite  perfect,  but  the  membranes  had  disappeared  through 
absorption. 

Captain  Russell,  M.R.C.V.S.  {Veterinary  Journal,  November,  1876),  relates  that  he 
was  called  to  see  a  heifer  described  as  "  straining  a  good  deal,"  and  had  been  doing  so 
for  sixteen  hours,  as  if  attempting  to  calve ;  but  that  "  nothing  was  visible,  nor  was  her 
time  up  for  another  month  or  six  weeks."  The  Cow  was  lying,  and  evidently  in  great 
pain;  it  was  straining  violently  ;  the  eyes  were  sunken;  the  pulse  was  very  frequent, 
feeble,  and  almost  fluttering ;  with  other  symptoms  denoting  great  exhaustion,  and  ap- 
parently speedy  dissolution.  On  making  an  examination /('r  vaginam  in  the  usual  man- 
ner, to  ascertain  if  it  was  merely  a  case  of  mal-presentation  of  the  foetus,  the  hand  could 
only  be  introduced  about  six  inches,  the  walls  of  the  canal  feeling  as  if  coiled  from  left 
to  right  ;  the  mucous  membrane  seemed  to  be  much  congested,  and  felt  "  corded,"  hot 
and  swollen.  Twisted  uterus  was  diagnosed,  and  reduction  was  attempted  by  turning 
the  animal  from  right  to  left,  but  without  any  benefit. 

The  symptoms  being  so  urgent,  and  as  the  Heifer  was  in  good  condition,  it  was  im- 
mediately destroyed.  On  opening  the  abdomen,  the  entire  body  of  the  uterus  was  dis- 
covered to  have  made  a  rotation  from  left  to  right,  the  upper  having  become  the  under 
surface.  The  torsion  itself  was  much  congested  and  strangulated,  and  the  pelvic  cavity 
between  the  walls  of  the  vagina  and  rectum,  and  between  the  former  and  the  floor  of  the 
pelvis,  was  full  of  effused  serum  of  a  jelly-like  consistence — evidently  the  result  of  long- 
continued  strmining.  The  foetus  was  well  developed,  and  had  apparently  been  dead  for 
some  hours,  decomposition  having  set  in. 

How  or  when  the  uterus  became  displaced  in  this  instance,  could  not  be  discovered, 


DYSTOKIA  BY  DISPLACEMENT.  31, 

as  the  animal  had  been  tiimed  out  to  pasture  with  several  others,  and  nothing  had  been 
observed  amiss  with  it  until  the  previous  day  Then  it  was  observed  to  lie  down  and 
get  up  frequently,  and  to  stand  with  the  back  raised  and  the  tail  elevated ;  straining 
Very  much  in  that  attitude. 

Treatment. 

The  successful  treatment  of  torsion  of  the  uterus  had,  to  the  great 
majority — indeed,  to  all — of  the  veterinary  obstetrists  of  not  long  ago, 
evidently  appeared  hopeless  ;  consequently,  the  animal  suffering  from 
this  accident  was  either  left  to  die  without  succor,  or  was  consigned  to 
the  butcher  if  its  carcase  could  be  utilized  for  food.  In  some  few  in- 
stances, as  we  have  seen,  the  animal  has  not  succumbed,  but  recovered 
from  the  effects  of  the  torsion,  and  without  reposition  of  the  organ  having 
been  effected.  After  fruitless  efforts,  the  labor  pains  have  subsided,  the 
foetus  dies  and  becomes  mummified  ;  the  Cow  is  in  an  ailing  condition, 
perhaps,  for  some  time,  but  rallies,  and  may  even  regain  its  former  con- 
dition, not  unfrequently  even  yielding  a  certain  quantity  of  milk. 

In  other  cases  the  Cow  becomes  emaciated  and  miserable  looking, 
gives  no  milk,  and  generally  succumbs,  after  a  variable  period,  to  chronic 
peritonitis.  But  in  far  more  instances  serious  illness  ensues  at  the  very 
commencement,  and  we  have  metritis  and  peritonitis,  gangrene  of  the 
uterus,  putrefaction  of  the  foetus,  septikaemia,  paraplegia,  or  other  grave 
conditions  which  quickly  terminate  life. 

In  British  vetennary  literature  only  two  successful  attempts  have  been 
recorded,  and  these  by  Mr.  Cartwright,  of  Whitchurch,  one  being  so  late 
asa875. 

On  the  Continent,  although  many  cures  have  been  published,  yet  they 
only  date  from  a  comparatively  recent  day.  Nevertheless,  according  to 
Rainard  {Traite  Coniplet de la  Farturitioji.,  vol.  i.,  p.  420),  Vieillard  long  ago 
(1823)  succeeded  in  one  instance  in  saving  a  Cow  and  calf,  through  hav- 
ing recourse  to  vaginal  hysterotomy.  In  this  case  there  was  inversion  of 
the  uterus,  the  cervix  of  which  was  extruded  beyond  the  vagina,  and 
fShowed  three  markedly-salient  spiral  rings.  He  experienced  much  diflfi- 
[culty  in  making  convenient  openings  ;  the  extensive  incisions  he  was 
compelled  to  make,  in  order  to  remove  the  foetus,  became  lacerations, 
and  there  was  serious  haemorrhage.  Yet  the  animal  made  a  good  recov- 
ery. This  formidable  operation  has  not  found  an  imitator,  and  does  not 
require  one  :  except  perhaps  in  a  similar  case,  and  in  which  there  is 
, aversion  of  the  vagina,  so  that  the  parts  to  be  incised  are  visible. 

The  principal — indeed,  the  sole — indication  for  the  relief  of  this  accident 
[is  to  untwist  the  uterus ;  in  doing  this  the  cervix  and  os  are  restored  to 
Itheir  normal  condition,  and  the  vagina  rendered  patent,  while  the  uterus 
itself  assumes  its  ordinary  relations. 

Various  methods — all  of  which  have  been  attended  with  more  or  less 
juccess  in  practice — have  been  devised  to  accomplish  this  object. 

They  are  (i)  Abdominal  taxis;  (2)  Vaginal  hysteroto7ny ;  (3)  Vaginal 
taxis  ;  (4)  Denoc's procedure;  (5)  Darreau's  procedure ;  (6)  Rotation  of  the 
yCoTv's  body  ;  and  (7)  Gastro-hysterotomy,  or  Ccesarean  section. 

I.  Abdominal  Taxis. — The  idea  of  opening  the  abdomen,  and  thrust- 
ping  the  hands  and  arms  into  its  cavity,  in  order  to  search  for  the  twisted 

iterus,  then  to  untwist  it  directly  by  turnmg  it  on  its  axis  in  a  contrary 
^direction  to  the  torsion,  in  order  to  deliver  the  animal  by  th6  natural  pas- 

>ages,  is  at  first  sight  an  eminently  rational  and  practical  procedure,  and 


312 


MATERNAL  DYSTOKIA. 


one  which,  occurring  independently  to  several  minds,  has  been  resorted 
to  by  a  number  of  veterinary  obstetrists.  But,  however  simple  and 
feasible  it  may  appear,  yet  it  is  very  far  from  being  an  easy  or  always 
successful  method,  and  this  for  several  reasons.  Among  these  may  be 
cited  the  great  weight  of  the  gravid  uterus — from  112  to  180  pounds — its 
immense  size,  its  convex,  smooth,  and  slippery  surface  ;  the  limited  space 
there  is  in  the  abdominal  cavity  for  manipulation  ;  and  the  obstacles  the 
other  viscera  offer  to  version  manoeuvres. 

"  Nothing,"  says  Mazure,  after  repeatedly  trying  this  method,  "  appears 
more  simple  to  the  mind  than  to  seize  with  the  hand  one  of  the  sides  of 
the  uterus,  and  to  swing  it  round,  and  especially  as  it  is  restoring  the 
organ  to  its  natural  position.  Yet  no  one  whom  I  know  is  competent  to 
perform  this  simple  movement." 

"  My  confrere  and  I  tried  to  swing  round  the  uterus,"  writes  Gosselin, 
"  but  it  was  in  vain  ;  all  our  efforts  could  not  even  cause  it  to  change  its 
place." 

Bouley  attempted  this  method  in  1853, but  did  not  succeed.  After  fail- 
ing in  other  manoeuvres  to  effect  the  detorsion  of  the  uterus,  in  despair 
he  made  a  large  incision  in  the  right  flank,  in  order  to  try  if  he  could  not, 
by  direct  taxis  on  the  organ  itself,  restore  it  to  its  ordinary  condition. 
But  he  was  disappointed  :  for  the  uterus,  enormously  distended,  so  com- 
pletely filled  the  abdominal  cavity  that  the  hand  could  scarcely  be  intro- 
duced between  it  and  the  walls  of  the  abdomen  ;  while  the  surface  of  the 
uterus  was  so  smooth  that  the  operator's  fingers  could  not  cling  to  it. 

Notwithstanding,  this  operation — which,  from  having  been  performed 
in  the  region  of  the  flank,  has  received  the  designation  of  "  laparotomy  " 
(from  ka-dpa^Jlank  or  loins^  and  rijjysiv^  to  ait) — has  been  practised  with 
variable  success  in  Germany  by  Fausel  (1849),*  Epple  (1852),  Kohler 
(1853),  Diccas  (1867),  Lechleuthner  (1868),  Obich  (1869),  Heichlinger 
(1869),  etc.  ;  in  France  by  Darreau,  Garreau,  and  others ;  in  Italy  by 
Santoni  and  Rocco  ;  and  in  Denmark  by  Stockfleth. 

We  have  said  that  the  success  attending  laparotomy  has  been  variable. 
This  is  exemplified  in  Obich's  experience  ( Wochenschrift  fiir  Thierheil- 
kunde,  1869).  This  veterinarian  had  three  cases  of  uterine  torsion,  in 
which  he  resorted  to  this  operation  to  replace  the  organ.  Two  of  the 
cases  were  attended  with  complete  success  ;  but  in  the  third  the  uterus 
was  of  such  an  extraordinary  size  and  weight,  that  he  failed  to  restore  it 
to  its  natural  position.  He  proposed  in  future  to  facilitate  the  operation 
by  using  a  looped  cord  with  which  to  raise  the  organ, 

Heichlinger  operated  successfully  on  a  Cow  in  the  same  manner,  but 
the  animal  afterwards  perished  through  gangrene  of  the  uterus. 

It  must  be  admitted  that  the  operation  has  not  been  performed  suffi- 
ciently often,  and  then  sometimes  in  very  unfavorable  circumstances,  to 
enable  us  to  draw  any  satisfactory  conclusions  as  to  its  value.  Darreau, 
who  has  been  fortunate  in  some  of  his  attempts,  writes :  "  Direct  taxis  by 

*  It  is  worthy  of  note  that  the  idea  of  resorting  to  laparotomy  occurred  to  an  excellent  veterinary  practi- 
tioner in  Scotland,  perhaps  long  before  it  did  to  Fause!,  though  for  lack  of  opportunity  it  was  not  carried 
into  effect.  Mr.  Cartwright,  of  Whitchurch,  writing,  m  1850,  "On  Torsion  of  the  IJterus  in  the  Cow" 
{Veterinarian,  vol.  xxiii.,  p.  248),  and  its  treatment,  and  proposing  to  try  rolling  the  animal,  adds  :  "  If  I 
did  not  succeed  in  this  way,  I  should  proceed  according  to  a  suggestion  given  me  by  Mr.  John  Steel,  of 
Biggar,  Lanarkshire— viz.,  to  make  an  incision  between  the  ilium  and  the  ribs  on  the  right  side,  and  try  to 
untwist  it  (the  uterus).  If  I  succeeded,  I  should  sew  up  the  wound  and  allow  the  labor  to  take  its  natural 
course  ;  but  if  not,  I  am  not  aware  that  there  is  any  other  means  but  that  of  performing  the  Cjesarean 
operation.  Mr.  Sfeel,  althou2:h  he  has  not  yet  had  an  opportunity  of  testing  its  practicability,  deserves 
the  thanks  of  the  profession  for  such  a  suggestion,  and  it  is  one  which  I  think  very  likely  to  succeed.  At 
any  rate,  if  it  does  not,  we  can  but  perform  the  Cjesarean  operation." 


DYSTOKIA  BY  DISPLACEMENT. 


313 


an  opening  made  in  the  flank  has  had  some  advantages ;  I  have  even 
thought  for  a  moment  after  my  first  success  that  it  would  be  the  only 
means  I  should  resort  to  for  the  future.  But,  unfortunately,  new  cases 
upset  my  predictions,  and  compelled  me  to  seek  for  more  efficacious 
means."  And  Faussel  admits  that  the  considerable  weight  of  the  uterus 
may  sometimes  prove  an  insurmountable  obstacle. 

The  dangers  attending  the  operation,  even  if  reposition  of  the  uterus  is 
effected,  are  as  great   as   its  difficulties.     Several  good  authorities  have  • 
therefore  recommended  its   abandonment,  or   at  least  its   being  adopted 
only  in  very  exceptional  circumstances. 

Operation. — Different  operators  have  different  modes  of  operating. 
Some  prefer  the  animal  in  a  standing  position  ;  others  throw  it  down. 
One  selects  the  left  flank  ;  another,  and  perhaps  with  more  reason,  in- 
cises the  right  flank.  Diccas,  whose  procedure  appears  to  be  preferred  by 
Saint-Cyr,  operates  as  follows  :  The  animal  is  led  into  a  suitable  place, 
and  secured  as  if  to  be  operated  upon  for  internal  hernia.  The  skin  and 
muscles  of  the  right  flank  are  carefully  divided  for  about  five  or  six 
inches,  the  opening  being  directed  downward  and  slightly  forward.  The 
cord  fixing  the  hind  quarters  of  the  animal  (which  is  standing)  is  slack- 
ened a  little,  and  the  hand  is  introduced  into  the  abdominal  cavity  and 
pushed  towards  the  left  side,  passing  it  above  the  uterus  if  the  torsion  is 
from  right  to  left ;  but  towards  the  right  side  and  below  the  uterus  if  the 
twist  is  in  the  opposite  direction.  The  displaced  organ  is  then  seized, 
and  endeavors  made  to  bring  it  into  its  normal  position  by  lifting  and 
drawing  it  towards  the  incision.  To  prevent  the  hand  slipping  on  the 
surface  of  the  uterus,  it  is  wrapped  round  with  a  piece  of  thin  cloth.  Two 
assistants  are  required,  one  of  whom  exercises  a  certain  amount  of  pres- 
sure on  the  abdominal  w^alls  ;  while  the  other  finds  out,  by  vaginal  palpa- 
tion, the  extent  of  replacement  which  the  uterus  undergoes. 

When  reposition  is  complete,  the  hand  is  withdrawn  from  the  abdomi- 
nal cavity,  and  the  lips  of  the  wound  are  brought  together  by  four  or  five 
tape  or  wire  sutures,  aftd,  if  thought  necessary,  a  pitch  plaster  may  be 
fixed  over  it. 

According  to  Obich,  within  eight  days  the  wound  will  have  healed  by 
first  intention. 

2.  Vaginal  Hysterotomy. — We  have  noticed  that  Vieillard,  so  long 
ago  as  1823,  removed  the  foetus  from  a  twisted  uterus  by  means  of  vagi- 
nal section.  In  1856  Ercolani  proposed  vaginal  hysterotomy,  ih^o^^xixw^ 
being  made  through  the  upper  wall  of  the  vagina,  for  the  reposition  of 
the  twisted  uterus.  The  operation  is  of  the  same  kind,  and  is  conducted 
in  a  similar  manner,  as  that  for  the  castration  of  Cows,  introduced  by 
Charlier ;  except  that,  instead  of  the  ov^aries  being  seized,  the  uterus  is 
grasped  through  the  wound,  and  attempts  made  to  untwist  it.  Rueff 
speaks  in  favor  of  the  proceeding  ;  but  we  cannot  find  that  it  has  ever 
been  carried  into  practice,  and  serious  doubts  may  be  entertained  as  to 
the  likelihood  of  its  being  successful,  from  the  weight  and  size  of  the 
gravid  uterus,  and  only  one  hand  being  employed  to  turn  the  displaced 
mass,  unless  the  displacement  should  be  very  trifling ;  in  which  case  a 
simpler  operation  might  succeed.  * 

If  attempted,  not  much  risk  may  be  apprehended  from  incising  the 
vagina,  as  it  has  generally  been  found  to  be  attended  with  little  danger, 
and  cicatrization  soon  takes  place. 


314  MATERNAL  DYSTOKIA, 

3.  Vaginal  Taxis. — All  sanguinary  and  serious  operations  for  the  cure 
of  uterine  torsion^like  the  two  preceding — should  be  avoided,  if  possi- 
ble, until  the  simpler  means  which  modern  veterinary  science  has  indi- 
cated are  tried.  We  allude  more  particularly  to  version,  which  rarely 
fails  to  bring  the  case  to  a  satisfactory  termination.  That  is,  of  course, 
on  the  assumption  that  this  is  resorted  to  sufficiently  early ;  for  it  must 
be  remembered  that  nothing  is  gained  by  delay  in  this  accident,  and  if 
relief  is  to  be  afforded  it  must  be  rendered  promptly,  and  as  soon  as  the 
existence  of  displacement  is  fairly  established.  When  delay  has  been 
allowed  to  take  place,  more  or  less  serious  consequences  must  ensue  to 
either  the  foetus  or  the  maternal  organs,  or  to  both. 

In  certain  cases  of  very  incomplete  torsion — quarter  rotation  of  the 
uterus,  for  instance — and  when  there  is  sufficient  space  in  the  vagina  for 
the  hand  to  pass  through  the  obstacle  and  into  the  os  or  uterus,  detorsion 
has  been  accomplished  by  seizing  the  most  suitable  parts  of  the  foetus 
and  exercising  direct  traction  on  it.  Instances  of  success  by  adopting 
this  course  have  been  furnished  by  Chambon,  Cann,  Gaven,  Darreau,  and 
others. 

The  mode  of  procedure  may  be  as  follows  : — After  ascertaining  the 
direction  of  the  torsion,  the  arm  is  to  be  introduced  into  the  uterus  as 
deeply  as  possible  ;  if  the  foetal  membranes  are  yet  intact,  they  must  be 
largely  ruptured,  and  the  most  convenient  parts  of  the  foetus  sought  for. 
In  this  respect  it  will  be  found  that  every  part  of  the  young  animal  does 
not  offer  the  same  advantages  to  the  operator,  for  reposition  of  the  uterus. 
The  head  is  too  large  and  does  not  afford  sufficient  hold  for  the  hand  ; 
the  pasterns  and  knees  are  too  much  removed  from  the  body  and  too 
round  ;  but  the  hocks  and  elbows  are,  of  all  parts  perhaps,  -those  best 
adapted  for  this  kind  of  manipulation.  If  one  of  them  can  be  reached, 
it  should  be  firmly  grasped,  and  endeavors  made  by  it  to  raise  the  body 
of  the  foetus,  at  the  same  time  giving  it  a  turning  movement  contrary  to 
that  which  we  would  give  the  uterus  in  order  to  untwist  it. 

Supposing,  for  example,  that  the  torsion  is  to  the  right,  and  that  the 
foetus,  offering  an  anterior  presentation,  is,  from  the  fact  of  the  quarter 
revolution  of  the  organ,  in  the  right  vertebro-ilial position  ;  then  the  object 
must  be  to  place  it  in  the  vertebrosacral  position. 

To  effect  this,  the  right  hand,  in  a  state  of  supination  (knuckles  down- 
wards, palm  upwards),  must  be  introduced  be?ieath  the  foetus,  and,  if  pos- 
sible, the  left  fore  limb  seized  by  the  elbow  ;  then  the  operator,  turning 
his  arm  round,  raises  the  body  of  the  creature,  at  the  same  time  turning 
so  that  the  withers  describe  the  arc  of  a  circle  from  right  to  left — from 
the  right  flank  of  the  Cow  towards  the  sacrum. 

Sometimes  when  the  foetus  is  alive,  at  the  moment  this  manoeuvre  is 
being  executed  it  makes  a  movement  which  greatly  assists  the  efforts  of 
the  operator. 

If  the  dimensions  of  the  vagina  admit  of  it,  the  limbs  of  the  foetus  may 
be  drawn  into  the  pelvis,  and  even  as  far  as  the  vulva  ;  and  while  the 
operator  is  acting  as  described  on  the  upper  part  of  one  of  the  legs,  an 
assistant  presses  on  the  free  portion,  and  by  thus  aiding  in  the  version 
considerably  facilitates  the  task. 

By  this  procedure  several  ob^tetrists  have  been  successful  in  re-adjust- 
ing the  uterus,  through  the  medium  of  the  foetus  ;  the  adjustment  being 
ascertained  by  the  disappearance  of  the  spiral  mucous  folds  from  the 
vagina  and  the  patency  of  the  canal. 


DYSTOKIA  BY  DISPLACEMENT.  315 

Nevertheless,  it  has  been  remarked  that  this  operation  is  not  so  easy 
as  one  would  be  inclined  to  imagine  it  without  testing  it  in  practice.  It 
requires  much  force  to  raise  and  turn  the  foetus  in  this  way ;  and  the  con- 
stricted and  powerful  uterine  contractions  are  formidable  obstacles  to 
the  exercise  of  that  force. 

Some  Veterinarians,  as  Meyer  and  Losner,  have  succeeded  in  adjust- 
ing a  slightly  twisted  uterus  by  introducing  the  hands  into  the  vagina, 
and  aided  by  assistants,  who  manipulated  either  with  their  hands  or  by 
means  of  boards  or  sheets  applied  externally  to  the  abdomen,  so  as  to 
set  the  organ  straight.  Of  course,  such  attempts  must  be  greatly  pro- 
moted if  the  foetus  can  be  reached  and  used  as  an  instrument  in  the 
manner  just  alluded  to. 

4.  Denoc's  Procedure. — Denoc  appears  to  have  been  the  first  veteri- 
narian who  attempted  reduction  of  this  torsion  by  the  simple  means 
stated  above,  but  applied  in  such  a  manner  as  to  merit  the  designation 
of  "  original."  His  procedure  marked  a  great  step  in  advance,  so  far  as 
veterinary  obstetrics  are  concerned. 

In  1845  he  describes  the  case  of  a  Cow  {Reciieil  de  Med.-  Veterinaire, 
1845,  p.  69)  unable  to  calve,  but  whose  os  uteri  was  sufficiently  dilated 
to  allow  him  to  pass  his  hand  into  the  uterus,  where  the  foetus  lay  in  a 
good  position,  but  from  which  it  could  not  be  expelled,  owing  to  a  wide 
membranous  fold  extending  from  the  cervix  to  the  fundus  of  the  organ. 

His  manner  of  getting  rid  of  the  torsion  consisted  in  suspending  the 
animal  by  a  very  narrow  sack  passed  under  its  chest ;  and  two  pulleys 
having  been  fixed  in  the  wall  on  the  right  side — one  corresponding  to 
the  fore  limbs,  the  other  to  the  hind  ones — the  fore  legs  were  tied  by  a 
cord  which  passed  through  the  corresponding  pulley,  while  the  hind  ones 
were  also  secured  by  another  cord  running  through  the  posterior  pulley. 
Five  men  were  posted  to  the  distal  end  of  each  of  these  cords,  and  di- 
rected to  pull.  When  this  was  done,  the  suspended  Cow  was  swung 
into  a  dorsal  position.  Then  two  strong  men,  placed  on  the  left  side, 
were  directed  to  push  the  animal's  body  to  the  right — a  movement  which 
caused  it  suddenly  to  rotate. 

An  exploration  with  the  hand  led  to  the  discovery  that  the  uterus  had 
changed  its  place,  but  that  there  was  either  a  double  torsion,  or  the  in- 
version of  the  animal  had  only  incompletely  turned  the  uterus,  as  the 
duplicature  was  still  present  at  the  cervix. 

Another  pull  was  given  at  the  cords,  and  the  previous  manoeuvre  re- 
peated, and  this  time  with  a  good  effect,  as.  it  was  found  that  the  ob- 
structing fold  had  now  vanished,  and  the  uterus  was  in  its  ordinary  posi- 
tion. 

The  Cow  was  then  left  alone,  to  await  the  result  of  its  own  expulsive 
efforts  ;  but  nothing  having  transpired  after  about  an  hour,  a  dose  of 
ergot  of  rye  was  administered.  Another  hour  had  not  elapsed  until 
parturition  was  accomplished  without  the  slightest  difficulty,  two  calves 
being  born. 

5.  Darreau's  Procedure. — Denoc's  method  does  not  appear  to  have 
been  much  practised,  either  because  it  was  lost  sight  of,  or  was  only 
adapted  for  cases  of  very  slight  torsion  ;  and  in  view  of  the  great  diffi- 
culty generally  experienced  in  vaginal  taxis — which  is,  after  all,  the  most 
reasonable,  least  dangerous,    and  perhaps  the    most  convenient  of  all 


3i6 


MATERNAL  DYSTOKIA. 


methods — several  devices  have  been  brought  forward  to  render  it  more 
easy  and  effective.  Of  these  none  deserves  more  notice  than  that  of 
Darreau,  and  which  was  brought  before  the  Central  Veterinary  Medical 
Society  of  Paris  in  1852.  The  improvement  in  vaginal  taxis  for  this 
accident,  mainly  consists  in  the  employment  of  what  has  been  designated 
a  "  uterine  retroversor  "  {iiterm  retroverseur),  an  appliance  which  would 
appear  to  be  very  ingenious,  if  complicated.  And,  besides,  it  is  only  of 
service  in  those  cases  in  which  the  hand  can  be  introduced  in  the  uterus 
and  the  feet  of  the  foetus  seized — a  state  of  affairs,  unfortunately,  not 
always — nor  indeed  very  often — present  in  torsion  of  this  viscus.  Liau- 
tard  and  some  others,  however,  while  admitting  that  the  apparatus  is 
not  very  easily  applied,  yet  testify  to  its  utility. 

The  apparatus  is  composed  of  three  rods  (A,  A',  A"  ;  Fig.  76)  ;  of  a 


^^     M 


Fig.  76. 
Darreau's  Retroversor. 


winch  (B)  ;  of  a  screw,  with  a  movable  screw-nut  (D),  pierced  by  three 
holes  ;  and,  finally,  three  cords  (E,  E',  E")  with  a  loop  (F).  The  end  of 
each  rod  (G),  a  little  thickened,  has  a  longitudinal  hole  (H)  ;  the  other 
extremity  (I)  has  a  hole  punched  through  it,  and  a  shoulder  (K).  This 
end  of  the  three  rods  is  inserted  into  the  three  holes  of  the  winch. 

The  apparatus  is  put  together  for  use  in  the  following  manner  : — The 
cords  are  fastened  by  their  loop  (F)  to  the  two  pasterns  and  the  lower 
jaw  of  the  foetus,  and  serve  as  points  of  attachment  as  well  as  conduc- 
tors to  the  rods.  With  this  object  the  obstetrist  passes  them,  one  by 
one,  through  the  hole  (H)  in  each  rod  ;  then,  by  one  hand,  he  seizes  the 
extremity  (I),  and  with  the  second  hand  the  other  end  (G)  ;  directing 
the  latter  towards  the  part  of  the  foetus  to  be  pulled  at,  an  assistant  who 
keeps  the  cord  tense  passes  this  through  the  hole  (I).     This  done,  each 


D  YSTOKIA  B  Y  D  ISP  LA  CEMENT. 


317 


rod  is  inserted  in  one  of  the  openings  of  the  winch,  the  screw  (C)  is 
pushed  through  the  middle  hole,  and  the  cords  are  passed  through  the 
holes  in  the  nut  (D)  of  the  screw  (C),  by  means  of  which  they  are  made 
as  tight  as  may  be  necessary. 

The  apparatus  may  be  used  either  while  the  Cow  is  standing  or  lying 
on  its  back.  By  turning  the  handle  of  the  winch  in  a  contrary  direction 
to  the  torsion,  counter-torsion  is  at  once  effected  without  difficulty,  and 
without  causing  the  animal  any  fatigue.  If  the  resistance  is  at  all  great, 
the  operator  entrusts  the  instrument  to  the  assistant,  passes  his  hand  into 
the  uterus,  presses  on  the  head  of  the  calf,  and  in  this  way  aids  the  ac- 
tion of  the  retroversor.     Parturition  then  takes  place  naturally. 

6.  Rotation  of  the  Cow's  Body. — The  methods  of  Denoc  and  Dar- 
reau  are  likely  to  be  useful  only  in  cases  in  which  the  uterus  is  slightly 
twisted  ;  and  in  these  instances,  and  others  in  which  the  torsion  is  much 
greater,  the  method  about  to  be  considered  is  so  simple,  attended  with  so 
little  danger,  and  hitherto  has  yielded  such  favorable  results,  that  it  is 
certainly  to  be  preferred,  unless  vaginal  taxis  can  be  resorted  to  with 
every  chance  of  speedy  success.  This  method  consists  in  rolling  the  ani- 
mal affected  with  uterine  torsion,  in  such  a  manner  that  the  twist  which 
forms  an  obstacle  to  parturition  is  effaced,  and  the  genital  passages  are 
open  for  the  passage  of  the  foetus. 

This  method  has  been  in  vogue  for  a  long  time,  and  its  introduction  is 
due,  according  to  Dieterichs,  of  the  Berlin  Veterinary  School,  to  Fricke, 
a  Hanoverian  veterinary  surgeon.  At  least  this  would  appear  to  be  the 
fact  from  what  Dieterichs  has  stated  with  regard  to  Denoc's  procedure  in 
1845  {R^cueil  de  Med.  Veferinaire),  when  he  says  that  not  only  had 
Schmidt,  Vix,  Irminger,  and  Schenker, — all  German  veterinarians — men- 
tioned the  occurrence  of  torsion  of  the  uterus ;  but  that  Fricke,  in  addi- 
tion, cured  a  Cow  of  the  accident  by  tying  its  feet,  two  and  two,  then 
rolling  it,  taking  care  to  move  it  in  a  contrary  direction  to  that  in  which 
the  torsion  had  been  produced. 

German,  French,  Belgian,  and  Italian  veterinary  obstetrists  have  prac- 
tised this  method  of  reduction  in  a  very  large  number  of  instances,  and 
altogether  with  most  gratifying  results.  Mr.  Cartwright,  in  England,  has 
been  successful  in  two  cases.  As  with  Denoc's  rotation  method,  this  is 
a  version  of  the  uterus,  and  not  of  the  foetus. 

The  manner  of  rolling  the  animal  varies  somewhat  with  different  au- 
thorities, but  in  principle  all  are  agreed.  The  first  step,  after  ascertaining 
the  existence  and  the  direction  of  the  displacement,  is  to  empty  the  udder 
of  its  milk  as  completely  as  possible,  so  as  to  prevent  the  gland  being  in- 
jured during  the  operation. 

While  this  is  being  done,  a  sufficiently  roomy  place  should  be  got  ready, 
and  the  floor  covered  with  a  thick  layer  of  straw  ;  on  this  the  Cow  is 
thrown  on  the  proper  side,  and  with  all  possible  care,  the  feet  being  fas- 
tened together.  The  hand  and  arm  are  then  to  be  introduced  as  far  into 
the  vagina  as  its  condition  will  permit.  Should  the  os  be  accessible,  and 
dilated,  some  part  of  the  foetus  must  be  secured,  and  more  especially  a 
limb;  this  must  be  firmly  maintained  in  one  position.  If  the  foetus  can- 
not be  reached,  then  nothing  remains  but  to  make  the  wall  of  the  vagina 
the  point  of  resistance  until  a  better  can  be  made  available. 

The  assistants  are  then  to  pull  at  the  ropes  which  secure  the  feet,  so  as 
to  bring  the   Cow  on  its  back  ;  then  gently,  and  without  jerking,  allow  it 


3i8  >  MATERNAL  DYSTOKTA. 

to  fall  on  the  opposite  side.  This  being  done,  the  animal  is  raised  on  its 
chest,  by  the  shoulder  and  quarter,  and  turned  over  on  thQ  side  on  which 
it  was  thrown.     In  this  way  it  will  have  made  a  complete  rotation. 

While  the  assistants  are  rolling  the  Cow,  the  operator,  with  his  hand 
in  the  vagina  or  uterus,  as  the  case  may  be,  endeavors,  by  pressing  in 
the  opposite  direction,  to  keep  the  organ  fixed  and  to  prevent  its  following 
the  movement  the  body  is  undergoing. 

If  the  operation  is  well  conducted,  and  the  body  of  the  Cow  moved  in 
the  proper  direction,  the  obstetrist  will  find,  as  rotation  is  carried  on, 
that  the  genital  passage  is  becoming  wider  and  the  obstacle  disappearing, 
until,  the  spiral  rings  having  become  effaced,  the  hand  can  reach  the  cer- 
vix and  penetrate  the  uterus  if  the  os  is  relaxed.  Generally  a  gush  of  the 
liquor  amnii  from  the  organ  announces  the  termination  of  the  operation. 

If,  however,  the  hand  is  more  strongly  compressed  by  the  spiral  folds 
as  the  animal  is  turned  on  its  axis,  and  the  vaginal  canal  is  diminishing 
in  length,  it  is  a  proof  that  rotation  is  effected  in  the  wrong  direction. 
This  is  remedied,  of  course,  by  reversing  the  movement. 

Sometimes  it  is  sufficient  to  make  the  animal  execute  a  complete  turn 
to  bring  the  uterus  into  its  usual  position.  More  frequently,  however, 
this  rotation  only  relaxes  the  constriction  and  does  not  entirely  efface 
the  rings  ;  so  that  it  is  necessary  to  continue  the  turning — always  in  the 
same  direction — until  the  desired  result  has  been  obtained.  Then  par- 
turition can  be  completed  in  the  ordinary  way. 

It  will  be  seen  from  this  description  that  the  method  consists  simply  in 
rolling  the  Cow  as  one  would  roll  a  barrel  ;  and  the  only  point  now  to  be 
discussed,  is  the  direction  in  which  it  should  be  rolled. 

This  point,  strange  to  say,  has  given  rise  to  as  warm  and  as  unsatisfac- 
tory discussions  as  some  of  the  other  points  to  which  reference  has  al- 
ready been  made.  Some  authorities  have  declared  that,  to  achieve  the 
reduction  of  the  torsion,  the  Cow  must  be  rolled  in  the  same  direction  as 
it ;  others  assert  thit  the  rolling  should  be  contrary  to  the  torsion  ;  while 
others,  again,  pretend  that  both  procedures  are  correct,  according  as  in 
one  the  uterus  is  maintained  fixed,  while  in  the  other  it  remains  free  in 
the  abdominal  cavity. 

The  confusion  imported  into  the  discussion  was  probably  largely  due 
to  the  manner  in  which  each  disputant  looked  at  the  question — or,  rather,: 
to  the  position  in  which  he  mentally  placed  himself  during  the  supposed; 
operation.  For  instance,  one  may  have  fancied  an  animal  in  a  standing] 
attitude  placed  before  him ;  another,  with  a  Cow  lying  on  its  back ;  an- 
other stood  in  front  of  the  beast ;  another  imagined  he  was  behind  it ;  and; 
another  stood  at  its  right  side,  while  a  seventh  viewed  it  from  the  left. 
Consequently,  each  discussed  the  torsion,  and  the  mode  of  remedying  it^ 
by  rolling,  from  his  own  particular  point  of  view  j  so  that  the  terms  they' 
employed  in  the  discussion  could  not  fail  to  be  contradictory. 

Fortunately,  in  practice  no  great  harm  could  result  ;  as  in  whatever* 
direction  the  torsion   may  have   existed,  and  however   baffling  the   spiral] 
curving  of  the  vaginal  rugae  may  have  appeared  in  bad  cases,  the  grand? 
test  and  guide  was  the  effect  produced  by  rolling.     If,  when  the  Cow  was 
turned  to  the  right,  the  vagina  became  shorter  and  more  firmly  constricted, 
then  it  was  evident  that  the  animal  was  being  rolled  in  the  wrong  direc-; 
tion,  and  rolling  to  the  left  was  indicated,  when  the  constriction  would  be^ 
diminished  and  the  vagina  lengthened.     The  procedure  might  be  empiri- 
cal ;  nevertheless  it  was  invaluable. 


DYSTOKIA  BY  DISPLACEMENT. 


319 


But  there  can  be  no  reason  why  the  remedy  should  be  empirical,  or 
why  the  confusion  in  terms  which  has,  unfortunately,  existed  should  be 
allowed  to  hinder  the  progress  of  science,  and  even  throw  obscurity  on 
the  practice  of  such  an  important  operation  in  obstetrical  surgery. 

Saint-Cyr  had  already  explained  as  succinctly  and  clearly  as  possible 
the  exact  meaning  to  be  attached  to  the  terms  "right  torsion"  and  "  left 
torsion  ;  "  and  he  has  set  himself  as  diligently  to  demonstrate  what  should 
be  understood  by  "  rolling  an  animal  to  the  right,"  and  "  rolling  it  to  the 
left."  He  supposes  an  animal  laid  on  its  right  side ;  if  it  is  desired  to 
turn  it  on  its  left  side,  it  is  evident  that  this  may  be  accomplished  in  two 
different  ways  :  first,  by  rolling  it  on  its  back  and  allowing  it  to  fall  on  the 
left  side  ;  and,  second,  placing  it  on  its  sternum  and  pushing  it  over  on 
its  left  side.  In  both  cases  the  result  is  the  same  :  the  animal  lying  at 
first  on  the  right  side,  finds  itself  at  last  on  the  left  side.  And  yet  it  is 
perfectly  obvious  that  the  second  movement  is  exactly  the  reverse  of  the 
first ;  while  it  is  not  less  evident  that  the  creature  in  both  movements  has 
been  turned  from  right  to  left :  for  this  expression  in  its  real  sense  simply 
means  that  the  animal  has  been  moved  from  its  right  to  its  left  side. 

But  in  order  to  give  to  this  expression  a  precise  signification,  a  conven- 
tional interpretation  is  necessary.  This,  Saint-Cyr  proposes,  should  be 
as  follows  ; — "  It  ought  to  be  thoroughly  understood  that,  in  the  move- 
ment of  rotation  impressed  on  the  body  of  an  animal,  we  should  always 
commence  by  placing  it  on  its  back  before  bringing  it  on  the  side  oppo- 
site to  that  on  which  it  first  lay." 

In  this  sense,  "to  turn  or  roll  a  Cow  from  right  to  left,"  means  that 
the  animal,  "  laid  at  first  on  its  right  side,  was  placed  on  its  back,  then 
on  its  left  side,  then  on  the  sternum,  and  finally  on  the  side  from  which 
it  commenced — the  right." 

The  contrary  expression  of  course  means  a  precisely  contrary  move- 
ment :  left  side,  back,  right  side,  sternum,  left  side. 

From  all  this  it  must  be  admitted  that,  in  order  to  effect  detorsion  of 
the  uterus,  the  Cow  should  be  rolled  in  the  same  direction  the  uterus 
followed  during  torsion  ;  and  it  is  also  clear  that  the  uterus  does  not 
participate  to  the  same  extent  as  the  body  of  the  animal  in  the  rotatory 
movement  to  which  the  latter  has  been  subjected. 

Supposing,  as  Saint-Cyr  has  done,  that  the  torsion  has  been  recognized 
as  left,  and  as  is  depicted  in  figure  75  (page  308). 

In  such  a  case  the  animal  would  be  cast  on  its  left  side,  and  turned  suc- 
cessively on  its  back,  right  side,  sternum,  and  left  side — it  would  be  rolled^ 
in  fact,  from  left  to  right. 

If  one  complete  rotation  does  not  suffice,  then  the  movement  must  be 
continued  in  the  same  direction  until  the  hand  can  freely  pass  to  the  cer- 
vix and  into  the  uterus. 

The  soundness  of  these  views  of  our  estimable  colleague  is  amply 
verified  in  the  very  numerous  cases  of  torsion  of  the  uterus  which  have 
been  published  during  the  last  thirty  years  on  the  Continent,  and  particu- 
larly in  France,  of  which  he  gives  a  few  examples. 

I.  Bouley,  in  a  very  interesting  and  complete  observation  communicated  to  the  Cen- 
tral Veterinary  Medical  Society  of  Paris  [Recuetl  de  Mid.  Veterinaire,  1853,  p.  469), 
makes  us  acquainted  with  the  following  features  in  a  case  of  this  description : 

The  obstacle  which  his  hand  encountered  in  the  vagina  seemed  to  be  a  spiral  infundi- 
bulum,  the  curves  of  which  were  directed  from  right  to  left  and  from  above  downwards 
— there  was,  in  fact,  left  torsion.     The  Cow  fell  on  the  right  side,  and  was  fixed  in  this 


320  MATERNAL  DYSTOKIA. 

position  ;  the  operator  then,  keeping  the  hand  firmly  fixed  in  the  spiral  turns,  in  order 
to  make  certain  of  his  diagnosis,  ordered  the  assistants  to  roll  the  animal /r^w  right  to 
left,  turning  it  on  its  back.  When  this  was  done,  he  found  his  hand  strangled,  as  it  were, 
in  the  os.  He  at  once  ordered  them  to  roll  it  in  the  opposite  direction :  and  when  the 
Cow,  which  was  lying  on  the  left  side  at  the  commencement  of  this  second  rolling,  had 
been  returned  to  her  right  side  by  being  pivoted  on  its  back,  he  had  it  further  rolled  by 
placing  it  on  the  belly,  and  then  on  the  left  side  again.  Then  he  discovered  that  he  had 
attained  his  object,  for  his  hand  could  enter  the  uterus  freely,  and  a  gush  of  sanguino- 
lent,  but  odorless,  fluid  announced  that  the  communication  between  the  uterus  and  va- 
gina was  again  established. 

Here  the  torsion  was  to  the  left,  and  when  rotation  to  the  left  was  at- 
tempted the  twist  became  increased  ;  but  when  it  was  made  from  left  to 
right,  reduction  was  easy  and  complete. 

2.  Chambon  has  published  a  case  of  demi-torsion  of  the  uterus  [Reaieil  de  Med.  Veter- 
inare,  i860).  The  hand,  on  being  passed  into  the  vagina,  reached  a  multitude  of  spiral 
folds  of  the  mucous  membrane,  the  upper  of  which  were  directed  to  the  right  and  the 
lower  to  the  left.  The  os  could  be  penetrated  with  much  difficulty,  and  a  careful  explo- 
ration led  him  to  believe  that  the  left  cornu  was  higher  than  usual  and  more  to  the  right ; 
while  the  right  cornu,  which  contained  the  foetus,  had  become  inferior.  The  diagnosis 
was  torsion  of  the  uterus  to  the  right.  The  animal  lay  down  voluntarily,  at  first  on  the 
left  side,  then  rising  with  difficulty  on  its  knees  and  hocks,  it  fell  on  the  right  side. 
Chambon  immediately  took  advantage  of  this  last  position,  and  introduced  his  hand 
once  more  into  the  vagina,  requesting  his  assistants  to  turn  the  animal  over  on  the  belly 
by  raising  the  shoulders  and  haunch,  and  placing  it  on  its  left  side.  In  doing  this,  he 
felt  the  constriction  caused  by  the  vaginal  folds  notably  increased  on  his  arm.  Turning 
over  the  animal  again  to  its  original  position  on  the  right  side,  he  had  the  limbs  tied  to- 
gether with  cords,  and  then  rotated  the  body :  placing  it  on  the  back,  then  the  left  side, 
belly,  and  right  side.     This  revolution  made  the  detorsion  complete. 

3.  Heu  publishes  three  cases  of  torsion  [Op.  Cit.,  i860,  p.  833),  one  of  which  will  be 
sufficient  for  illustration.  This  was  a  Cow  suffering  from  uterine  torsion,  as  evidenced 
by  the  numerous  duplicatures  arising  in  the  vagina,  and  which  converged  from  left  to 
right,  downwards  and  forwards,  radiating  towards  a  common  centre — the  cervix  uteri — 
where  they  formed  a  kind  of  spiral  arrangement.  Right  torsion  was  diagnosed.  The 
Cow  was  raised  on  the  right  side,  and  the  limbs  being  gathered  under  the  body  it  was 
turned  on  the  left  side  by  pushing  on  the  withers,  then  on  the  right  side  by  rolling  on 
the  back.  The  torsion  increased  ;  so  it  was  necessary  to  change  the  manoeuvre,  and 
after  a  turn  and  a  half  in  the  new  direction,  the  hand  was  no  longer  opposed  by  any  ob- 
stacle, but  was  at  once  carried  into  the  uterus,  the  "  waters  "  escaping  in  gushes. 

4.  Liautard  [Journal  de  Med.  Vitiyinaire  de  Lyon,  1861)  was  called  to  attend  a  Cow 
suffering  from  torsion  during  parturition  ;  but  too  late,  as  it  died  a  few  minutes  after  his 
arrival.  Nevertheless,  he  took  advantage  of  the  opportunity  to  enlighten  himself  ex- 
perimentally as  to  the  procedure  to  be  adopted  in  such  cases.  The  hide  having  been 
removed,  he  made  a  large  incision  in  each  flank,  through  which  he  could  easily  intro- 
duce his  hand  to  explore  the  uterus  He  then  assured  himself  as  to  the  direction  of  the 
torsion,  and  found,  by  vaginal  exploration,  numerous  folds  arranged  in  two  fasciculi,  one 
of  which — the  right — passed  from  right  to  left  to  form  a  spiral  series  running  upwards 
from  left  to  right ;  the  other  fasciculus  turned  in  the  opposite  direction.  He  noted,  be- 
sides, and  by  means  of  abdominal  exploration,  that  the  left  horn  of  the  uterus,  which 
contained  the  foetus,  had  passed  over  the  right  horn,  and  that  the  latter,  which  was 
empty,  occupied  the  left  flank.  It  was  therefore  clear  that  this  was  an  instance  of  right 
torsion.  The  carcase  was  then  rolled  from  the  left  side,  on  which  it  lay,  on  its  back  to 
the  right  side.  In  doing  this  it  was  observed  that  the  plies  became  tighter  and  closer. 
It  was  moved  in  the  contrary  direction — from  the  right  side,  on  the  back,  left  side,  and 
sternum  to  the  right  side.  At  the  third  turn  in  this  sense  the  uterus  regained  its  nor- 
mal position. 

5.  Chuchu  [Recueil  de  Med.  Veieriftaire,  1866,  p.  705)  publishes  ten  cases  of  torsion, 
one  of  which  has  been  selected  by  Saint-Cyr  for  the  purpose  of  illustration. 

In  this  case  it  is  attempted  to  show  the  comparative  merits  of  the  two  procedures.  It 
was  a  demi-torsion /riw/  right  to  left — or  a  left  torsion,  in  fact ;  the  right  cornu,  passing 
above  the  left,  became  the  left.  The  Cow  was  laid  on  the  right  side,  and  rolled  over  on 
its  back  to  the  left  side.  But  there  was  no  change.  It  was  then  rolled  in  the  contrary 
way ;  detorsion  was  at  once  effected. 


DYSTOKIA  BY  DISPLACEMENT.  321 

All  the  facts  collected  b}^  Saint-Cyr  are  unanimous  in  justifying  the  ac- 
ceptance of  the  precept  which  he  has  formulated  in  the  following  brief 
and  distinct  manner  for  application  in  these  often-times  difficult  cases  : 
Torsion  I0  the  left — lay  the  animal  on  the  left  side.  Torsion  to  the  right — 
lay  the  animal  on  the  right  side.  Or  the  same  precept  might  be  formulated 
in  this  way :  In  torsion  from  right  to  left,  roll  the  Cow  from  left  to  right ; 
and  vice  versA. 

Though  this  precept  appears  contradictory  to  what  has  been  recom- 
mended above — in  order  to  reduce  the  torsion,  make  the  body  of  the 
animal  execute  an  equal  degree  of  movement,  and  in  the  same  direction, 
as  that  executed  by  the  uterus  ;  yet  the  contradiction  is  only  apparent,  not 
real.  In  fact,  in  this  manoeuvre  the  movement  of  rotation  does  not  really 
commence  at  the  moment  when  the  Cow,  lying  on  its  side,  is  turned  on 
its  back;  but  rather  at  the  time  when  it  is  thrown  on  its  side  from  the 
standing  posture.  If  it  is  thrown  on  the  left  side  for  a  left  torsion, 
it  really  falls  from  right  to  left — or  in  the  same  sense  as  the  uterine 
twist. 

Since  the  publication  of  these  valuable  remarks,  further  confirmation 
of  their  exactness  has  been  afforded  by  various  papers  published  in  dif- 
ferent veterinary  periodicals. 

Of  these  we  will  only  select  two — the  most  recent  and  interesting. 

I.  Coquet  [Journal  de  Med.  Veterinaire  et  de  Zootechnie,  1876,  p.  66)  relates  that  on 
May  21,  1875,  he  was  sent  for  to  see  a  Cow  which  for  several  days  had  been  endeavoring 
to  calve.     On  arrival  he  found  the  animal,  which  was  eight  or  nine  years  old,  lying  on 
its  left  side  in  a  sterno-costal  attitude,  the  head  bent  on  the  neck  and  the  muffle  resting 
on  the  litter.    The  pulse  was  small  and  quick — about  62  per  minute — the  ears  were  cold, 
and  the   respiration   plaintive.     The   Cow  was  not  making  any  expulsive  efforts;  the 
udder  was  flaccid,  though  somewhat  voluminous ;  the  vulva  was  not  si.uollen,  and  there 
was  no  sign  of  secretion  or  discharge  from  it.     The  animal's  condition  was  moderate. 
The  Cow  had  been  purchased   twenty  days  previously,  apparently  in  good  health ; 
'   eight  days  afterwards  symptoms  of  approaching  parturition  t)egan  to  show  themselves. 
;   On  the  1 6th,  expulsive  efforts  began  to  be  made  :  the  animal  pawed,  lay  down  and  got 
I    up  again  several  times,  and  appeared  to  be  suffering  from  colic.     In  three  or  four  hours 
i   these  symptoms  subsided,  the  Cow  became  quiet,  and  all  seemed  well  again.     During 
i  the  following  night  there  was  some  indication  of  colic,  but  less  agitation  than  before, 
and  the  next  there  appeared  to  be  nothing  whatever  amiss.     On  the   i8th,  the  animal 
was  dull,  pawing,  lying  down  first  on  one  side,  then  on  the  other,  making  expulsive  ef- 
forts at  times. 

The  attendants  kept  looking  out  for  the  '"  water-bag,"  but  nothing  whatever  appeared 
at  the  vulva.  The  Cow  was  still  suffering  on  the  19th ;  it  remained  lying  the  greater 
part  of  the  day  and  refused  all  food.  On  the  20th  it  was  in  the  same  condition,  making 
expulsive  efforts  every  now  and  again.  The  prostration  was  great  on  the  21st,  and  there 
were  no  labor  pains ;  the  appetite  was  lost,  and  the  moans  were  constant. 

On  obtaining  this  information.  Coquet  proceeded  to  examine  the  genital  organs.  Oil- 
I  ing  his  right  hand,  he  introduced  it  into  the  vagina,  where  he  found  numerous  spiral 
folds  which  converged  towards  the  bottom  of  the  passage,  where  they  gathered  so 
closely  that  he  could  pass  his  fingers  no  farther  forward.  In  following  these  folds,  his 
hand,  introduced  in  a  state  of  pronation^  rotated  on  the  wrist ;  so  that  the  cubital  border 
which  was  at  first  to  the  right,  became  inferior,  then  internal,  so  as  to  bring  the  hand 
into  a  state  of  supination,  the  elbow  looking  downwards.  He  therefore  diagnosed  torsion 
of  the  uterus  to  the  right,  the  torsion  being  complete  ;  for  notwithstanding  all  his  efforts 
his  hand  could  not  reach  the  cervix. 

The  prognosis  was  unfavorable,  because  of  the  long  duration  of  the  torsion,  as  well 
as  its  extent.  Nevertheless,  it  was  determined  to  effect  reposition  of  the  uterus  if  pos- 
sible ;  and  with  that  object  five  or  six  men  were  sent  for,  ropes  were  procured,  and  the 
other  articles  necessary  for  such  an  operation  were  provided.  A.n  attempt  was  first 
aiade  to  raise  the  Cow,  but  this  was  unsuccessful,  and  it  remained  lying  on  the  left 
;ide. 

In  this  position-its  legs  were  tied  together  by  means  of  a  rope,  and  an  assistant  having 
3een  placed  at  its  head,  the  others  were  told  off  to  roll  it  on  the  litter,  turning  it  first  on 

21 


322 


MATERNAL  DYSTOKIA. 


its  sternum,  then  on  the  right  side,  back,  and  so  on.  While  this  was  being  done.  Coquet, 
with  his  hand  in  the  vagina,  endeavored  to  fix  the  uterus  ;  and  as  the  rotation  move- 
ment went  on,  the  cervix  was  reached,  then  the  os  was  felt  to  open,  and  when  a  com- 
plete turn  had  been  made,  two  fingers  were  introduced.  When  two  rotations  of  the 
body  had  been  completed,  the  obstructing  folds  had  disappeared,  and  the  hand  could 
enter  the  cavity  of  the  uterus  with  ease.  Then  the  membranes  were  ruptured,  the  fore 
limbs  of  the  foetus  were  seized — the  calf  being  in  an  anterior  presentation  and  vertebro- 
sacral position. 

Notwithstanding  the  dilatation  of  the  os,  energetic  traction  had  to  be  employed,  as 
the  Cow  made  no  attempt  to  assist  in  parturition ;  five  men  had  to  pull  with  all  their 
strength  at  the  cord  fastened  to  the  limbs  of  the  foetus  before  delivery  could  be  effected. 
A  living  and  well-developed  calf  was  extracted  ;  but  the  Cow  lay  extended  on  the  litter, 
perfectly  exhausted  apparently.  Immediately  after  the  extraction  of  the  calf  a  stream 
of  blood  issued  from  the  vulva,  which  necessitated  plugging  of  the  vagina  by  means  of 
cloths  steeped  in  cold  w^ater.  This  arrested  the  haemorrhage,  but  the  animal  continued 
to  lie  motionless  and  perfectly  indifferent  to  everything  going  on  around  it.  Stimulants 
were  administered,  the  next  day  it  was  able  to  eat,  and  soon  after  it  perfectly  recovered, 
regaining  condition  and  suckling  the  calf. 

2.  On  May  26,  1875,  M.  Dus,  of  Mehun  [Renieil  de  Med.  Veterinaire,  September, 
1876),  had  to  attend  a  young  Cow  of  small  size,  which  had  arrived  at  the  termination  of 
its  second  pregnancy,  but  was  unable  to  calve,  though  it  had  been  attempting  to  do  so 
for  about  fifteen  hours.  For  some  months  the  animal,  although  well  fed,  had  been 
losing  condition,  and  was  unwell;  it  had  not  quitted  the  cow-shed  since  winter,  except 
to  go  to  the  watering-place,  a  short  distance  away,  and  access  to  which  was  easy.  When 
seen  by  Dus,  it  was  lying  on  the  sternum,  a  little  inclined  to  the  left.  From  time  to 
time  it  made  slight  expulsive  efforts  which  had  no  result.  The  "waters  "  had  not  es- 
caped, and  nothing  was  to  be  seen  at  the  vulva,  which  was  much  dilated  and  oedema- 
tous,  through  the  manipulations  of  an  empiric  who  had  been  previously  called  in.  The 
udder  was  very  large,  and  milk  flowed  from  the  teats.     The  appetite  was  lost. 

The  Cow  was  got  up,  and  a  vaginal  exploration  made;  when  it  was  immediately  dis- 
covered that  there  existed  at  the  bottom  of  the  canal  a  duplicature  of  the  mucous  mem- 
brane, which  was  directed  from  left  to  right  and  downwards  and  forwards,  leaving  be- 
low an  aperture  through  which  the  cervix  uteri  could  be  reached.  The  os  uteri  was 
dilated,  but  the  hand  could  only  be  introduced  into  the  organ  with  extreme  difficulty. 
When  so  introduced,  however,  the  feet  of  the  foetus  could  be  felt,  but  the  arm  was  so 
severely  compressed  by  the  vaginal  duplicature  that  delivery  was  considered  to  be  utterly 
impossible.  Torsion  of  the  uterus  from  left  to  right  was  diagnosed,  and  attempts  at  re- 
duction were  at  once  made.  The  animal  was  laid  on  the  right  side  by  tying  its  limbs 
together  and  pushing  it  over.  The  hand  was  introduced  into  the  uterus  to  fix  it  as  much 
as  possible  by  means  of  the  fore  limbs  of  the  foetus,  which  was  in  a  normal  position. 
The  assistants  present  were  then  told  to  raise  the  Cow's  limbs,  so  as  to  turn  it  on  its 
back  and  to  the  left  side.  After  this  half-turn  of  the  body,  it  was  found  that  the  arm 
was  not  so  compressed  ;  and  on  continuing  the  movement  of  rotation  on  the  sternum 
and  right  side  again,  the  animal's  body  having  now  made  a  complete  revolution,  the 
uterus  was  discovered  to  be  completely  untwisted,  and  the  "  water-bag  "  immediately 
passed  through  the  os  without  rupturing. 

The  Cow's  limbs  were  then  unfastened  and  it  was  led  to  its  stable,  where  delivery 
was  effected  in  a  natural  manner ;  though  not  without  assistance,  the  animal  being  so 
prostrated  from  the  previous  ineffectual  efforts.  In  a  few  days  recovery  was  complete, 
and  Cow  and  calf  subsequently  did  well. 

There  is  not  much  to  add  with  regard  to  this  "  rotation  "  treatment  of 
torsion.  We  have  recommended  that  if  the  animal  can  be  moved  from 
its  stall,  and  time  permit,  it  should  be  thrown  down  on  litter  in  a  roomy 
place  ;  all  the  limbs  may  be  tied  together  at  once  ;  or  first  the  two  fore 
and  then  the  two  hind  legs,  these  being  fastened  together  afterwards,  but 
not  allowed  to  cross.  For  an  ordinary-sized  Cow  five  assistants  are  nec- 
essary ;  one  of  these  is  to  be  placed  at  the  animal's  head  to  hold  it,  and 
make  it  follow  the  movements  of  the  body  ;  the  second  should  keep  the 
limbs  as  close  to  the  belly  as  possible,  when  the  Cow  is  rolled  over  on 
them.  It  is  very  important  during  the  operation  that  the  hocks  be  kept 
flexed  as  much  as  possible,  in  order  to  prevent  the  udder  being  damaged, 
and  also  to  avoid  muscular  injuries  to  the  upper  part  of  the  hind  limbs. 


DYSTOKIA  BY  DISPLACEMENT  323 

The  other  three  assistants  should  lift  and  roll  the  Cow,  and  aid  the  second 
in  pulling  at  the  hind  legs  when  the  animal  is  being  placed  on  its  back. 
We  have  already  described  how,  and  explained  why,  rotation  should  be 
made  either  in  one  direction  or  the  other. 

The  operator  need  not  endeavor  to  render  the  uterus  perfectly  immov- 
able during  the  rolling,  as  it  turns  a  good  deal  with  the  body  of  the 
animal,  and  particularly  when  the  mass  of  the  rumen  presses  with  all  its 
weight  on  the  organ.  This  is  also  the  reason  why,  according  to  Zundel, 
a  half  or  even  quarter  torsion  requires  for  its  reduction  at  least  a  com- 
plete revolution  of  the  body-  It  often  needs  a  number  of  turns  to  reduce 
the  torsion,  but  generally  two,  three,  or  four  are  sufficient. 

There  is,  therefore,  no  pressing  necessity  for  maintaining  the  uterus 
absolutely  fixed  while  the  Cow  is  being  rolled  ;  indeed,  as  a  rule,  it  is  no 
easy  matter  to  keep  it  at  all  near  the  desired  position,  there  being  a  great 
difficulty  to  find  a  part  to  cling  to.  The  hand  should  rather  be  employed 
to  discover  the  effects  of  the  version,  and  to  find  when  the  genital  pas- 
sage is  patent. 

An  important  precaution  in  this  operation  has  been  notified  by  some 
practitioners  ;  and  that  is  to  roll  the  Cow  on  a  slightly  inclined  floor,  if 
possible.  It  may  be  observed,  however,  that  while  Wegerer  and  others 
recommend  that  the  hind  quarters  of  the  animal  should  be  the  highest, 
Chambon  and  Liautard  maintain  that  they  ought  to  be  lower  than  the 
rest  of  the  body.  And  we  can  scarcely  be  in  doubt  as  to  the  correctness 
of  the  latter  opinion  ;  for  in  the  position  indicated,  the  uterus  falls 
towards  the  plevic  cavity,  and  this  favors  relaxation  of  the  torsion,  and 
the  more  easy  introduction  of  the  hand  through  the  obstacle  in  the 
vagina,  if  it  is  desired  to  attempt  to  fix  the  organ  by  the  hand  while  roll- 
ing is  taking  place. 

Wegerer's  position — the  hind  quarters  raised — is  nevertheless  to  be 
preferred  if  it  is  sought  to  fix  the  uterus  by  its  own  weight,  when  the 
hand  cannot  be  passed  into  the  vagina  or  cannot  act  advantageously 
there. 

As  in  the  majority  of  cases  there  is  only  incomplete  torsion,  and  all 
that  has  to  be  done  is  simply  to  replace  the  foetus,  or  rather  the  uterus, 
on  its  bed  or  hammock,  reposition  can  sometimes  be  effected  by  merely 
rolling  the  animal  on  its  back. 

In  some  instances,  when  slow  steady  rolling  will  not  suffice,  a  quick  or 
jerking  roll  may  be  successful  j  in  other  instances  it  has  been  found 
advantageous  to  place  the  animal  on  its  back,  and  roll  it  from  side  to 
side. 

Wegerer,  Sacchero,  Rueff,  and  some  others,  have  combined  rolling 
with  abdominal  manipulation  and  compression,  so  as  to  fix  the  foetus  and 
uterus,  or  to  push  them  in  the  desired  direction  for  effecting  detorsion  \ 
at  the  same  time  rotation  is  practised  according  to  the  directions  laid 
down. 

Numerous  practitioners  are  content  to  roll  the  Cow  without  attempting 
to  fix  or  manipulate  the  vagina  or  uterus,  and  many  successful  cases  are 
recorded  by  them. 

But  this  success  appears  to  have  been  obtained  at  the  expense  of  the 
Cow  or  its  foetus,  as  the  rotation  had  to  be  carried  on  for  a  longer  time 
than  if  the  organ  had  been  fixed  ;  several  turns  may  be  necessary  where 
one  would  suffice  with  the  hand  in  the  vagina. 

If  detortion  does  not  take  place  so  soon  as  anticipated,  there  is  no 


[^^4r  MATERNAL  DYSTOKIA 

reason  to  despair.  If  the  direction  of  the  twist  has  been  exactly  made  out, 
the  rotation  may  be  continued.  Weber,  Wannovius,  and  Fischer  mention 
instances  in  which  the  Cow  has  been  rolled  from  fifteen  to  twenty  turns 
b'efore  success  crowned  their  efforts.  It  is  even  mentioned  that  the  roll- 
ings in  some  cases  has  occupied  an  hour  or  more.  Weber  writes  : — 
"  The  Cow  is  often  rolled  for  more  than  an  hour.  The  operation  is 
laborious,'  sometimes  painful,  to  the  operator  ;  it  demands  an  expendi- 
ture of  strength  which  the  most  vigorous  can  scarcely  boast  of,  and  it 
needs  a  good  deal  of  amour-propre  Xo  undertake  such  a  task.  The  efforts 
required  to  complete  it  are  so  great,  that  often  when  a  successful  result 
has  been  obtained  the  operator  is  out  of  breath  and  exhausted." 

Happily,  these  extreme  and  baffling  cases  are  rare,  and  they  have 
generally  been  observed  with  Cows  in  which  the  foetus  was  dead.  It  is 
a  common  remark,  that  reposition  is  easier  when  the  foetus  is  alive  than 
when  it  is  dead. 

Unfortunatel)-,  cases  will  be  met  with  in  which  replacement  of  the 
uterus,  and,  consequently,  delivery  of  the  foetus,  is  impossible  by  this 
method  of  rotation,  and  these  are  more  particularly  cases  of  multiple 
torsion.  Rueff  says  that  they  are  sometimes  accompanied  by  decompo- 
sition of  the  foetus,  when  the  gases  which  are  developed  in  the  uterus 
inflate  the  organ,  and  prevent  its  being  untwisted.  In  other  instances 
there  is  plastic  adhesion  between  the  spiral  folds,  or  between  the  uterus 
and  other  abdominal  viscera,  or  even  the  parietes  of  the  abdomen. 

It  has  often  been  predicted  that  the  rotation  procedure  may  give  rise 
to  serious  accidents — such  as  volvulus  of  the  intestines,  hernise,  etc.  But 
we  cannot  find  any  notice  of  such  accidents  having  occurred. 
'  If  the  diagnosis  is  co'rrect,  the  nature  and  direction  of  the  torsion  well 
ascertained,  and  the  animal  not  too  much  exhausted  nor  the  parts  involved 
seriously  injured,  a  successful  result  may  be  anticipated  in  the  large 
majority  of  cases,  if  the  treatment  above  indicated  is  carried  out. 

When  the  uterus  is  replaced  in  its  normal  position,  the  genital  passages 
patent  and  in  a  proper  state  for  delivery,  the  Cow  not  much  exhausted, 
and  the  foetus  in  a  good  attitude  for  birth,  time  maybe  allowed  for  Nature 
to  effect  the  expulsion  of  the  young  creature.  Birth  is  generally  not  long 
delayed  under  such  circumstances,  and  the  operator  has  the  satisfaction 
of  knowing  that  he  has  been  the  means  of  saving  the  Cow,  and  very  often 
its  progen}^,  with  but  trifling  inconvenience  to  both.  The  after  conse- 
quences, so  far  as  the  Cow  is  concerned,  are  of  no  more  importance  than 
those  of  ordinary  parturition. 

But  not  unfrequently,  deceived  by  the  slight  symptoms  of  indisposition 
the  Cow  at  first  exhibits,  the  owner  does  not  send  for  the  veterinarian 
until  too  late  to  save  the  foetus,  and  even  the  Cow. 

In  some  cases  it  will  be  found  that  birth  cannot  take  place  after  repo- 
sition of  the  organ,  from  inertia  or  paralysis  of  its  muscles  :  due  either  to 
the  great  extension  the  fibres  have  experienced,  the  interrupted  circula- 
tion of  blood  in  the  organ,  or  injury  to  its  nerves. 

In  such  cases  stimulants  should  be  given,  and  friction  applied  to  the 
abdomen  and  loins..  Ergot  of  rye  is  recommended  by  Continental  veteri- 
narians. Should  uterine  action  not  speedily  ensue,  and  particularly  if 
the  OS  is  dilated  and  the  membranes  are  ruptured,  the  foetus  must  be 
removed  by  traction.  If  the  os  is  impervious,  and  atony  of  the  uterus 
continues,  then  steps  must  be  adopted  toMleliver  artificially. 
•  When  the  torsion  has  been  in  existence  for  some  time,  the  liquor  amnii 


DYSTOKIA  BY  DISPLACEMENT.  ^25 

expelled,  and  the  uterus  closely  applied  round  the  foetus,  then  extraction 
is  difficult  and  laborious,  and  prolapsus  uteri  is  not  unlikely  to  follow. 
The  genital  canal  should  be  lubrified  with  glycerine,  injections  of  tepid 
water  may  be  thrown  into  the  uterus ;  and  when  the  secundines  are 
removed,  it  may  be  necessary  to  inject  some  antiputrescent  substance,  if 
there  are  foul-smelling  discharges  or  any  apprehension  of  septikaemia. 

In  serious  cases,  after  reposition  of  the  uterus  and  delivery  of  the 
foetus,  grave  complications  may  ensue — such  as  metritis,  metro-peritoni- 
tis, etc.  It  may  also  then  be  discovered  that  a  rupture  of  the  viscus 
exists. 

These  complications  must  be  treated  according  to  their  indications. 

7.  Gastro-hysterotomy,  or  Cesarean  Section. — This  operation 
has  been  recommended,  when  the  other  measures  described  above  have 
failed,  with  the  object  of  saving  the  foetus,  if  it  is  still  alive,  or  to  preserve 
the  life  of  the  Cow.  Laparotomy  may  be  resorted  to  sometimes,  instead 
of  abdominal  section  towards  the  linea  alba. 

Rocco  {II  Medico  Veteri?iaria,  1863)  has  twice  successfully  performed 
the  Caesarean  section  in  torsion  of  the  uterus,  and  delivered  living  calves. 
Lemaire  {Recueil  de  Med.  Veterinaire)  relates  a  case  of  torsion  and  rup- 
ture of  the  uterus,  in  which  recovery  was  hopeless.  The  Cow  was  killed, 
the  abdomen  immediately  and  widely  opened,  and  the  foetus  extracted 
from  the  uterus  with  all  haste.     The  Calf  was  alive,  and  did  well. 

We  shall  describe  the  operation  hereafter. 

Torsion  of  the  Uterus  in  the  Mare. 

Torsion  of  the  uterus  in  the  Mare  is  a  rare  accident.  This  is  doubt- 
less owing  to  the  direction  of  the  uterine  cornua,  and  the  manner  in 
which  the  broad  ligaments  are  attached  to  them,  which  renders  rotation 
of  the  organ  very  difficult,  unless  there  is  some  anatomical  anomaly  in 
the  parts. 

Nevertheless,  undoubted  instances  of  this  displacement  in  the  preg- 
nant Mare  are  on  record.  Belhomme,  in  1850,  was  the  first  to  describe 
the  accident  ;  he  was  followed,  in  1852,  by  Elsen  and  Delwart  ;  in  i860, 
by  Hamon  ;  in  1861,  by  Canu  ;  in  1863,  by  Schmidt ;  in  1866,  by  Jan- 
sen  ;  in  1870,  by  Gierer ;  and  in  1875  ^"^^  ^^11^  by  Cox  {Veterinajy 
yournal,  vol.  i.,  p.  263,  vol.  iv.,  p.  28). 

Serious  doubts  having  been  entertained  as  to  the  possibility  of  such 
an  accident  in  this  animal,  the  fact  that  it  can  take  place  was  experi- 
mentally demonstrated  by  Goubaux  in  1864. 

Causes. 

The  cause  of  uterine  torsion  in  the  Mare  are  not  well  ascertained.  It 
is  not  improbable  that  some  of  the  causes  which  produce  it  in  the  Cow 
will  also  be  effective,  in  certain  circumstances,  in  the  Mare. 

Wolff  mentions  that  he  has  witnessed  it  in  a  Mare  which  had  suffered 
from  attacks  of  colic  four  days  previously,  and  whgn  so  affected  had 
thrown  itself  down  and  rolled  violently.  In  Cox's  case,  a  few  weeks  be- 
fore parturition,  the  Mare  had  an  attack  of  colic,  and  rolled  over  several 
times. 

The  accident  has  only  been  seen  in  Mares  whose  period  of  gestation 
had  nearlv  terminated.     In  Elsen's  case  the  Mare  had  been  ten  months 


326  MATERNAL  DYSTOKIA. 

pregnant ;  in  Hamon's  case  the  ordinary  period  had  expired  ;  and  the 
Mare  which  was  attended  by  Schmidt  was  within  a  few  days  of  foaling. 

Symptoms. 

The  general  symptoms  appear  to  be  similar  to  those  observed  in  the 
Cow.  The  local  symptoms,  however,  differ  somewhat,  the  torsion  being 
generally Iriore  forward  in  the  body  of  the  uterus;  so  that  the  spiral 
vaginal  folds  are  often  not  so  distinct,  and,  from  Goubaux's  experiments, 
may  even  not  be  felt  at  all. 

Rectal  exploration  is  recommended  by  Saint-Cyr  in  these  cases,  the 
torsion  being  felt  as  a  thick,  short,  and  hard  cord.  Schmidt  easily  in- 
troduced his  hand  into  the  rectum  as  far  as  the  abdominal  margin  of  the 
pubis,  and  there  he  felt  under  his  hand  an  obstacle  which  prevented 
further  progress,  as  only  three  fingers  could  be  introduced  beyond  this. 
The  body  under  his  hand  was  hard,  resisting,  and  immovable  ;  whereas 
the  contents^ of  the  colon  were  soft  and  easily  indented  by  the  fingers. 

The  posterior  portion  of  the  floating  colon,  as  in  this  instance,  may  be 
obstructed  in  the  Mare  by  the  twist  formed  by  the  uterus  and  the  broad 
ligaments,  and  this  obstruction  will,  of  course,  prevent  expulsion  of  the 
faeces. 

Prognosis  and  Treatment. 

This  accident  must  be  considered  more  serious  in  the  Mare  than  the 
Cow,  for  some  of  the  reasons  already  alluded  to  as  influencing  parturi- 
tion and  its  results  in  these  animals. 

The  treatment  must,  of  course,  be  similar.  Belhomme  succeeded,  by 
powerful  traction,  and  without  previous  reduction  of  the  twisted  uterus, 
in  extracting  a  dead  foal  in  what  he  describes  as  a  case  of  "  demi-tor- 
sion."  It  is  probable  that  the  torsion  could  not  have  been  so  great,  for 
when  it  exists  to  this  degree  delivery  by  traction  is  impossible. 

Elsen  and  Delwart  succeeded  in  reducing  the  torsion  in  their  case,  by 
rolling  the  Mare  in  the  manner  we  have  recommended  to  be  adopted 
with  the  Cow.  In  this  instance,  however,  every  thing  was  against  the 
success  of  the  operation,  for  the  foetus  had  already  been  two  months  be- 
yond its  time  in  the  uterus  ;  it  was  dead  and  in  a  state  of  putrefaction, 
and  had  to  be  removed  piecemeal.  The  Mare  died  from  septic  infec- 
tion eleven  days  after  the  operation. 

In  Canu's  interesting  case  the  result  was  favorable.  The  Mare  had 
been  endeavoring  to  foal,  it  would  appear,  for  ten  days,  and  was  evi- 
dently about  to  succumb.  Canu,  recognizing  torsion  of  the  uterus,  was 
proceeding  to  open  it  by  force,  when  the  animal  fell  with  great  violence, 
and  the  shock  her  body  received  had  the  unlooked-for  result  of  com- 
pletely untwisting  the  organ,  so  that  parturition,  though  difficult,  became 
possible.  The  foal  was  dead,  as  might  have  been  predicted  ;  but  the 
Mare  was  saved,  and  continued  to  recover  sufficiently  to  be  put  to  light 
work,  when,  on  the  thirtieth  day  after  the  operation,  it  was  attacked  with 
metrorrhagia  which  nearly  killed  it.     It  eventually  got  well. 

Hamon,  in  France,  and  Schmidt,  in  Germany,  endeavored  to  effect  re- 
duction of  the  torsion  in  their  cases  by  rolling  the  Mares  first  in  one 
direction,  then  in  the  other  ;  but  without  success,  as  both  animals  died 
without  being  delivered. 

Gierer  observed  two  cases  of  complete  torsion  in  Mares,  in  both  of 
which  the  accident  was  complicated  by  a  large  rupture  at  the  base  of  the 
uterus,  through  which  the  foetus  had  escaped  into  the  abdominal  cavity. 


MORBID  ALTERATIONS  IN  THE  GENITAL  ORGANS. 


327 


Cox  (  Veterinary  yournal,  1875,  p.  264)  found  the  head  and  fore  legs 
of  the  foetus  protruding  through  the  inferior  wall  of  the  uterus.  Explora- 
tion discovered  the  vaginal  passage  beyond  these  parts,  but  it  suddenly 
terminated  ;  though  a  small  rpgose  opening,  barely  admitting  two  fingers, 
was  found.  The  Mare  died  in  two  hours  ;  and  on  examination  there 
was  noted  a  double  twist  of  the  cervix  uteri,  with  rupture  of  the  uterus 
and  vagina. 

Torsion  of  the  Uterus  in  other  Animals. 

We  need  not  allude  to  this  accident  in  the  other  animals  mentioned  as 
liable  to  the  accident,  as  it  is  scarcely  possible  to  diagnose  its  existence, 
owing  to  their  small  size.  Besides,  it  appears  to  be  extremely  rare  in 
them.  We  may,  however,  refer  to  a  case  of  uterine  torsion  in  the  Cat, 
which  is,  we  believe,  unique. 

Vivier  {Archives  Veterinaires,  Sept.,  1876,  p.  424)  had  a  fine  large  Cat,  two  years  old, 
and  just  dead,  brought  to  him.  A  few  hours  previously  it  had  been  apparently  quite 
well.  The  owner,  suspecting  it  had  been  poisoned,  wished  a  post-mortem  examination 
to  be  made.  Vivier  found  the  muscles  almost  bloodless  when  the  skin  was  removed ; 
and  on  incising  the  abdominal  parietes,  he  was  surprised  to  find  one  of  the  uterine  cor- 
nua  suddenly  escape  from  the  opening.  This  cornu  was  deeply  congested ;  indeed,  it 
was  almost  of  a  violet  tint,  and  the  veins  were  gorged  with  dark-colored  blood.  The 
other  cornu  was  less  voluminous,  but  offered  the  same  lesions.  It  was  evident  the  Cat 
was  pregnant. 

When  the  abdomen  was  completely  opened,  it  was  discovered  that  the  uterus  had  made 
two  turns  on  itself,  the  tivists  being  to  the  right  and  left ;  the  cervix  presented  the  spiral 
appearance  characteristic  of  torsion  ;  the  broad  ligaments  were  intact,  and  had  followed 
the  uterus  in  its  revolution.  The  two  cornua  being  opened  lengthways,  they  were  found 
to  contain  a  large  quantity  of  black  blood  mixed  with  clots ;  in  this  fluid  were  five 
foetuses  (three  in  one  cornu,  and  two  in  the  other)  contained  in  their  membranes,  and 
probably  about  fifteen  days  old. 

This  was,  therefore,  a  case  of  double  torsion  of  the  uterus,  and  it  was  most  probable 
that  death  was  immediately  due  to  the  considerable  haemorrhage.  Nothing  could  be 
learned  as  to  the  cause  of  the  accident. 


CHAPTER  HI. 

Dystokia  from  Morbid  Alterations  in  the  Genital  Organs. 

Following  the  arrangement  adopted  by  Saint-Cyr,  we  will  in  this  chapter 
study  the  obstacles  to  parturition  which  are  due  to  (i)  Tumors  developed 
in,  /)r  in  the  vicinity  of,  the  genital  organs  of  the  female ;  (2)  Rigidity  of  the 
cervix  uteri ;  (3)  Morbid  dege?ierations  of  the  cervix  uteri ;  and  (4)  Oblitera- 
tion  of  the  os  uteri. 

I.  Uterovaginal  Tumors. 

The  tumors  met  with  in  the  vagina  and  uterus  differ  much  with  regard 
to  their  nature,  origin,  structure,  and  influence  on  the  act  of  parturition. 
Sometimes  they  are  contained  in  the  interior  of  the  genital  organs  :  in  the 
uterus  or  its  cornua  or  cervix,  and  on  the  walls  of  the  vagina,  as  well  as 
on  the  labia  of  the  vulva  ;  at  other  times  they  hav^e  their  seat  in  the  neigh- 
boring parts  or  organs:  in  the  bladder,  rectum,  or  pelvic  connective 
tissue.  They  may  be  constituted  by  degenerations  or  displacements  of 
these  parts,  or  by  heteroplastic  products  developed  there. 


328  MATERNAL  DYSTOKIA. 

Their  volume,  form,  and  consistence  are  very  diverse  ;  and  they  may 
either  adhere  closely  or  loosely  to  the  adjacent  parts,  being  fixed  in  the 
one  case  and  movable  in  the  other.  Some  are  attached  or  implanted  by 
wide  bases,  others  are  pediculated  or  retained  by  a  more  or  less  narrow 
pedicle.  • 

Tumors  of  the  soft  parturient  passages  are  rather  rare  in  the  domesti- 
cated animals,  and  their  occurrence  has  only  recently  been  brought  under 
observation.  The  first  instance  is  probably  that  recorded  by  Jeanroy,  in 
1828  {Recueil  de  Med.  Veierinaire,  1828,  p.  639).  Since  that  period  a 
number  of  cases  have  been  recorded  by  veterinarians  in  this  and  other 
countries,  and  as  some  of  these  are  very  interesting,  we  will  give  them  a 
brief  notice  hereafter. 

With  regard  to  parturition,  these  tumors  may  be  considered  in  a  gen- 
eral manner  according  to  their  {1)  Seat ;  (2)  Mode  of  attachment ;  and  (3) 
Consistence. 

1.  Seat. — The  situation  of  genital  tumors — whether  in  the  vagina,  on 
the  cervix  uteri,  in  the  os  uteri,  body  of  the  uterus,  or  cornua — will  make 
a  very  great  difference  in  the  act  of  parturition. 

Those  tumors  which  are  developed  in  the  uterine  cornua  may,  by  alter- 
ing the  structure  of  the  walls  of  the  uterus,  hinder  the  amplification  of  the 
organ,  impair  the  nutrition  of  the  foetus,  and  even  cause  it  to  be  expelled 
prematurely.  If,  however,  they  do  not  interfere  with  the  regular  course 
of  gestation,  birth  may  take  place  in  a  natural  manner  and  without  inter- 
ruption. If  the  foetus  is  situated  behind  the  tumor,  towards  the  body 
of  the  uterus,  of  course  it  meets  with  no  obstruction  in  its  passage  out- 
wards j  and  if  it  should  happen  that  labor  is  longer  and  more  difficult 
than  usual,  this  can  only  be  attributed  to  the  alteration  the  pathological 
production  has  effected  in  the  muscular  structure  of  the  uterus,  an-d  which 
may  produce  a  diminution  in  its  contractile  or  expelling  power. 

When,  however,  the  tumor  is  between  the  foetus  and  the  genital  passages, 
the  case  is  much  more  serious.  If  it  is  fixed  directly  on  the  cervix,  it 
may  prevent  dilatation  of  the  os  to  the  necessary  extent,  or  perhaps 
altogether.  When  it  is  situated  in  front  of  the  cervix,  towards  the  body 
of  the  uterus,  but  in  the  immediate  vicinity  of  the  former,  and  is  movable 
to  a  certain  extent,  it  may  be  carried  into  the  dilated  os,  occupy  it  to  a 
greater  or  less  extent,  and  render  the  exit  of  the  foetus  impossible,  unless 
the  tumor  is  moved  out  of  the  way.  If  the  tumor  occupies  the  vagina,  it 
will  prove  a  more  or  less  formidable  obstacle,  as  it  is  large  or  small,  hard 
or  soft,  and  consequently  diminishes  the  calibre  of  this  outlet  for  the 
foetus. 

2.  Mode  of  Attachment. — The  manner  in  which  these  tumors  are  attached 
to  the  membranes  from  which  they  spring,  has  some  influence  on  their 
action  as  obstacles  to  birth.  They  have  either  a  wide  basis  of  attachment, 
or  they  are  sessile  or  pediculated. 

Those  tumors  which  have  a  very  wide  base  are  generally  of- a  malignant 
character ;  and  though  they  may  prove  very  serious,  so  far  as  the  female 
is  concerned,  yet  they  do  not  often  prove  a  cause  of  difficult  parturition, 
provided  they  are  not  situated  in  the  vagina  or  on  the  cervix.  Animals 
so  affected  do  not  generally  breed,  though  they  may  regularly  exhibit 
oestrum  ;  if,  however,  they  should  chance  to  conceive,  and  pregnancy  has 
terminated,  with  these  exceptions  parturition  may  not  be  delayed  in  its 
course. 

The  circumscribed  sessile  tumors  are  generally  more  serious  than  those 


MORBID  ALTERATIONS  IN  THE  GENITAL  ORGANS.      329 

which  are  pediculated  ;  as  the  latter  may  be  more  or  less  easily  displaced 
when  they  are  in  the  way,  and  delivery  rendered  as  easy  as  usual.  Or  if 
the  pediculated  tumors  cannot  be  temporarily  removed  from  the  path  of 
the  foetus,  they  may  easily  be  altogether  got  rid  of  by  a  simple  opera- 
tion, particularly  if  their  base  is  very  attenuated. 

3.  Consistence. — The  hardness  or  softness  of  the  tumors  has  an  impor- 
tant bearing  on  their  obstructiveness.  Such  tumors  as  the  fibroids  are  so 
dense  and  inelastic,  that  the  strongest  compression  will  scarcely  diminish 
their  volume  or  alter  their  shape  ;  while  others — such  as  the  condyloma- 
tous  or  papillomatous  tumors^ — readily  change  their  form  and  dimensions 
when  submitted  to  pressure. 

We  will  allude  to  each  of  these  morbid  productions  more  fully  here- 
after. 

Diagnosis. 

The  diagnosis  of  these  tumors  is  not  always  so  easy  in  the  domesti- 
cated animals  as  in  woman.  In  the  latter,  as  Saint-Cyr  truly  says,  the 
surgeon  may  sometimes  have  to  discover  the  existence  and  to  determine 
the  nature  of  such  growths  during  pregnancy  ;  and  he  may,  consequently, 
be  prepared  beforehand  to  overcome  the  difficulties  which  will  present 
themselves  at  a  later  period.  But  with  the  veterinary  obstetrist's  patients 
this  is  not  so  ;  and  it  is  only  and  always  during  parturition,  in  the  midst 
of  the  trouble  which  inevitably  accompanies  a  difficult  birth,  that  he  is 
called  upon  to  give  an  opinion. 

But  as  some  compensation  for  this  disadvantage,  in  animals  direct  explo- 
ration is  easier  than  in  woman  ;  while  the  entire  hand  can  be  introduced 
into  the  genital  passages  of  the  larger  creatures  with  facility,  and  explore 
every  part  \  so  that  if  the  period  is  late  for  acquiring  information  with 
regard  to  the  existence  of  tumors,  yet  these  facilities  enable  the  obstetrist 
to  obtain  most  valuable  notions  with  regard  to  diagnosis,  prognosis,  and 
treatment. 

But  this  exploration  should  be  complete  and  intelligent ;  as  errors  in 
diagnosis  are  easily  committed,  and  may  lead  to  serious  consequences. 
Here  the  hand,  not  the  eye,  must  be  the  guide,  and  just  as  the  sense  of 
touch  is  well  developed  in  this  organ,  so  it  will  all  the  more  readily  distin- 
guish between  a  tumor,  the  "  water-bag,"  or  some  part  of  the  foetus  which 
is  covered  by  or  denuded  of  its  membranes  ;  as  well  as  discover  the 
exact  seat,  volume,  consistence,  and  mode  of  attachment,  besides  some- 
thing of  the  nature,  of  such  pathological  productions  as  we  are  now 
considering. 

Treatmejit. 

The  indications  for  the  treatment  of  these  obstacles  to  birth  will,  of 
course,  depend  upon  a  variety  of  circumstances,  the  majority  of  which  have 
been  referred  to.  Sometimes  we  may  be  able  to  act  directly  on  the 
tumor,  and  remove  it  from  the  genital  passages  ;  in  other  cases,  from  its 
situation  and  nature,  it  may  be  beyond  the  reach  of  direct  action. 

When  in  the  vagina  and  not  far  from  the  vulva,  and  particularly  when 
pediculated,  it  is  occasionally  extruded  as  the  foetus  is  expelled  from  the 
uterus,  and  may  then  be  readily  seized  by  the  hand  or  forceps,  and  taken 
out  of  the  way.  In  such  a  case  the  tumor  may  be  either  drawn  outside 
the  vulva,  pushed  to  one  side  so  as  to  clear  the  passage,  or  extirpated. 

If  it  is  situated  beyond  the  os,  and  is  sufficiently  movable,  it  may  be 


330 


MATERNAL  DYSTOKIA. 


pushed  in  front  of  the  pelvic  inlet,  and  the  parts  of  the  foetus  which  pre- 
sent be  immediately  brought  therein  :  so  that  the  tumor  may  be  kept  out 
of  the  track  of  the  latter. 

Should  the  growth  be  of  the  nature  of  a  kyst  or  abscess,  merely  punc- 
turing it  by  means  of  a  bistoury,  scalpel,  or  trocar,  will  evacuate  its  fluid 
contents,  when  it  will  collapse  and  birth  be  rendered  possible. 

When  it  is  a  pediculated  tumor  like  a  polypus,  it  may  be  got  rid  of  at 
once  by  extirpation,  if  the  pedicle  is  easily  accessible.  To  this  end  the 
pedicle  may  be  simply  ait  through  ;  but  this  measure,  though  the  most 
expeditious,  is  not  always  the  best ;  as  there  may  ensue  internal  haemor- 
rhage, which  will  be  all  the  more  troublesome  as  haemostatic  agents  are 
difficult  of  application  to  the  wound. 

The  pedicle  may  certainly  be  ligatured,  either  in  mass  or  partially 
previous  to  extirpation,  in  order  to  obviate  the  disadvantages  attending 
simple  excision.  This  means  has  been  successfully  employed,  and 
though  perhaps  a  longer  and  more  difficult  operation,  it  is  to  be  preferred 
when  possible. 

Saint-Cyr  recommends,  before  all  other  measures,  linear  ecrase?ndnt, 
should  Chassaignac's  or  any  other  ecraseur  be  available.  This  ecrascme7it 
should  be  no  more  difficult  than  simple  excision,  and  so  far  as  haemorrhage 
is  concerned,  it  is  as  safe  as  the  ligature,  while  its  consequences  are 
much  more  trifling.  Cartwright  has  most  successfully  removed  a  vaginal 
tumor  by  the  ecraseur. 

When  the  base  of  the  tumor  is  very  small,  and  has  but  a  slender  attach- 
ment to  the  textures  from  which  it  springs,  and  when,  in  addition,  it  is 
beyond  the  application  of  a  ligature  or  the  use  of  the  ecraseur,  it  may  be 
torn  off,  or  removed  by  the  finger-nail. 

The  most  difficult  tumors  for  treatment  are  those  which  are  hard  and 
sessile,  and  to  which  the  foregoing  measures  are  not  applicable.  It  some- 
times happens,  however,  that  these  formations  have  only  a  very  loose 
connection  with  the  subjacent  tissues,  and  it  is  often  possible  to  remove 
them  either  wholly  or  in  part,  by  making  incisions  through  them,  and 
enucleating  the  divided  portions  by  means  of  the  fingers. 

It  is  rare  that  these  neoplasms  developed  in  the  labia  of  the  vulva 
offer  any  obstacle  to  birth  ;  should  they  chance  to  do  so,  however,  it  is 
easy  to  remove  them  by  means  of  the  scalpel  or  bistoury.  If  the  subse- 
quent oedema  of  the  labia  has  not  disappeared  when  parturition  com- 
mences, and  if  it  hinders  exploration  by  the  hand,  or  the  expulsion  of 
the  foetus,  it  may  be  combated  by  scarifications.  These,  however,  should 
only  be  made  during  parturition. 

There  may  occur  cases,  nevertheless,  in  which,  either  from  the  nature, 
mode  of  attachment,  or  situation  of  these  tumors,  their  removal  is  not 
possible,  and  birth  cannot  be  effected.  In  such  cases  it  will  be  for  the 
obstetrist  to  decide  whether  he  will  have  recourse  to  embryotomy  or  the 
Caesarean  section  :  this  decision  being  arrived  at  after  duly  weighing  all 
the  circumstances  and  facts  relating  to  them. 

Having  completed  these  general  considerations  on  utero-vaginal  tumors 
as  a  cause  of  dystokia,  and  offered  the  above  indications  in  the  way  of 
treatment,  we  will  now  proceed  to  notice  each  class  of  these  formations, 
in  so  far  as  they  have  been  recognized  as  obstacles  to  parturition  in 
animals. 


MORBID  ALTERA  TICK'S  IN  THE  GENITAL  ORGANS.     331 
CANCEROUS,  CARCINOMATOUS,  OR   SARCOMATOUS   TUMORS. 

Cancer  of  the  uterus,  and  other  organs  of  generation,  would  appear 
to  be  rare  in  animals,  and  very  few  veterinary  writers  allude  to  it.  Even 
those  observations  which  have  been  published  have  but  little  interest  for 
the  obstetrist,  as  nearly  all  of  them  have  no  relation  to  difficult  parturi- 
tion. Some  cases,  however,  have  been  recorded  in  which  cancer  of  the 
cervix  uteri  has  produced  contraction  of  the  os,  and  necessitated  opera- 
tive interference  in  order  to  effect  delivery  ;  and  one  or  two  instances  are 
noted  in  which  cancerous  tumors  have  elsewhere  proved  an  obstacle  to 
parturition,  and  even  when  that  act  has  been  accomplished  have  proved 
dangerous  from  the  haemorrhage  they  occasioned. 

When  the  cancer  is  situated  at  the  cervix,  and  the  os  cannot  be  dilated 
by  the  foetus,  then  treatment  must  be  directed  to  effect  sufficient  dilata- 
tion for  its  passage  through  the  canal.  In  nearly  every  instance  this 
must  be  accomplished  by  free  incision  of  the  cervix. 

CONDYLOMATOUS,  PAPILLOMATOUS,  AND  LIPOMATOUS  TUMORS. 

These  tumors  are  met  with  most  frequently  in  the  generative  organs  of 
the  Cow  and  Bitch,  and  particularly  in  the  vagina.  They  seldom  prove  a 
serious  obstacle  to  the  passage  of  the  foetus. 

They  first  appear  as  soft,  fungoid,  cauliflower-like  vegetations,  which 
bleed  from  the  slightest  contact,  and  are  readily  crushed  or  deformed. 
In  the  Bitch  they  sometimes  completely  fill  the  vagina,  and  give  rise  to 
a  constant  sanious,  and  most  offensive  discharge  from  the  vulva. 

Lipomatous  tumors  are  also  most  frequently  noticed  in  the  vagina  of 
the  Bitch  ;  and  in  two  instances  observed  by  Oreste  and  Falconio,  one 
tumor  was  the  size  of  a  filbert,  the  other  of  a  large  walnut. 

The  general  indications  for  treatment  are  applicable  to  these  growths. 

FIBROID   AND    MYOMATOUS   TUMORS. 

Fibroids  are  not  at  all  uncommon  in  the  generative  organs,  and  are 
frequently  the  cause  of  difficult  parturition.  They  have  been  observed  in 
the  uterus  and  vagina  of  the  Mare,  Cow,  Sow,  Goat  and  Bitch. 

In  structure,  it  would  appear  that  the  fundamental  portion  of  these 
tumors  is  composed  of  connective  tissue,  which  may  present  the  histologi- 
cal characters  of  areolar,  mucous,  or  tendinous  tissue,  the  fibres  of  which, 
more  or  less  closely  interlaced,  have  connective  tissue  corpuscles  or  cells 
lying  between  them,  and  are  cemented  into  a  solid  mass  by  an  inter- 
elementary,  more  or  less  abundant,  amorphous  substance  that  greatly 
contributes  to  increase  the  consistency  of  the  neoplasm,  giving  it  a  dull 
white  or  nacrous  appearance,  as  if  composed  of  cartilaginous  tissue. 
The  connective-tissue  corpuscles  composing  these  tumors  are  sometimes 
considerably  enlarged  and  hypertrophied,  and  this  is  more  particularly 
observed  in  the  fibroids  of  the  uterus.  This  arrangement  has  been  found 
to  exist  in  the  uterine  fibroma  of  a  Cow  examined  by  Ercolani  in  1855  ; 
cartilaginous  transformation  of  the  structure  has  even  been  detected. 

The  fibroids  are  developed  from  the  submucous  or  subserous  connec- 
tive tissue,  or  from  the  muscular  texture  of  the  uterine  parietes.  When 
the  latter,  the  tumor  is  rarely  pediculated,  but  nearly  always  remains  ses- 
sile.    The    uterine    fibroma   of   submucous    origin    is    certainly  at   first 


332^      •  MATERNAL  DYSTOKIA. 

sessile,  and  is  covered  by  the  mucous  membrane ;  but  as  it  grows  it 
becomes  pediculated. 

The  fibroids  of  the  uterus,  as  well  as  those  of  the  vagina,  are  some- 
times covered  by  the  mucous  membrane,  and  at  other  times  grow  beyond 
it.  They  are  sessile  or  pediculated,  and  of  v^ariable  volume  and  consis- 
tency ;  their  surface  is  either  smooth  or  irregular,  as  if  composed  of 
a  number  of  smaller  tumors. 

Franck  mentions  that  the  pathological  museum  of  the  Munich  Veteri- 
nary School  contains  the  uterus  of  a  Cow,  one  of  the  cornua  of  which  is 
occupied  by  a  myomatous  tumor,  springing  from  the  muscular  layer  of 
the  part,  and  as  large  as  a  man's  head. 

Sometimes  the  pediculated  fibroids  of  the  uterus,  in  consequence  of  the 
elongation  of  their  pedicle,  extend  beyond  the  os  into  the  vagina,  and 
even  in  some  instances  pass  through  the  latter  and  the  vulva,  and  remain 
suspended  between  the  thighs.  A  case  of  this  kind  has  been  observed 
by  Granaveri  and  studied  by  Ercolani.* 

As  we  have  observed,  the  presence  of  fibroids  has  a  variable  influence 
on  the  process  of  parturition,  according  to  their  situation.  Of  course, 
the  larger,  and  particularly  the  submucous  interstitial  fibroids,  only  very 
exceptionally  allow  successful  fecundation  to  take  place ;  though  in  some 
instances,  when  this  occurs,  absorption  follows.  During  labor  they  may 
predispose  to  rupture  of  the  uterus,  from  the  alteration  they  have  pro- 
duced in  the  texture  of  the  organ. 

Submucous  or  superitoneal  fibroids,  when  situated  towards  the  fundus 
of  the  uterus,  or  when  only  of  a  moderate  size,  very  frequently  offer 
no  particular  obstacle  to  birth,  and  interfere  but  little  with  labor.  It  is 
only  when  they  are  very  large,  and  situated  towards  the  cervix  or  vaginal 
canal,  that  they  may  become  a  serious  impediment  to  delivery.  Those 
with  short  pedicles,  and  which  are  designated  "polypi,"  maybe  projected 
backwards  before  the  advancing  fcetus,  and  be  mistaken  for  some  part  of 
the  latter  by  the  unobservant  obstetrist. 

Sometimes  the  tumors  soften  towards  the  termination  of  gestation,  so 
that  during  parturition  they  may  be  sufficiently  compressed  and  flattened 
for  the  foetus  to  pass  over  them.  If  they  have  an  elongated  pedicle 
attached  to  some  parts  which  is  easily  displaced,  they  may  be  pushed 
beyond  the  vulva  by  the  fcetus,  or  the  pedicle  may  be  ruptured  by  the 
latter,  and  the  parturient  passage  thus  left  unobstructed. 

The  recognition  of  these  tumors  is  not  very  difficult  when  they  are 
within  reach  of  the  hand.  To  prevent  their  being  mistaken,  during 
manual  exploration,  for  some  part  of  an  ordinary  or  deformed  fcetus, 
their  nature  and  mode  of  attachment  must  be  attended  to.  With  this 
object,  the  hand  should  be  carefully  passed  between  them  and  the 
uterus  and  vagina  in  every  direction,  so  as  to  find  their  pedicle,  and  thus 
be  assured  that  they  do  not  belong  to  a  foetus. 

With  regard  to  the  treatment,  we  must  refer  to  the  general  indications 
already  given.  We  may  only  add  that,  when  the  tumors  are  not  very 
large,  it  is  better  not  to  interfere  until  Nature  has  done  what  it  can 
in  overcoming  the  obstacle  ;  for  in  these  Instances,  as  in  so  many  others, 
it  sometimes  effects  surprising  results.  If  they  are  pediculated  and  can 
be  reached,  they  may  be  incised,  ligatured,  or  removed  by  the  ecraseur  ; 
should  the  base  not  be  attainable,  or  very  extensive,  they  may  be  par- 
tially extirpated. 

*  Oreste  and  Falconio.     Stiidii  sulle  Neoplasie  a  Massa  distinta  degli  Animali  Domestici,  p.  58. 


MORBID  ALTERATIONS  IN  THE  GENITAL  ORGANS. 


2>IZ 


If,  after  parturition,  there  appears  any  thing  like  a  serious  haemorrhage 
due  to  this  extirpation,  this  may  be  suppressed  by  plugging  with  lint  or 
fine  tow,  which  may  be  steeped  in  perchloride  of  iron. 

The  following  selected  observations  will  illustrate  what  has  been  said 
with  regard  to  these  fibrous  tumors  : 

1.  The  first  case  on  record  is  that  published  by  Jeanroy  {Recueil  de  Med.  Veterinaire, 
1S28,  p.  639).  In  this  instance  the  Cow  was  in  parturition,  and  being  unable  to  calve  an 
empiric  had  been  called  in ;  this  man,  though  the  foetus  was  in  a  good  position,  tore  off 
the  head.  Jeanroy  found  the  Cow  to  be  suffering  from  ascites,  and  on  puncturing  the 
abdomen  more  than  two  gallons  of  fluid  escaped.  On  exploring  the  uterus,  he  discov- 
ered a  large  pplypus  occupying  the  upper  part  of  the  organ.  With  a  probe-pointed  bis- 
toury he  removed  a  large  portion  of  it  by  incision,  and  extirpated  the  remainder  by 
enucleation.  The  operation  was  completely  successful,  as  when  the  polypus  was  re- 
moved the  calf  could  be  easily  extracted,  and  two  months  afterwards  the  Cow  had  com- 
pletely recovered.     The  animal  subsequently  produced  three  calves. 

2.  Leaux  mentions  the  case  of  a  Cow,  seven  months  pregnant,  which  had  been  exhib- 
iting violent  expulsive  efforts.  On  examinadon  the  vagina  was  found  to  be  unobstructed, 
but  the  OS  uteri  was  so  contracted  that  a  finger  could  not  be  introduced.  Nothing  was 
done.  Next  day  the  animal  was  found  lying  dead,  and  behind  it  was  a  foetus  in  its  envel- 
opes, as  well  as  a  tumor  which  had  been  expelled  at  the  same  time.  This  tumor  was  of 
a  reddish-brown  color,  %oft,  and  weighed  about  eleven  pounds ;  it  appeared  to  be  of  a 
fibrous  nature,  and  was  perforated  by  cavities  which  contained  a  serous  fluid. 

3.  Corbet  (  Veterinarian,  vol.,  vii.  p.  78)  alludes  to  a  Cow — "  a  large  roomy  animal  " — 
which  had  occasionally  exhibited  symptoms  of  colic  while  pregnant,  and  discharged 
copiously  from  the  vagina.  It  had  been  gored  by  other  cattle,  and  had  also  sustained 
some  heavy  falls  while  in  calf.  Being  unable  to  calve  at  its  full  time,  Mr.  Corbet  had  to 
attend;  but  he  could  not  deliver  the  calf,  though  it  was  small,  and  was  preparing  to  re- 
sort to  embryotomy  when  the  Cow  died.  A  polypus  weighing  upwards  of  six  stones  was 
found  in  the'uterus.  The  greater  part  of  the  tumor  was  composed  of  matter  closely  re- 
sembling coagulated  blood,  the  smaller  end  which  lay  towards  the  bladder  being  more 
highly  organized  and  of  a  bluish  color.     The  mass  was  easily  torn. 

4.  Horsburgh  (Ibid.,  vol.  xiv.,  p.  604)  was  sent  for  to  attend  a  Mare  which  had  been  at- 
tempting to  foal  for  some  time.  He  found  the  animal  very  weak  from  long-continued 
straining,  and  discovered  in  the  vagina  a  yellow-colored  mass,  the  size  of  a  man's  head. 
This  mass  projected  considerably  beyond  the  vulva  whenever  the  "pains"  returned, 
and  had  "  been  forcibly  kept  back  by  a  stout  fellow  every  time  these  labor  pains  came 
on."  The  Mare,  having  been  lying,  was  got  up  in  order  that  a  better  examination  might 
be  made,  and  then  a  firm  hard  body  was  found  beyond  this  substance,  and  which  was 
surmised  to  be  the  head  of  the  foal.  A  pain  coming  on,  Horsburgh  did  not  hesitate  to 
cautiously  make  an  incision  through  what  he  then  discovered  to  be  a  "  substance  resem- 
bling coagulable  lymph."  On  enlarging  the  incision,  the  head  of  the  foal  presented 
itself,  covered  by  the  foetal  membranes,  and  the  creature  was  then  extracted  alive.  Soon 
the  placenta  was  removed,  and  then  the  obstruction  was  examined.  It  was  found  to  be 
firmly  adherent  to  the  os  uteri,  was  about  two  inches  in  thickness,  and  when  removed 
weighed  nearly  eight  pounds.  At  the  previous  parturition,  about  twelve  months  before, 
it  had  appeared  a  little.     The  Mare  quite  recovered. 

5.  Dick  [Ibid.,  vol.  xix.,  p.  458)  relates  the  case  of  a  Cow  at  the  full  period  of  preg- 
nancy, and  which  was  straining  for  many  hours  without  being  a1)le  to  calve  ;  the  os  had 
at  last  to  be  dilated,  when  the  calf  was  removed  with  much  difficulty.  Uneasiness  contin- 
ued for  two  days  afterwards — indeed  the  animal  was  quite  ill,  and  no  faeces  or  urine  were 
passed.  A  tumor  was  then  observed  in  the  vagina ;  it  was  about  eight  inches  in  length 
and  the  same  in  circumference,  and  was  loosely  attached,  its  anterior  extremity  being 
fixed  near  the  meatus  urinarius ;  it  was  not  covered  by  the  mucous  membrane,  which 
was  distinctly  ruptured  at  that  part  of  the  vagina  to  which  it  was  attached.  No  pain  was 
evinced  on  pressing  the  tumor,  into  which  the  fingers  could  be  easily  passed  without 
much  bleeding  ensuing ;  it  had  all  the  appearance  of  imperfectly  organized  lymph,  and 
did  not  possess  the  usual  characters  of  a  polypus.  As  no  harm  seemed  likely  to  arise 
from  its  removal,  it  was  excised.  Soon  after  this  micturition  was  easily  effected.  The 
Cow  was  recovering  when  it  was  attacked  by  pleuro-pneumonia,  and  had  to  be  killed. 

6.  Lewis  (Ibid.,  vol.  xxv.,  p  184)  attended  a  Cow  which  had  gone  a  week  beyond  its 
time,  and  could  not  deliver  itself.  The  os  uteri  was  sufficiently  dilated  to  admit  two 
fingers,  but  it  appeared  to  be  so  indurated  that  further  dilatation  was  deemed  impossible, 
the  constriction  being  so  great  that  it  felt  as  if  a  ligature  had  been  passed  around  the 
cervix.     Next  day  nevertheless,  a  calf  was  with  difficulty  extracted  ;  and  on  the  animal 


334 


MA  TERN  A  L  D  YSTOKIA . 


lying  down  soon  after,  the  uterus  became  completely  inverted.  The  broad  ligaments 
were  torn,  and  the  organ  was  so  much  injured  that  amputation  of  it  was  attempted. 
The  Cow,  however,  succumbed,  and  on  examination  it  was  discovered  that  the  os  uteri 
was  "  torn  into  fragments,"  and  "  had  a  large  excrescence  in  a  schirrous  state  around  its 
neck,  which  had  evidently  acted  as  a  strong  ligature.'  The  broad  ligaments  were 
ruptured  as  was  the  uterus  itself ;  likewise  the  vagina,  through  inversion,  and  also  the 
rectum. 

7.  Howell  {Ibid.,  vol.  xlii.,  p.  97)  describes  a  tumor  which  had  formed  beneath  themu- 
cous  membrane  of  the  vagina  of  a  pregnant  Cow.  The  animal  was  aged,  and  exhibiting 
symptoms  of  parturition  for  some  time  without  any  visible  progress  being  noted,  an  explo- 
ration was  made  per  vagmam.  This  revealed  the  existence  of  an  immense  tumor  filling 
up  the  vaginal  canal  and  firmly  pressing  against  the  cervix  uteri.  With  much  difficulty 
the  OS  was  reached,  when  it  was  found  that  although  the  fcEtal  presentation  was  natural, 
delivery  was  impossible.  The  Cow  was  consequently  slaughtered.  The  tumor,  which 
was  ovoid  in  form,  with  slightly  flattened  sides,  measured  fifteen  inches  in  its  long  and 
ten  in  its  short  diameter — having  a  circumference  of  twenty-five  inches  at  its  largest 
part.  Its  surface  was  smooth  and  unbroken,  and  covered  by  the  vaginal  mucous  mem- 
brane;  while  its  color  was  but  little  different  from  that  of  the  adjacent  parts.  Its  at- 
tachment, which  was  just  above  the  os  uteri,  was  broad  and  thick  ;  in  this  respect  it  dif- 
fered greatly  from  ordinary  vaginal  polypi.  Its  weight  was  a  little  under  twenty-one 
pounds.  Histologically,  its  fibres  were  closely  arranged  in  a  network,  and  their  meshes 
contained  exudation  corpuscles. 

8.  Cartwright  {Ibid.,  vol.  xlv.,  p.  203)  gives  an  account  of  a  vaginal  polypus  (lipoma- 
tous)  in  a  Cow,  and  which  was  removed  by  means  of  a  coppir  wire  ligature.  The  tu- 
mor, which  was  pendant  from  the  vagina,  was  pear-shaped,  about  nine  inches  in  length 
and  five  across  its  widest  part ;  its  surface  was  uneven.  The  ligature  was  applied  around 
the  pedicle  and  tightened  on  the  fifth  day.  Three  days  afterwards  the  tumor  was  ex- 
cised close  to  the  ligature,  and  the  remaining  parts  returned.  The  animal  did  well.  It 
was  not  pregnant. 

9.  A  case  similar  to  the  foregoing  is  mentioned  by  Lemaitre  {Memoires  de  la  Soc.  Vet. 
du  Calvados  et  dc  la  Manche,  No.  iii.,  p.  109).  This  was  a  non-pregnant  eighteen  months 
old  Mare,  which  showed  febrile  symptoms,  had  frequent  attacks  of  colic,  made  expulsive 
efforts,  and  reddish-colored  matter  escaped  from  the  vulva.  When  the  hand  was  intro- 
duced into  the  uterus,  it  encountered  a  fleshy  mass  fixed  by  a  narrow  pedicle  to  the  left 
side  of  the  organ,  in  the  vicinity  of  the  cornu.  The  tumor  was  removed  by  twisting  and 
pulling  it.  It  weighed  about  four  and  a  half  pounds.  The  Mare  had  quite  recovered 
in  seven  days  after  the  operation. 

10.  Delhaye  [Anttales  de  Med.  Veterinaire  de  Bruxelles,  1853,  p.  549)  reports  the  case 
of  a  Cow  which  was  in  labor  for  twelve  hours.  On  a  vaginal  exploration  being  made, 
an  unusual-sized  polypus  was  found  obstructing  the  os  uteri  in  which  it  was  fixed.  A 
kind  of  incision  was  made,  which  allowed  Delhaye  to  introduce  his  hand  between  the 
cervix  and  the  substance  of  the  polypus,  and  then,  by  a  brief  manipulation,  he  was  able 
to  isolate  the  mass  from  the  subjacent  tissues  and  remove  it  altogether.  Ten  minutes 
afterwards  parturition  was  accomplished  spontaneously,  and  the  Cow  and  calf  did  well. 

11.  Delwart  {Ibid.,  p.  550)  describes  a  polypus  growing  from  the  floor  of  the  vagina 
near  the  cervix  uteri,  and  which,  while  the  animal  was  straining  in  parturition,  was 
pushed  beyond  the  vulva.  At  first  sight  it  looked  like  a  case  of  inversion  of  the  vagina  ; 
but  on  exploration  its  true  character  was  detected.  It  was  easily  removed,  and  normal 
delivery  afterwards  took  place  with  ease. 

12.  Leconte  {Memoires  de  la  Soc.  Centrale  de  Mid.  Veterinaire,  vol.  v.,  p.  153)  ob- 
served a  heifer,  two  years  old,  and  advanced  in  pregnancy,  in  whose  vagina  were  a  num- 
ber of  polypi,  some  of  which  were  so  large  that  they  projected  beyond  the  vulva  when 
the  animal  was  lying.  The  largest  measured  from  four  to  five  inches  in  diameter  and 
its  pedicle  was  as  thick  as  a  finger.  Nothing  was  done  until  parturition  commenced, 
when  the  mass  was  removed  by  incision  and  enucleation. 

13.  A  heifer,  about  twenty  months  old  was,  according  to  Fabry  {Annales  de  Med.  Vet. 
de  Bruxelles,  i860,  p.  415),  making  violent  expulsive  efforts  without  any  assignable  cause. 
Exploration  revealed  the  presence,  on  the  upper  wall  of  the  vagina,  of  an  oblong  fluctu- 
ating tumor  as  thick  as  a  man's  arm,  and  which  so  filled  up  the  passage  that  the  finger 
could  scarcely  be  introduced  beyond  the  meatus  urinarius.  No  treatment  was  adopted 
and  the  animal  was  killed  for  food.  On  the  carcase  being  dressed,  it  was  observed 
that  this  tumor  extended  to  the  neck  of  the  uterus,  and  that  it  contained  a  dark-colored 
fetid  pus,  enclosed  in  a  dark-tinted  kyst.  The  walls  of  the  uterus  were  extraordinarily 
thickened  by  a  massive  exudate — the  product  of  a  previous  inflammation. 

14.  Fleury  {Recueil  de  Med.  Vetirinaire,  1863,  p.  259)  has  given  a  very  interesting  history 
of  a  Cow  which  was  in  labor  for  nine  hours,  and  with  which,  at  each  pain,  there  appeared 
between  the  labia  of  the  vulva,  at  the  same  time  as  the  fore-feet  of  the  fcetus,  a  volumi- 


I 


MORBID  ALTERATIONS  IN  THE  GENITAL  ORGANS. 


335 


nous  round  tumor.  In  order  to  make  an  examination,  it  was  necessary  to  push  the  tumor 
as  far  forward  as  the  uterus,  and  then  it  was  ascertained  that  the  head  of  the  foetus  was 
turned  towards  its  back,  the  nose  being  directed  to  the  sub-lumbar  region  of  the 
mother.  The  head  was  brought  down,  a  cord  was  passed  behind  the  occiput  and  the 
ears,  and  on  this  being  pulled  at  the  head  and  neck  were  put  straight.  Then  the  left 
hand  of  the  operator  keeping  the  tumor  in  the  interior  of  the  uterus,  in  front  of  the  pelvic 
inlet,  the  assistants  pulled  at  the  cords,  and  without  much  trouble — owing  to  the  large 
size  of  the  pelvis  and  smallness  of  the  foetus — brought  away  a  living  and  well-formed 
calf.        • 

Parturition  being  thus  happily  accomplished  there  remained  the  tumor,  which  was 
found  to  be  attached  by  a  short,  but  very  thick  pedicle  within  and  almost  on  the  lower 
border  of  the  os,  to  the  left  side.  Owing  to  the  mobility  of  the  uterus,  the  tumor  could 
be  withdrawn  outside  the  vulva,  and  there  it  was  fixed  by  the  hands  of  two  assistants, 
while  Fleuiy  passed  a  long  sacking-needle,  furnished  with  a  long  and  very  strong  thread, 
through  the  middle  of  its  pedicle,  and  in  this  way  enclosed  this  portion  in  a  tight  double 
ligature.  By  tv>'o  cuts  of  a  bistoury  the  pedicle  was  then  divided  a  short  distance  from 
the  ligatures,  and  these,  with  the  mucous  membrane  dragged  out  by  the  tumor,  being 
immediately  put  back  in  the  vagina  nothing  was  seen  of  ihe  operation  save  the  ends  of  the 
thread  which  were  purposely  left  outside  the  vulva. 

In  twelve  days  after  the  operation  the  Cow  was  discharged  as  cured. 

The  tumor  was  oblong,  irregular  on  the  surface,  hard  and  resisting,  and  divided  into 
two  unequal  lobes  by  a  deep  fissure  ;  it  was  covered  by  mucous  membrane,  though  this 
was  only  loosely  adherent  to  it.  In  its  largest  diameter  it  measured  more  than  ten 
inches,  and  it  weighed  over  twelve  pounds.  It  grated  when  cut  into  by  the  bistoury,  as 
if  it  was  an  unripe  apple,  and  a  yellow  serous  fluid  escaped  from  its  interior,  which  was 
hollow  near  the  end  opposite  the  pedicle.  Around  this  cavity  the  fibrous  tissue — soft 
and  rose-colored — yielded  by  pressure  a  greyish  opaque  fluid  which  was  miscible  in  wa- 
ter, and  was  not  found  in  any  part  of  this  growth.  Seven-tenths  of  the  mass  was  com- 
posed of  a  dense  dull-white  fibrous  tissue  disposed  in  irregular  striae  or  in  concentric 
tufts. 

Watson  (F'^^'<'r/«rt:r/a«,  vol.  xlv.,  p.  174)  gives  the  history  of  a  sheep-dog  which  had 
been  in  labor  for  a  day,  but  could  not  deliver  itself  because  of  what  the  owner  called  the 
"  pup-bed  "  coming  out.  This  had  been  frequently  returned,  though  it  caused  the  poor 
animal  great  pain,  which  was  only  relieved  when  the  mass  was  again  extruded.  On 
examination,  a  tumor  as  large  as  a  hen's  egg  was  found  protruding  from  the  vagina. 
"  At  first  sight  it  had  every  appearance  of  an  everted  bladder,"  but  on  manipulation  it 
was  discovered  to  be  a  firm  fibrous  tumbr,  v/ith  a  long  pedicle  extending  into  the 
vagina.  A  ligature  was  applied  to  the  neck  of  the  tumor,  and  this  was  removed  by  the 
scalpel  :  tincture  of  opium  enemata  were  administered,  and  in  about  an  hour  three 
puppies  were  born.     The  bitch  afterwards  did  well. 

15.  To  Barbenoire  and  Arloing  [Journal  de  Med.  Viterinaire  de  Lyon,  1868,  p.  76)  we 
owe  our  last  example  of  this  kind  of  tumor.  A  Cow  thirteen  years  old,  which  had 
calved  in  a  natural  manner  fifteen  months  previously,  and  was  supposed  to  be  again 
about  five  months  pregnant,  was  suddenly  taken  ill.  Suspecting  abortion,  Barbenoire 
introduced  his  arm  into  the  uterus,  the  os  of  which,  strongly  contracted,  had  to  be  pre- 
viously incised  ;  there  he  found  an  enormous  hard  tumor,  which  he  vainly  endeavored 
to  extirpate.  The  animal  died  next  day,  after  suffering  for  four  days  ;  the  cause  of  death 
appeared  to  be  due  to  metrorrhagia.  The  tumor,  on  a  post-mortem  examination,  was 
discovered  to  be  entirely  confined  to  the  uterus,  with  the  exception  of  a  somewhat 
voluminous  "  appendice,"  which  was  found  to  be  strangulated  at  the  origin  of  the  left 
cornu.  into  which  it  was  prolonged. 

Arloing  examined  this  morbid  production  and  described  it  as  follows :  An  oval, 
uneven  surfaced  tumor,  traversed  by  grooves  or  fissures,  one  of  which  deeper  than  the 
others,  limits  the  appendice  mentioned  by  Barbenoire  as  extending  into  the  left  horn  ;  and 
studded  by  small  fibro-vascular  prolongations  by  which,  no  doubt,  it  grafted  itself  on  the 
uterine  walls.  Its  longitudinal  diameter  measures  35  centimetres  (nearly  fourteen 
inches),  transversal  20  centimetres  (nearly  eight  inches),  audit  weighs  about  6,610  kilo- 
grammes (about  fifteen  pounds).  The  tissue  of  which  it  is  composed  is  hard,  resisting, 
and  grates  under  the  scalpel :  it  has  a  fibrous  aspect ;  its  density  is  pretty  much  the  same 
throughout ;  and  its  color  is  in  general  a  dull  white  or  nucrous  tint,  with  here  and  there 
light  red  down  to  carmine  and  violet  points,  according  to  the  degree  of  vascularization. 
This  vascularity  is  very  considerable  on  the  surface  of  the  tumor,  but  diminishes  as  the 
centre  is  approached.  Examined  miscroscopically,  the  neoplasm  is  found  to  be  formed, 
throughout  the  whole  of  its  mass,  of  fine  long  parallel  fibres,  on  whose  course  are  seen 
dark-colored  dilatations  corresponding  to  the  nuclei  which  the  caustic  soda  has  rendered 
visible.     These  fibres  are  joined  in  bundles,  which  cross  each  other  in  various  directions. 


336  MATERNAL  DYSTOKIA. 

There  are  found,  in  addition,  cells  or  fusiform  bodies,  as  well  as  somewhat  irregular 
globular  bodies  with  dark  contours. 

From  the  histological  characters,  Arloing  came  to  the  conclusion  that  the  tumor  was 
a  fibroid. 

THROMBUS    OR    HEMATOMA, 

Thrombus  or  haematoma  of  the  -vagina  or  vulva,  usually  appears  most 
frequently  after  delivery.  Pfirter,  however,  has  recorded  the  case  of  a 
Mare  in  which  a  large  blood  tumor,  or  haematoma,  was  caused  by  the  rup- 
ture of  blood-vessels  and  the  escape  of  blood  into  the  connective  tissue 
around  the  vagina.  It  formed  a  great  swelling  on  the  sides  of  the  vagina 
and  vulva,  the  infiltration  of  blood  extending  to  the  perineum.  This 
tumefaction  proved  an  obstacle  to  parturition  ;  so  that  it  was  necessary  to 
remove  it  by  opening  it  freely,  and  taking  away  the  clots  of  blood  which 
had  formed.  The  haemorrhage  which  ensued  was  checked  by  the  injec- 
tion of  a  solution  of  perchloride  of  iron. 

Saake  has  observed  these  blood-kysts  most  frequently  in  Swine  ;  death 
from  haemorrhage  has  sometimes  resulted  from  their  rupture. 

The  application  of  ice  or  cold  water,  or  perchloride  of  iron,  or  even  the 
actual  cautery,  and  plugging  the  vaginal  canal,  will  generally  arrest  the 
bleeding. 

SEROUS    KYSTS. 

Kopp,  Hering,  Ayrault,  Lafosse,  Liautard,  Miiller,  and  others,  have 
observed  serous  kysts  on  the  vaginal  mucous  membrane,  and  even  in  the 
uterus,  of  the  Mare  and  Cow. 

The  vaginal  kysts  are  of  variable  size,  but  most  frequently  as  large  as 
a  pear,  which  they  are  generally  not  unlike  in  shape.  They  are  attached 
to  the  mucous  membrane  by  a  very  narrow  pedicle,  and  in  some  instances 
appear  between  the  labia  of  the  vulva  when  the  animal  is  reclining,  but 
disappear  again  into  the  vagina  when  the  standing  posture  is  assumed  ; 
though  occasionally  they  are  so  large  that  they  cannot  return  without 
assistance. 

The  kyst  is  smooth  and  transparent,  and  contains  a  clear  limpid 
serosity,  in  which  albuminous  flakes  are  often  observed. 

Not  unfrequently,  the  glands  of  Bartholin  in  the  vagina  of  the  Cow  are 
greatly  distended  with  mucus,  serum,  or  even  pus,  as  a  result  of  inflam- 
mation. 

Such  kysts  are  not  likely  to  retard  parturition,  and  if  they  should,  their 
treatment  is  very  simple  j  as  a  lancet  puncture  suffices  to  evacuate  the 
fluid  they  contain,  and  the  walls  readily  adhere  and  cicatrize. 

Hering  has  seen  them  occupy  the  vagina  and  extend  into  the  uterus  ; 
and  in  the  latter  organ  their  presence  may  be  more  serious  than  when 
they  are  -limited  to  the  vagina.  We  have  given  an  instance  of  this, 
furnished  by  Liautard  {see  p.  167),  and  which  shows  that  they  may  prove 
troublesome  obstacles  to  delivery,  as  well  as  dangerous  to  the  animal  in 
whose  uterus  they  may  have  formed. 

When  the  kyst  is  attached  to  the  cervix  or  its  neighborhood,  it  may 
pass  into  the  os  and  obstruct  it,  and  thus  prevent  the  foetus  passing 
through.  When  very  large  it  may  so  closely  simulate  the  "  water-bag," 
as  to  be  mistaken  for  it — though  the  mistake  need  not  lead  to  grave 
results ;  indeed,  if  ruptured  the  kyst  immediately  collapses,  and  can  no 
longer   prove   a  barrier  to  the  expulsion  of  the  foetus.     If  the  kyst  is 


MORBID  ALTERATIONS  IN  THE  GENITAL  ORGANS, 


337 


situated  towards  the  os,  and  if  puncturing  it  be  deemed  inadvisable, 
pushing  it  beyond  the  pelvic  inlet  out  of  the  track  of  the  foetus  will  be 
sufficient  to  overcome  the  obstacle. 

Vaginal  kysts  may  be  mistaken  for  an  everted  bladder :  a  mistake 
which  we  are  assured  if  often  committed,  from  the  external  aspect  of  the 
tumor,  its  oval  shape,  and  its  color.  Of  course,  this  mistake  would 
prove  most  unfortunate,  should  the  treatment  we  have  recommended  be 
adopted  ;  but  a  careful  examination  should  always  be  made  before  any 
active  interference  is  attempted,  and  this  examination  will  obviate  such 
an  error.  • 

Hernia  of  the  bladder  through  the  ruptured  v/alls  of  the  vagina,  may 
also  simulate  a  vaginal  kyst  ;  and  if  this  viscus  is  punctured  in  this  posi- 
tion, it  will  lead  to  the  same  lamentable  results,  in  all  probability,  as  in 
inversion. 

This  accident  we  will  now  notice,  and  point  out  the  signs  by  \vhich  it 
may  be  distinguished. 

HERNIA    OF    THE    BLADDER    INTO    THE    VAGINA  :     VAGINAL    CYSTOCELE. 

Dystokia  from  the  existence  of  a  vaginal  cystocele  is  a  somewhat  rare 
accident,  and  only  a  few  instances  are  recorded  as  having  been  observed 
in  the  Mare  and  Cow  during  parturition. 

Inversion  of  this  viscus  may  occur  in  two  ways  : — i.  When  empty,  it 
may,  by  a  spasmodic  contraction  of  its  walls,  evert  itself — the  mucous 
membrane  becoming  external  and  the  peritoneal  coat  internal — and  thus 
turned  outside-in,  it  may  pass  through  the  meatus  urinarius  into  the 
vagina  ;  2.  It  may,  without  being  everted,  escape  into  the  vagina  by  an 
old  or  recent  fissure  in  the  floor  of  the  passage.  Most  of  the  cases  occur 
during  parturition,  and  when  the  animal  is  straining  violently,  whereby  a 
portion  of  the  contents  of  the  abdomen  and  uterus  are  pressed  against  the 
bladder,  and  may  thus  produoe  its  inversion.  It  is  not  at  all  improbable 
that  the  viscus  may,  in  consequence  of  the  pressure  it  occasionally  receives, 
be  in  a  spasmodic  state,  or  the  cervix  may  be  dilated  and  relaxed  at  times 
(Cartwright). 

In  the  Mare  and  Cow  the  urethra  is  short,  straight,  and  wide  ;  and 
this  no  doubt  renders  the  bladder  liable  to  inversion.  Zundel  states  that 
it  may,  during  parturition,  acquire  such  dimensions  from  retention  of 
urine  that  it  will  entirely  fill  the  vagina,  and  protrude  externally  during 
the  expulsive  efforts  of  the  animal. 

However  this  may  be,  it  is  certain  that  the  cystocele  will  present  a 
different  appearance  in  the  vagina  according  as  its  peritoneal  or  mucous 
membrane  is  visible :  i.e.,  everted  or  non-everted. 

In  the  first  case  we  find  a  somewhat  hard,  red  tumor  with  a  corru- 
gated surface,  and  attached  to  the  floor  of*  the  vagina  by  ^  short  narrow 
pedicle.  Examining  the  lower  wall  of  the  vagina  attentively,  the  meatus 
urinarius  cannot  be  found,  but  on  the  soft  pulpy  surface  of  the  tumor 
will  be  observed  two  small  openings — the  apertures  of  the  ureters — from 
which  a  fluid  continually  escapes,  and  which  may  be  recognized  by  its 
odor  as  urine  ;  this  fluid  may  even  be  thrown  out  with  a  certain  degree 
of  force  during  the  labor  pains.  These  characters  should  be  sufficent  to 
indicate  the  nature  of  the  obstacle. 

In  the  second  variety,  the  bladder  escapes  through  a  rent  in  the  wall 
of  the  vagina,  and  this  rent  may  only  involve  the  muscular   layer — the' 

22 


338  MATERNAL  DYSTOKIA. 

vaginal  mucous  membrane  remaining  intact  ;  or,  which  is  more  frequent, 
the  muscular  and  mucous  tissues  may  be  ruptured.  In  either  case  there 
is  found  in  the  vagina  a  round,  sm'ooth,  and  fluctuating  tumor,  attached 
to  the  floor  of  the  canal  by  a  pedicle  more  or  less  wide,  and  beneath 
which  the  meatus  urinarius  can  be  seen  or  felt.  The  most  striking 
pathognomonic  feature  of  this  kind  of  tumor  is  its  rapid  growth,  in 
consequence  of  the  accumulation  of  urine  in  the  interior  of  the  displaced 
bladder,  the  fundus  of  which  is  towards  the  vulva  and  the  neck  directed 
forwards — its  position  being  the  reverse  of  normal  ;  the  fundus,  by 
pressing  on  the  urethra — which  is  doubled  on  itself — prevents  the  urine 
from  escaping,  and  we  have  in  this  way  a  rapidly  increasing  vaginal 
tumor.  In  a  case  recorded  by  Violet  {Recueii  de  Med.  Veterifiaire  de 
Lyon,  1862,  p.  371)  the  tumor  had  acquired,  within  eight  hours,  a  diam- 
eter of  from  eight  to  ten  inches.  Such  a  tumor  must,  therefore,  con- 
stitute a  more  or  less  serious  obstacle  to  parturition. 

We  have  pointed  out  the  necessity  for  a  careful  examination  of  the 
tumor,  in  order  to  avoid  making  a  mistake,  as  the  cystocele  resembles 
other  tumors,  and  especially  the  kysts  we  have  already  described,  or 
even  the  "  water-bag,"  and  an  error  in  diagnosis  may  lead  to  grave 
consequences.  Such  an  error  is  recorded  by  Charcot  {yournal  Pratique 
de  Med,  Veterinaire,  1826,  p.  165),  who,  being  called  upon  to  attend  a 
Cow  which  had  been  attempting  to  calve  for  three  days,  found  on  sepa- 
rating the  labia  of  the  vulva  a  whitish,  tense,  and  fluctuating  tumor. 
Thinking  that  this  was  only  the  "  water-bag,"  he  punctured  it ;  when  the 
color  and  odor  of  the  fluid  which  escaped  quickly  undeceived  him. 
When  the  bladder  had  collapsed,  he  then  recognized  the  tear  in  the 
vagina  through  which  the  viscus  had  passed.  The  Cow  being  in  a  dying 
condition  and  the  foetus  still  alive,  Charcot  had  recourse  to  the  Caesarean 
section  ;  the  calf  was  saved,  but  the  mother  died. 

As  the  diagnosis  of  this  accident  is  of  so  much  importance,  we  will 
notice  the  symptoms  in  greater  detail. 

Protruding  through  the  opening  of  the  vulva,  or  immediately  within 
the  labia,  will  be  discovered  a  tumor  of  a  pyriform  shape,  and  varying 
in  size  and  color,  according  to  the  duration  of  the  accident.  Sometimes 
this  tumor  will  be  seen  hanging  from  within  the  vagina  by  a  kind  of 
peduncle,  for  at  least  eight  or  nine  inches,  and  will  contain  two  or  three 
pints  of  fluid.  At  times,  the  protruded  part  will  be  nothing  more  than  a 
thickening  of  the  bladder,  produced  by  strangulation  and  inflammation; 
and  it  will  be  changed  from  its  normal  color  to  that  of  an  inflamed 
surface,  or,  if  it  has  been  hernied  for  some  time,  to  a  darker  hue. 
Sometimes  it  will  become  gangrenous  and  slough  ;  at  other  times  its 
surface  appears  rugged  and  plicated,  and  on  occasions  a  large  quantity 
of  blood  has  exuded  from  its  surface.  Should  there  exist  any  doubts  as 
to  the  nature  of  the  tumor,  the  meatus  urinarius  must  be  looked  for ;  if 
that  cannot  be  discovered,  then  the  greatest  circumspection  should  be 
exercised.  The  attachment  and  situation  of  the  protrusion  should  be 
noted,  and  also  whether  it  is  continuous  with  the  vagina.  The  nipple- 
shaped  prominences  which  mark  the  openings  of  the'  uterus  into  the 
bladder  should  also  be  looked  for,  as  their  presence  will  at  once  denote 
the  case  as  inversion  of  this  viscus,  as  will  the  escape  of  urine  from 
them. 

Treatment. 

The  chief  indication  in  vaginal  cystocele  is  reduction,  or  reposition  of 


MORBID  ALTERATIONS  IN  THE  GENITAL  ORGANS.     339 

the  displaced  viscus.  This,  however,  is  not  always,  if  ever,  an  easy  task. 
In  a  case  of  simple  hernia,  the  bladder  is  soon  distended  by  the  urine, 
and  owing  to  the  increase  in  size,  it  cannot  be  returned  by  the  opening 
through  which  it  passed  when  it  was  empty.  Compression  of  its  walls 
will  not  suffice  in  the  majority  of  cases  to  evacuate  its  contents,  because, 
as  has  been  shown,  the  weight  of  the  organ  lies  upon  the  doubled  urethra. 
To  empty  the  bladder  a  catheter  must  be  employed  ;  the  shoot  of  an  elder 
tree  deprived  of  its  pith  has  been  successfully  used  for  this  purpose  on 
an  emergency.  Once  emptied,  according  to  Saint-Cyr,  the  bladder  easily 
resumes  its  normal  situation. 

Puncture  of  the  organ  has  been  practised  when  catheterism  was  not 
tried  ;  a  fine  trocar  been  inserted  obliquely  into  the  upper  part  of  the 
viscus — which  was  now  of  course  the  inferior  part — so  as  to  make  it  pass 
for  a  certain  distance  between  the  membranes  before  entering  the  cavity 
of  the  sac,  in  this  way  imitating  the  entrance  of  the  ureters.  The  opera- 
tion was  completely  successful,  as  the  bladder  had  been  little  more  than 
half  emptied  before  the  hernia  was  spontaneously  reduced. 

Cartwright  says,  with  regard  to  treatment :  "  Provided  we  are  called  to 
the  case  at  an  early  period,  and  before  a  thickening  of  the  parietes  of  the 
bladder  and  sphincter  has  taken  place,  we  most  probably  will  succeed. 
We  should,  with  the  left  hand,  press  gently  upon  the  sides,  and  with  the 
right  hand  the  fundus  of  the  iDladder,  until  we  feel  it  gradually  receding 
from  us  ;  after  which  we  may  carefully  introduce  a  pessary  or  catheter, 
so  as  fairly  to  force  it  into  its  natural  situation.  If  there  should  be 
violent  straining  at  the  moment  w^e  are  employing  the  taxis,  we  had  better 
desist  for  a  time  until  we  have  abstracted  four  or  five  quarts  of  blood,  or 
give  a  dose  of  opium  in  solution,  to  allay  any  irritation  or  spasm.  But  if 
we  cannot  succeed  in  this  way,  I  think  a  far  more  preferable  plan  will  be 
to  get  a  stick  with  a  round  blunt  point  that  will  pass  through  the  sphinc- 
ter, and  force  it  against  the  base  of  the  protruded  fundus.  A  very 
excellent  instrument  would  be  a  female  catheter,  such  as  is  used  for  the 
Cow  or  Mare,  as  it  would  have  the  necessary  curve.  In  thus  trying  to 
rein  vert  it,  we  may  use  considerable  force  without  rupturing  it ;  though, 
of  course,  we  must  be  cautious  in  our  pressure." 

Should  the  distended  cystocele  be  immediately  in  the  track  of  the 
foetus,  and  the  expulsion  of  the  latter  urgent,  if  the  bladder  cannot  be 
returned  before  birth,  it  must  at  least  be  emptied,  to  allow  the  young 
creature  to  get  through  the  vagina.  As  the  latter  passes  over  it,  the 
viscus  should  be  protected  from  injury  by  the  fingers. 

We  will  return  to  a  consideration  of  this  condition  when  treating  of  the 
accidents  occurring  as  a  sequel  of  parturition.  In  the  mean  time,  we  will 
give  one  or  two  illustrative  cases  to  show  the  importance  of  exercising 
care  in  diagnosing,  g.nd  skill  in  treating,  this  accident. 

Youatt  [Cattle,  p.  522)  relates  that  a  Cow  had  been  three  days  in  labor,  and  little  ad- 
vance had  been  made.  It  was  lying  on  the  right  side,  exhausted,  and  at  intervals  lowing 
mournfully,  and  making  violent  efforts  to  expel  the  foetus.  A  round,  fibrous  white 
tumor  presented  itself;  it  was  evidently  distended  with  some  fluid,  fluctuation  being 
detectable  on  the  slightest  touch.  Not  dreaming  that  it  could  be  any  thing  but  the  mem- 
branous bag  that  contained  the  natural  uterine  fluid,  he  punctured  it,  and  found  that 
what  escaped  was  urine.  It  was  the  bladder  which  had  protruded  through  a  rent  in  the 
vagina,  adds  Youatt,  and  which  he  might  have  recognized  by  its  smaller  bulk  and  firmer 
texture,  and  by  the  ease  with  which  the  neck  would  have  been  discovered  on  a  slight 
examination. 

Baker  (  Transactions  of  the  Veterinary  Medical  Association,  vol.  ii.  p.  57)  records  a  case 
of  inversion  of  the  bladder  in  a  Mare  while  in  the  act  of  foaling.     It  was  replaced  three 


340 


MATERNAL  DYSTOKIA. 


times  within  two  hours,  and  there  was  little  difficulty  in  doing  so ;  probal^ly  owing  to 
unusual  width  of  the  urethra. 

Littler  (  Veterinaria7t,  vol.  xxxvi.,  p.  273)  was  sent  for  to  see  a  Mare  which  was^  unable 
to  foal.  He  found  the  animal  being  led  about  in  a  straw  yard,  in  order  to  avert  or  miti- 
gate the  violent  throes  of  parturition  which  had  been  present  for  two  and  a  half  hours. 
Protruding  from  between  the  labia  of  the  vulva,  during  each  throe,  were  the  Mare's 
urinary  bladder  and  three  foetal  feet.  The  bladder  was  completely  inverted,  and  '*  from 
its  elastic  or  yielding  nature  apparently  contained  gas  on  its  peritoneal  surface,  distend- 
mg  it  to  the  size  of  an  inflated  Sheep's  bladder."  It  was  not  observed  to  have  been  in- 
jured either  by  exposure  to  the  air,  or  by  the  repeated  and  forcible  compression  to  which 
it  had  been  subjected  by  the  foetal  extremities  during  the  parturient  paroxysms.  Its 
mucous  membrane  was  not  in  the  least  discolored,  being  clean  and  shining,  and  without 
the  slightest  trace  of  congestion.  The  foetus  was  lying  on  its  left  side,  the  head  and 
neck  thrown  back  and  extending  along  the  floor  of  the  uterus,  from  the  right  to  the  left 
flank  of  the  Mare.  The  fore-feet  were  beyond  the  vulva,  and  the  right  or  upper  hind- 
foot  was  in  the  vagina.  Reposition  of  the  displaced  bladder  was  the  first  thing  attempted, 
and  this  was  readily  effected  by  equable  pressure  being  exerted  by  the  hand  on  the 
surface  of  the  viscus,  "  when  the  elastic  matter  was  speedily  expelled,  and  the  collapsed 
body  easily  passed  through  its  widely  dilated  neck,  which  was  relaxed  to  such  a  degree 
as  to  admit  of  the  free  introduction  of  the  three  middle  fingers." 

Though  so  easily  returned,  however,  it  was  as  readily  inverted  again,  every  expulsive 
effort  bringing  it  into  the  vagina;  and  the  frequent  attempts  made  to  prevent  its  pro- 
trusion, by  the  operator  placing  his  arm  firmly  on  its  cervix,  while  his  hand  was  engaged 
in  rectifying  the  position  of  the  foetus,  were  perfectly  ineffectual,  and  even  the  applica- 
tion of  the  hand  of  a  strong  assistant  over  the  meatus  was  equally  unavailing.  Delivery 
of  the  foetus,  which  was  dead,  had  therefore  to  be  effected  over  the  cystic  hernia  ;  this 
was  accomplished  without  any  visible  laceration  of  the  bladder  by  the  violence  to  which 
it  had  been  subjected ;  its  mucous  membrane,  however,  was  thickened  and  congested 
throughout  its  whole  extent,  and  the  effusion  of  blood  on  its  abraded  surface  gave  it  the 
appearance  of  a  "  spherical  mass  of  coagulated  arterial  blood." 

After  being  washed,  it  was  readily  placed  in  its  natural  situation  by  gentle  pressure, 
when  its  cavity  was  explored  to  "  correct  local  deviation."  No  subsequent  displace- 
ment occurred.  The  operation  occupied  thirty-five"  minutes.  Suitable  treatment  was 
adopted — chiefly  the  administration  of  opiates,  clothing  the  body  and  limbs,  with 
mashes  and  infusion  of  linseed  as  diet  ;  thick  dark  bloody  urine  was  passed  for  some 
days  ;  there  was  also  much  difficulty  in  moving  the  limbs.  In  six  days  recovery  was 
complete. 

fi     This  was  one  of  three  cases  of  inversion  of  the  bladder  during  parturition,  which  this 
veterinary  surgeon  had  met  with  in  his  practice. 

TUMORS    IN    THE    VICINITY    OF    THE    GENITAL    ORGANS. 

Tumors  in  the  bladder,  when  of  large  size — as  polypi,  steatomous 
growths,  etc.,  as  well  as  calcareous  concretions,  may  hinder  parturition, 
or  even  render  it  impossible.  Even  an  excessively  distended  bladder 
may  offer  an  obstacle  to  the  accomplishment  of  this  act,  either  in  check- 
ing the  advance  of  the  foetus,  or  by  sympathetically  disturbing  the  uterine 
contractions. 

The  indications  here  are  obvious. 

Tumors  of  various  kinds  may  be  developed  in  the  connective  tissue 
of  the  pelvic  organs,  and  especially  between  the  vagina  and  rectum,  and 
more  or  less  obstruct  labor.  Ovarian  tumors  may  "also  prove  trouble- 
some, as  may  likewise  multiple  abscesses  and  kysts  in  the  neighborhood 
of  the  genital  passages.  In  some  cases  these  may  be  successfully  punc- 
tured ;  in  others  extirpation  may  be  possible  ;  while  in  others,  again,  the 
obstetrist  can  only  choose  between  embryotomy  and  the  Caesarean  sec- 
tion. 

Distention  of  the  rectum  from  an  accumulation  of  faeces  may  prove  a 
cause  of  dystokia — particularly  in  the  Mare  ;  but  this  should  be  easily 
discovered,  and  readily  removed.  Tumors  in  the  immediate  vicinity  of 
the  anus  are  rarely  a  cause  of  difficult  parturition. 

We  have  already  alluded  to  melanotic  tumors. 


MORBID  ALTERATIONS  IN  THE  GENITAL  ORGANS.      341 
2.  Rigidity  of  the  Cervix  Uteri. 

/Rigidity  or  spas7n  of  the  cervix  uteri  is  a  condition  notunfrequently  met 
with  among  animals — most  frequently  in  the  Cow,  next  in  the  Goat,  and 
less  often  in  the  Mare.  It  appears  to  be  more  common  with  nervous, 
irritable  animals,  and  especially  primiparce,  than  others  ;  though  it  is 
sometimes  noted  in  emaciated  and  debilitated  animals,  and  even  in  those 
which  are  old,  and  which  have  previously  brought  forth  without  any 
trouble. 

Without  any  modification  in  the  structure  of  the  cervix,  but  merely  by 
a  kind  of  rigid  contraction  of  its  fibres,  the  os  remains  closed,  and  can- 
not be  dilated  by  the  efforts  of  the  parturient  animal.  '^The  cervix  is  not 
soft  and  elastic,  as  in  the  normal  condition,  but  feels  prominent  and  rigid, 
and  shows  less  sensibility  than  usual  ;  while  the  os  will  not  admit  a  fin- 
ger, or  if  it  does,  it  grasps  it  most  powerfully. 

The  majority  of  veterinarians  admit  the  existence  of  spasm  of  the  cer- 
vix, while  others  maintain  that  rigidity  and'  spasm  are  synonymous  terms, 
in  so  far  as  this  conditioh  is  concerned.  The  first  are  ready  to  confess, 
however,  that  spasm  is  not  always  present,  because  very  often  the  "  pains  " 
are  feeble  and  few,  and  the  absence  of  dilatation  appears  to  be  due  rath- 
er to  something  abnormal  in  the  contractility  of  the  uterus,  as  a  whole, 
than  of  this  part  in  particular  ;  whereas,  when  there  is  spasm,  it  has 
usually  been  observed  that  there  are  inordinate  and  disordered  contrac- 
tions of  the  organ.  In  short,  it  has  been  attempted  to  prove  that  in 
rigidity  of  tlie  cervix  there  is  a  purely  passive  condition  of  this  part,  while 
in  spasm  there  is  an  active  contraction  of  the  organ.  In  reality,  there  is 
no  marked  distinction  between  the  two  conditions,  at  least  so  far  as  ob- 
stetrical practice  is  concerned  ;  and  this  form  of  dystokia,  in  its  more 
salient  features,  might  be  looked  upon  as  merely  an  exaggerated  mani- 
festation of  that  derangement  which  we  have  designated  tumultuous  or 
irregular  parturition,  or '"false  \dhor  "  {metripercinesis,  2iS  distinguished 
from  ?netracinesia,  or  feebleness  of  the  uterine  contractions),  in  which  the 
contractions  are  irregular  or  partial. 

We  have  pointed  out  that  there  are  two  sets  6i  muscles  in  the  uterus — 
the  circular  and  longitudinal,  and  that  there  exists  a  marked  antagonism 
between  the  circular  fibres  of  the  cervix  and  fundus  of  the  organ,  and 
the  longitudinal  fibres.  So  that  if  the  first  are  more  active  than  the  sec- 
ond, and  the  latter  cannot,  as  a  consequence,  overcome  the  resistance 
they  offer,  the  os  remains  closed  and  labor  cannot  advance.  This  is, 
we  think,  the  true  explanation  of  this  condition. 

Symptoms. 

The  symptoms  vary  somewhat.  In  one  case  there  is  at  first  nothing 
unusual  to  be  noted,  the  pains  being  manifested  with  their  usual  regu- 
larity and  intensity,  and  the  animal  is  in  noways  distressed.  The  only 
thing  that  is  likely  to  awaken  suspicion,  is  the  unusual  duration  of  partu- 
rition, which  may  extend  over  two,  three,  four,  or  more  days,  if  assistance 
be  not  afforded.  As  the  period  is  prolonged,  the  animal  may  in  some 
instances  lose  condition,  exhibit  indications  of  exhaustion  and  suffering, 
and  gradually  sink  ;  or  it  may  appear  ill  for  some  days,  then  rally  and 
assume  its  ordinary  appearance — constituting  a  case  of  "  missed  birth.''  * 

*  We  may  here  call  attention  to  certain  signs  presented  bv  Cows,  and  which  have  been  described  by 
Biot  {Rectteil  de  Mid.    VHirinaire,  September,  1876,  p.  1007)  as  essentially  pathognomomic  of  uterine 


342  MATERMAL  DYSTOKIA. 

In  other  instances,  the  creature  manifests  an  unusual  amount  of  ex- 
citement at  first ;  there  is  agitation,  straining,  and  symptoms  of  colicky 
pains  ;  the  abdomen  is  frequently  looked  at  by  the  animal,  which  lies 
down  but  soon  gets  up  again  ;  the  pulse  is  full,  strong,  and  frequent  ;  the 
conjunctivae  are  injected  ;  the  skin  is  hot  ;  faeces  and  urine  are  passed  at 
frequent  intervals  ;  there  is  thirst  and  anorexia  \  and  sometimes  during 
the  throes  the  vagina  is  protruded  beyond  the  vulva,  and  appears  as  a 
large  red  mass. 

A  vaginal  exploration  is  necessary,  in  order  to  learn  the  cause  of  ob- 
struction. This  should  be  carefully  and  gently  made — the  latter  pre- 
caution being  most  important  to  observe  during  the  throes.  It  may  be 
necessary,  if  the  mucous  membrane  is  dry,  to  inject  some  emollient  fluid 
into  the  vagina,  or  introduce  it  by  a  sponge. 

When  the  hand  is  passed  through  the  vagina,  the  os  will  be  found  more 
or  less  contracted,  so  that  scarcely  one  or  two  fingers  can  be  introduced 
into  it,  owing  to  the  spasmodic  resistance  it  offers,  while  the  cervix  pre- 
serves its  elongated  shape. 

In  the  Cow,  Saint-Cyr  has  frequently  found  the  cervix  and  vagina  filled 
with  a  tenacious  gluey  matter,  which  sticks  to  the  fingers  like  bird-lime, 
and  which,  by  glueing  together  the  margin  and  walls  of  the  os,  doubtless 
increases  the  resistance  the  canal  offers  to  dilatation. 

If  the  finger  can  be  introduced  into  the  os,  it  will  be  found  that  there 
is  neither  deformity  nor  morbid  induration,  and  that  the  constriction  is 
due  to  the  fibres  of  the  cervix  alone. 

Saint-Cyr  points  out  that,  contrary  to  what  we  have  state'd  above,  the 
cervix  uteri  is  sometimes  completely  effaced  ;  the  bottom  of  the  vagina 
being  occupied  by  a  kind  of  smooth-surfaced  ball,  in  the  centre  of  which 
is  a  narrow  opening,  and  through  which  the  foetus  can  be  felt.  The  con- 
vex body  is  the  posterior  segment  of  the  uterus  which,  pressed  by  the 
hand  or  some  other  part  of  the  foetus,  is  pushed  into  the  vagina  ;  while 
the  small  aperture  is  the  os — partially  effaced  and  undilated.  This  trace 
of  the  OS,  instead  of  being  in  the  centre,  is  at  times  more  or  less  to  one 
side,  and  occasionally  it  can  only  be  found  with  much  difficulty. 
* 

Diagnosis. 

From  the  symptoms  enumerated,  there  should  not  be  much  doubt  or 
delay  in  diagnosing  this  cause  of  dystokia.  As  in  so  many  other  in- 
stances, however,  the  necessity  for  a  correct  diagnosis  is  imperative,  as 
on  its  accuracy  will  depend  the  success  of  treatment. 

If  the  exploration  has  been  carefully  made,  the  state  of  the  cervix  will 
dt  once  explain  the  delay  in  birth.  Perhaps  the  only  other  condition  of 
the  cervix  with  which  it  might  be  confpunded  is  "  induration  ;  "  but  in 
spasm  this  part  is  hot,  tense,  and  painful,  and  neither  hard,  lumpy,  nor 
deformed,  as  in  the  latter. 

disturbance  in  these  animals,  and  for  this  reason  have  been  specially  designated  as  uterine.  These  signs, 
upon  which  he  places  the  greatest  diagnostic  value,  are  observed  when  the  sick  Cow  is  approached  or 
touched  in  any  way.  The  animal  then  "suddenly  elongates  the  neck,  extends  the  head,  yawns,  protudes 
the  tongue,  and  emits  at  the  same  time  a  kind  of  aull  moan,  but  which  is  rather  a  powerful  expiration  than 
a  real  moan."  When  these  signs  are  present,  Biot  asserts  that  the  corps  delit — the  disturbance — is  in  the 
uterus,  and  never  elsewhere.  Laborious  or  protracted  parturition,  mal-positions  of  the  foetus  or  monstrous 
conformation,  occlusion  or  induration  of  the  cervix  uteri,  hydramnios,  torsion  of  the  uterus  ;  and  after  par- 
turition, inversion  of  the  uterus,  retention  of  the  plecenta,  and  vitulary  fever  with  or  without  paralysis  ;— 
all  these  may  give  rise  to  the  manifestation  of  this  singular  piienomenon,  which  he  has  never  witnessed  in 
any  other  affection — not  even  in  chronic  diseases  of  the  uterus. 


MORBID  ALTERATIONS  IN  THE  GENITAL  ORGANS.     343 

Prognosis. 

Simple  rigidity  or  spasm  of  the  cervix  uteri,  provided  there  is  no  alter- 
ation ill  its  texture,  is  not  in  itself  of  very  much  consequence.  In 
many  cases  Nature  overcomes  the  obstacle,  and  in  the  course  of  twenty- 
four,  forty-eight,  or  seventy-two  hours  of  more  or  less  severe  and  exhaust- 
ing labor,  delivery  is  effected  spontaneously,  and  the  animal  and  its 
progeny  are  none  the  worse  after  a  short  time.  This  delay  has  been  most 
frequently  observed  in  the  Cow  and  Goat ;  in  the  Mare  it  is  rarely  so 
prolonged. 

But,  as  a  rule,  it  is  not  advisable  to  allow  so  much  time  to  elapse  after 
labor  has  commenced,  without,  at  least,  ascertaining  the  nature  of  the 
obstacle  which  delays  birth  •  as  during  the  longer  intervals  especially, 
complications  may  arise  which  might  lead  to  serious  results.  The  foetus 
may  die,  or  it  may  assume  a  wrong  position  in  the  uterus,  which  may 
afterwards  prove  troublesome  to  the  obstetrist ;  the  mother  may  become 
exhausted  and  the  uterus  paralyzed,  so  that  the  foetus  cannot  be  expelled 
when  the  os  is  dilated  ;  or,  still  more  serious,  the  energetic  contractions 
of  the  uterus  may  produce  rupture  of  the  organ. 

So  that  a  prognosis  must  be  based  on  these  considerations  ;  and  both 
the  owner  of  the  animal  and  the  veterinarian  must  bear  in  mind  the  fact, 
that  while  premature  and  too  active  intervention  in  such  a  case  is  to  be 
deprecated,  too  long  delay  in  affording  assistance  is  to  be  equally  guarded 
against. 

Trcatmefit. 

As  this  condition  of  the  cervix  uteri  is,  at  the  commencement,  of  no 
great  importance,  and  merely  retards  natural  delivery,  active  interference 
is  forbidden  for  some  time. 

When  the  first  signs  of  parturition  do  not  extend  beyond  some  hours 
— one  or  two  for  the  Mare,  five  or  six  for  the  Cow,  according  to  Saint- 
Cyr ;  when  the  obstetrist,  by  vaginal  exploration,  has  assured  himself 
that  the  genital  organs,  as  welf  as  the  pelvis,  are  not  in  any  way  de- 
formed or  altered  ;  that  the  animal  is  all  right  otherwise  ;  and  that  rigid- 
ity of  the  cervix  is  alone  the  cause  of  delay  in  birth  ;  then  he  ought  to 
wait,  while  being  prepared  at  the  same  time  for  any  emergency.  The 
glutinous  matter  which  has  been  mentioned  as  occupying  the  vagina  and 
OS  and  covering  the  cervix,  should  be  removed  as  much  and  as  gently  as 
possible  from  these  parts,  so  as  to  permit  dilatation  to  take  place  when 
the  spasmodic  condition  begins  to  yield. 

If,  however,  labor  appears  to  be  unduly  prolonged  without  any  pro- 
gress being  made  in  parturition,  and  if  the  "pains"  are  energetic,  while 
the  animal's  condition  is  not  so  satisfactory,  then  intervention  may  be 
counselled.  But  this  intervention  should  be  of  the  simplest  and  mildest 
character ;  and  in  the  majority  of  cases  it  will  be  attended  with  entire 
success.  Injections  jz>^r  rectum  or  vagmam,  of  emollient  or  oily  fluids,  to 
which  tincture  pi  opium  or  extract  of  belladonna  has  been  added  ;  the 
ointment  or  extract  of  belladonna  smeared  around  the  cervix  or  intro- 
duced into  the  os ;  blankets  or  sacks  steeped  in  hot  water  and  applied 
over  the  loins  of  the  larger  animals,  or  warm  water  baths  for  the  smaller 
ones  ;  and,  in  certain  cases,  the  administration  of  draughts  containing 
some  soothing  medicament — such  as  chloral,  chloroform,  or  opium  j— 
these  are  the  means  to  be  adopted. 


344  MATERNAL  DYSTOKIA. 

Bleeding  has  been  advocated  by  some  authorities — particularly  on  the 
Continent ;  but  we  quite  agree  with  Saint-Cyr  that,  unless  something  very 
unusual  in  the  general  condition  of  the  animal  demands  it,  the  abstrac- 
tion of  blood  is  of  very  questionable  value. 

Opium  is  of  much  service,  from  the  influence  it  possesses  in  controlling 
the  uterine  spasms  ;  it  is  therefore  to  be  recommended  when  the  "pains  " 
are  severe  and  frequent.  It  may  be  given  in  large  doses,  both  in  draught 
and  enema,  and  frequently. 

Chloral  hydrate  and  chloroform,  particularly  the  former,  are  of  great 
utility,  and  possess  advantages  over  opium  as  soothing  agents. 

For  a  very  long  time,  belladonna  has  enjoyed  the  reputation — and  ap- 
parently with  justice — of  being  one  of  the  best  agents  for  combating 
spasm  of  the  cervix  uteri,  and  permitting  dilatation  of  the  os.  Occasion- 
ally its  efficacy  has  been  contested,  but  the  great  balance  of  evidence  is 
in  its  favor,  and  its  employment  is  almost  a  matter  of  course  with  every 
veterinary  obstetrist.  It  is  generally  applied  in  the  form  of  extract  around 
the  cervix,  about  a  drachm  or  so  being  required  for  one  application — it 
is  rare  that  a  second  application  is  needed.  Time  sliould  be  allowed  for 
its  action. 

Sometimes  it  is  attempted  to  dilate  the  os  uteri  by  manipulation — the 
fingers  and  hand  being  the  dilators ;  but  this  means  should  not  be 
adopted  until  milder  measures  have  failed,  and  until  time  and  patience 
have  been  exhausted  over  them.  The  hand  and  fingers  well  oiled,  or 
smeared  with  extract  of  belladonna,  should  be  introduced  in  the  form  of 
a  cone,  towards  the  os  ;  if  they  cannot  be  passed  into  the  canal  in  this 
shape,  then  the  insertion  of  one  finger  may  be  attempted,  followed  by  a 
second,  and  so  on  until  the  hand  has  been  pushed  through. 

Very  frequently  this  cannot  be  accomplished  at  the  first  trial,  nor  yet 
at  the  second  ;  but  with  patience  and  judgment  it  rarely  fails,  and  if  con- 
ducted with  the  care  and  gentleness  which  all  operations  of  this  kind 
should  receive,  such  manipulation  may  be  attempted  without  the  least 
danger  at  intervals  of  a  few  hours,  until  crowned  with  success.  The 
condition  of  the  os  should  be  ascertained,  after  a  certain  period  has 
elapsed  since  the  last  attempt,  every  precaution  being  adopted  to  prevent 
injury ;  and  an  entrance  to  the  os  ought  only  to  be  effected  when  the  re- 
sistance has  greatly  diminished,  and  can  easily  be  overcome. 

A  fairly  typical  case  of  this  condition,  and  one  which  illustrates  the  evil  results  of 
undue  haste  in  attempting  to  effect  delivery,  is  given  by  Cartwright  (  Veterinarian,  vol. 
XV.,  p.  371).  A  Cow,  three  years  old,  when  within  about  two  days  of  calving,  was  found 
straining  violently,  and  had  protruded  a  portion  of  the  vagina  and  rectum.  The  os 
uteri  was  not  in  the  least  dilated,  but  the  Cervix  felt  larger  and  harder  than  usual,  and 
projected  a  good  deal  into  the  vagina.  The  head  and  feet  of  the  calf  could  be  felt  by 
examination  -per  rectum,  and  were  not  far  from  their  natural  position ;  but  when  the  an- 
imal strained,  they  were  forced  with  such  violence  against  the  rectum  that  it  was  feared 
they  would  penetrate  it,  and  large  swellings  were  formed  at  the  anus  and  vulva.  Blood 
was  abstracted,  and  opium  given  in  solution.  In  threfe  hours  the  symptoms  were  not 
so  urgent,  and  more  opium  was  given.  During  the  night  an  amateur  had  repeatedly 
examined  the  os  uteri,  had  tried  to  dilate  it,  pulled  out  portions  of  hard  lymph  there- 
from, and  got. the  fore-feet  and  head  of  the  foetus  into  the  passage  ;  afterwards,  four  or 
five  persons  had  been  pulling  at  the  latter  with  ropes,  but  could  not  get  it  away.  Cart- 
wright  found  the  calf  properly  presented,  but  counselhd  abstention  for  an  hour  or  so, 
as  the  OS  was  not  sufficiently  dilated.  Two  hours  afterwards,  it  was  attempted  to  ex- 
tract the  calf  by  three  persons  pulling  at  the  cords  attached  to  it,  while  the  operator 
tried  to  dilate  the  os.  While  traction  was  being  made,  the  cervix  protruded  about  five 
inches  beyond  the  vulva,  and  was  excessively  tight  around  the  calf  s  head  ;  but  from  the 
force  of  pulling,  the  "  stricture  "  ruptured  to  the  extent  of  four  or  five  inches.     The  calf 


MORBID  ALTERATIONS  IN  THE  GENITAL  ORGANS. 


345 


then  immediately  came  away,  and  the  uterus  became  inverted.  The  placentulae  were 
removed  and  the  organ  was  returned. 

The  annnal  continued  to  strain  for  about  a  week,  and  nineteen  days  after  delivery  a 
fireat  quantity  of  putrefying  matter  was  removed  from  the  inner  surface  of  the  uterus  by 
manual  exploration  ;  in  four  days  after  this,  the  creature  being  in  a  helpless  state,  it  was 
killed. 

The  uterus  was  found  to  be  quite  contracted,  and  contained  about  a  pint  of  matter. 
There  was  a  distinct  cicatrix,  about  four  inches  long,  over  a  portion  of  the  cervix  and 
vagina,  where  probably  the  laceration  had  occurred.  "  Taking  the  cervix  uteri,  uterus, 
and  vagina  all  together,  there  was  little  amiss  with  them,  more  than  after  an  ordinary 
case  of  parturition.  The  cervix  uteri  was  a  little  rigid,  but  perhaps  scarcely  more  than 
usual," 

Mechanical  dilatation  of  the  os  by  means  of  the  sponge  tent  has  been 
much,  and  most  successfully,  employed  in  human  obstetrics  for  a  long 
time,  and  the  method  has  recently  been  greatly  simplified  and  perfected 
by  Sims  and  Joulin,  Saint-Cyr  thinks  that  it  is  perfectly  applicable  to 
animals,  and  we  are  of  the  same  opinion.  The  tent  can  perhaps  be  pur- 
chased at  any  druggist's,  but  if  not  it  is  easily  made,  Joulin  makes  those 
he  uses  \w  the  following  manner : — From  a  somewhat  fine  and  dry  sponge 
of  inferior  quality,  he  cuts  two  long  conical  pieces,  one  about  three  and 
a  quarter  inches  in  length,  about  an  inch  wide  at  the  base,  and  one-third 
of  an  inch  at  the  apex ;  the  other  five  or  six  inches  in  length,  two  and  a 
half  inches  at  the  base,  and  one-third  of  an  inch  at  the  apex.  Of  course 
they  would  require  to  be  larger  for  animals. 

These  cones  are  then  prepared  for  use  by  wrapping  them  closely  round 
in  twine,  the  circles  of  which  should  be  so  near  each  other  as  not  to  leave 
ridges  on  the  sponge.  By  this  pressure  the  tents  become  extremely  com- 
pact, and  look  like  a  thick  bougie. 

When  required  for  use,  the  twine  is  removed — this  should  not  be  done 
until  the  tent  has  been  prepared  for  at  least  two  or  three  hours,  when  it 
will  have  acquired  sufficient  rigidity.  A  piece  of  cord  should  be  attached 
to  its  base,  so  as  to  allow  it  to  be  withdrawn  when  inserted  in  the  os  ; 
but  before  this  insertion  takes  place,  the  apex  must  be  covered  with  a 
little  lard,  cerate,  or  extract  of  belladonna.  The  sponge  is  passed  into 
the  OS  as  far  as  possible,  either  by  the  fingers  or  forceps,  and  until  the 
base  of  the  tent  is  close  to  the  margin  of  that  opening.  The  narrow  and 
slightly  flexible  apex  of  the  tent  allows  of  its  passage  through  the  os  into, 
the  uterine  cavity  ;  but  in  order  to  be  successful  the  operation  must  be 
quickly  performed.  Otherwise,  the  sponge  rapidly  absorbs  mucus  and 
loses  Its  rigidity. 

No  plugging  or  other  means  are  necessary  to  retain  the  tent,  as  the 
portion  which  projects  into  the  uterus  quickly  increases  in  size  from  the 
absorption  of  moisture  ;  so  that,  after  a  few  minutes,  a  certain  amount  of 
force  is  necessary  to  withdraw  it  therefrom  by  means  of  the  cord. 

The  sponge-tent  acts  in  several  ways,  and  simultaneously:  i.  It 
detaches  the  membranes,  and  this  is  often  sufficient  to  induce  labor;  2. 
It  acts  as  a  foreign  body  in  irritating  the  posterior  segment  of  the  uterus, 
which  reacts  by  contracting  ;  3.  It  dilates  the  inner  opening  of  the  os  \ 
4.  It  also  dilates  the  entire  length  of  the  os,  by  swelling  through  imbibi- 
tion of  the  uterine  mucus. 

To  obviate  the  risk  of  softening  before  it  is  inserted  into  the  os,  Joulin 
prepares  the  tent  in  the  following  manner.  Instead  of  wrapping  it  round 
with  twine  while  it  is  in  a  dry  state,  he  saturates  the  sponge  in  a  solution 
of  gum  Arabic,  and  then  having  rolled  the   twine  round  it,  leaves  it  to 


3  46  MA  TERN  A  L  D  YSTOKIA . 

dry  for  some  days.  After  this  treatment  it  preserves  a  certain  degree  of 
siippleness,  but  may  remain  for  a  minute  or  two  in  contact  with  the  mucus 
before  imbibing  it. 

Barnes'  procedure  for  the  dilatation  of  the  os  uteri  in  woman,  has  also 
proved  of  great  service  in  human  obstetrics  ;  but  to  our  knowledge  it  has 
only  once  been  tried  with  animals,  though  there  is  no  reason  why  it  should 
not  be  successfully  employed,  not  only  in  producing  abortion  in  those 
cases  to  which  w^e  have  previously  alluded,  but  also  in  the  morbid  con- 
dition now  under  consideration. 

This  procedure  -consists  in  dilating  the  os  by  means  of  fiddle-shaped 
india-rubber  bags,  which  for  women  are  of  three  different  sizes  ;  but  the 
very  largest  of  them  would  probably  be  required  as  the  smallest  size  that 
could  advantageously  be  used  for  the  Cow  or  Mare.* 


Fig.   77- 
Barnes'  Uterine  Dilator. 

The  bag,  in  an  empty  condition,  is  introduced  into  the  os  by  means  of 
a  whalebone  sound  or  director,  which  fits  into  a  small  pocket  at  the  side  ; 
it  is  pushed  through  the  canal  until  the  pocket  end  projects  into  the 
uterus  j  then  water  is  steadily  injected  into  it  by  means  of  the  tube  at- 
tached to  the  other  end.  When  filled  with  water  the  bag  remains  in  the 
OS,  in  consequence  of  the  middle  portion  being  narrower  than  the  two 
ends. 

This  dilator  produces  the  same  results  as  the  sponge  tent,  over  which 
it  has  some  advantages.  The  only  drawback  to  it  is,  perhaps,  the  thick- 
ness of  its  substance  ;  as  it  cannot  be  passed  into  the  os  unless  this  is 
permeable  to  two  or  three  fingers. 

The  instance  to  which  we  have  alluded  as  that  in  which  this  dilating  bag  has  been 
tried,  is  recorded  by  West  ( Veterinarian,  1876,  p.  384).  On  February  9th,  1876,  lie  saw 
a  very  valuable  Cow,  the  winner  of  several  first-class  prizes,  which  should  have  calved  in 
the  previous  November,  but  had  showed  no  signs  of  doing  so.  It  was,  in  fact,  a  good 
example  of  the  condition  which  we  are  now  treating  of,  and  which  has  been  vulgarly 
designated  a  "  horned-up  "  os  uteri.  The  animal  was  apparently  healthy,  the  pulse  and 
temperature  being  normal,  and  there  being  no  offensive  discharge  from  the  vagina.  An 
examination /^r  rcctian  revealed  the  presence  of  a  foetus  in  the  uterus,  while  exploration 
per  vaginam  proved  that  the  os  uteri  was  nearly  closed,  and  that  the  end  of  a  finger 
could  not  be  inserted.  Belladonna  was  applied,  and  the  cervix  patiently  manipulated 
for  a  long  time,  but  the  constriction  could  not  be  dilated  to  the  smallest  extent.     From 

*  These  bags  are  made  by  Weiss  &  Son,  surgical  instrument  makers.  Strand,  London.  When  ordered, 
the  animal  for  which  they  are  to  be  used  should  be  mentioned. 


MORBID  ALTERATIONS  IN  THE  GENITAL  ORGANS. 


347 


the  time  that  elapsed  since  the  period  of  gestation  had  expired,  this  was  evidently  a  case 
of  "missed  birth." 

It  was  proposed  to  incise  the  cervix,  so  as  to  allow  the  hand  to  be  introduced,  but 
this  was  objected  to  by  the  owner,  as  it  would  probably  render  the  Cow  useless  for 
breeding  purposes.  The  case  was  left  as  hopeless,  and  as  it  was  decided  that  the  ani- 
mal should  not  be  killed,  it  was  kept  as  a  "  pensioner." 

About  the  end  of  April  it  was  proposed  that  Barnes'  infiating  india-rubber  bags,  as 
used  for  women,  should  be  tried,  As  might  have  been  foreseen,  it  was  soon  discovered 
that,  though  suitable  for  the  human  female,  the  bags  in  ordinary  use  were  neither  suffi- 
ciently long  nor  strong  enough.  Special  bags  were  therefore  prepared,  and  the  smallest 
was  introduced  into  the  os  by  means  of  the  whalebone  director,  though  with  the 
greatest  difficulty.  It  was  then  gradually  filled  with  warm  water  by  the  india- 
rubber  syringe  and  tube  attached  to  it.  In  about  ten  minutes  this  bag  had  sufficiently 
dilated  the  os  to  admit  that  of  the  next  size,  and  in  rather  less  than  an  hour  the  largest 
bag  was  filled,  when  the  passage  was  so  widened  that  the  decomposed  fcetus  was  re- 
moved with  very  little  trouble. 

The  uterus  contained  a  large  quantity  of  horribly  foetid  fluid  ;  this  was  removed,  and 
the  cavity  thoroughly  cleansed  and  syringed  out  with  a  dilute  solution  of  Condy's  fiuid. 
The  animal  quite  recovered. 

A  simpler  contrivance  than  that  of  Barnes,  and  which  will  perhaps  be 
found  useful  on  similar  occasions,  is  that  designed  by  Schnakenburg,  and 
named  the  "  Sphenosiphon."  It  is  merely  the  bladder  of  an  animal 
tied  to  a  syringe,  and  which,  when  water  is  injected  into  it,  mechanically 
dilates  the  cervix.  For  veterinary  purposes,  the  bladder  might  be  attached 
to  a  piece  of  india-rubber  tubing,  which  again  could  be  fixed  to  the  nozzle 
of  the  syringe.  It  and  Barnes'  dilator  act  in  the  same  manner  as  the 
natural  "  water-bag,"  formed  by  the  fcetal  membranes  and  liquor  amnii. 

Another  means  which  might  be  successfully  employed  in  such  cases,  as 
it  is  simple  and  without  danger,  and  at  the  same  time  effective  in  pro- 
ducing premature  artificial  delivery  in  woman,  is  the  uteri?ie  douche  intro- 
duced into  obstetrical  practice  in  1848,  by  Kiwisch  of  Dresden.  This  is 
generally  known  as  the  "  ascending  uterine  douche,"  and  consists  of  a  jet 
of  water  at  a  certain  temperature  directed  against  the  posterior  uterine 
segment  for  some  minutes,  and  repeated,  if  necessary,  at  intervals  of 
two  or  three  hours.  It  is  often  resorted  to  in  woman  to  favor  the  dilata- 
tion of  an  e?itirdy  closed  os,  and  to  prepare  it  for  the  application  of  an- 
other method,  which  may  be  either  Barnes'  or  Schnakenburg's. 

Saint-Cyr  proposes  to  adopt  this  method  to  animals  in  the  following 
manner.  The  apparatus  may  consist  merely  of  a  bucket,  or  barrel  with 
one  end  out,  such  as  may  be  found  in  almost  every  stable  or  cow-shed, 
and  a  long  piece  of  india-rubber  tubing  about  half  an  inch  in  diameter, 
which  can  be  procured  easily  and  cheaply.  To  one  end  of  this  tubing  is 
fitted  the  pipe  of  an  ordinary  syrfnge — either  enema  or  garden  ;  the  other 
end  is  immersed  in  the  barrel  or  pail,  which  should  be  filled  with  tepid 
water  at  a  temperature  of  about  40°  Cent.  (104°  Fahr.),  and  placed 
sufficiently  high  to  yield  a  pretty  strong  jet. 

In  order  to  set  the  water  flowing,  the  tube  must  be  exhausted  of  air 
by  suction  with  the  mouth,  and  the  end  provided  with  the  syringe  pipe 
carried  into  the  vagina  and  directed  towards  the  cervix  uteri.  Each 
douche  should  continue  for  about  ten  or  fifteen  minutes,  or  longer  ;  and 
it  may  be  repeated  every  two  or  three  hours,  or  even  at  short  intervals, 
according  to  circumstances,  until  the  desired  effect  has  been  produced. 

Cazeaux  speaks  highly  of  this  method  of  dilating  the  cervix  in  woman, 
and  for  the  following  reasons  : 

I,  The  uterine  douche  prepares  the  act  of  premature  birth  with  the 
greatest  possible  gentleness,  by  means  of  the  softening  and  the  necessary 
dilatation  of  the  inferior  searment  of  the  uterus. 


348  MA  TERNAL  D  YSTOKIA . 

2.  By  this  means  all  preparatory  treatment  is  needless. 

3.  This  procedure  is  easily  employed,  and  not  at  all  disagreeable  to 
the  woman,  as  the  injection  of  warm  water  does  not  produce  any  discom- 
fort. 

4.  It  does  not  require  much  time. 

5.  Its  action  can  be  graduated  at  the  will  of  the  obstetrist,  who  may, 
according  to  requirements,  increase  or  diminish  the  duration  of  the  douche 
and  the  temperature  of  the  water,  as  well  as  vary  the  parts  of  the  cervix 
on  which  he  directs  it. 

6.  Finally,  it  can  never  occasion  lesions  of  the  genital  organs,  nor  yet 
injure  the  foetal  membranes  or  the  fcEtus. 

We  deem  this  uterine  douche  well  worthy  of  notice,  and  though  there 
are  only,  so  far  as  we  can  ascertain,  three  cases  on  record  in  which  it  has 
been  tried  with  animals,  yet  as  these  were  most  successfully  treated  by  it, 
it  may  be  assumed  that  it  will  be  found  a  most  valuable  means  of  not  only 
dilating  the  os  uteri,  but  also  of  controlling  the  action  or  relieving  certain 
morbid  conditions  of  the  uterus  itself. 

Quivogne  communicates  to  Saint-Cyr  {Traite  de  Obstetrique  Veter- 
itiaire,  p.  373)  the  following  three  instances  of  the  successful  application 
of  the  douche. 

1.  In  1859,  a  Cow,  aged  five  years,  and  seven  months  pregnant,  was  purchased,  and 
two  days  afterwards  it  jumped  over  the  fence  of  the  meadow  in  which  it  had  been  placed. 
In  a  few  hours  it  began  to  exhibit  symptoms  of  colic.  A  vaginal  examination  was  made, 
and  it  was  discovered  that  there  was  complete  occlusion  of  the  os,  so  that  the  extremity 
of  the  little  finger  could  not  be  introduced.  Quivogne  deemed  it  the  best  course  to 
wait  before  interfering. 

Some  hours  having  elapsed,  however,  labor  pains  became  frequent  and  energetic ; 
though  the  cervix  was  in  the  same  state  as  before.  Still  later,  towards  the  evening,  the 
condition  of  the  animal  was  more  aggravated,  and  penetration  of  the  os  was  altogether 
impossible.  All  the  measures  that  might  be  adopted  in  such  a  case  were  passed  in  re- 
view, but  none  of  them  could  be  decided  upon.  Here  was  a  cervix  anatomically  healthy  ; 
to  resort  to  incision  appeared  to  be  imprudent,  and  too  dangerous  an  operation.  Irriga- 
tions with  tepid  water  were  then  thought  of,  and  it  was  resolved  to  try  them. 

In  order  to  apply  them,  Quivogne  had  recourse  to  a  small  garden  syringe,  to  which 
was  already  attached  an  india-rubber  tube.  The  irrigations  were  commenced  and  con- 
tinued until  the  morning,  at  first  under  the  direction  of  Quivogne,  then  by  the  people  be- 
longing to  the  house.  The  next  morning  at  six  o'clock  the  patient  was  lying  quietly  and 
was  being  douched  without  the  slightest  manifestation  of  displeasure.  Then  an  explo- 
ration was  made,  and  it  was  found  that  the  os  had  sensibly  dilated,  as  the  whole  of  the 
fingers  of  the  hand,  gathered  together  in  a  cone-like  manner,  could  be  inserted,  and  by 
a  slight  pressure  the  whole  hand  was  passed  through.  The  douches  were  resumed, 
but  only  for  a  short  time,  as  the  "  water-bag  "  was  not  long  in  appearing,  and  very  soon 
after  delivery  was  effected. 

2.  In  i860,  the  same  veterinarian  was  called  ^pon  during  the  night  to  attend  upon  a 
Goat,  which  was  showing  symptoms  of  abortion.  Vaginal  exploration,  although  difficult, 
on  account  of  the  smallness  of  the  pelvis,  nevertheless  satisfied  him  that  this  was  another 
case  of  rigidity  of  the  cervix.  He  at  once  decided  to  have  recourse  to  the  uterine 
douches.  For  lack  of  better  apparatus,  he  was  compelled  to  use  a  horse  syringe,  with 
which  he  directed,  as  well  as  he  could,  frequent  jets  of  tepid  water  on  the  cervix.  Here 
again,  notwithstanding  the  imperfect  apparatus  employed,  the  result  was  favorable ;  as 
delivery  was  effected  without  any  trouble  at  one  o'clock  next  morning. 

3.  In  the  same  year,  Quivogne  was  again  requested  to  see  a  Goat  which  was  about  to 
abort.  The  obstacle  to  the  passage  of  the  foetus  was,  in  this  case  also,  the  rigidity  of  the 
cervix  and  occlusion  of  the  os  uteri.  Having  already  succeeded  twice  with  the  douche, 
he  was  determined  to  give  it  another  trial,  though  in  a  modified  form.  He  placed  a 
washing-tub  on  a  table,  into  the  plug-hole  of  which  he  fitted  a  sufficiently-long  india-rub- 
ber tube ;  having  filled  this  vessel  with  tepid  water,  he  immediately  commenced  the 
vaginal  douches,  and  these  were  productive  of  complete  success  in  five  hours. 

Rougher  treatment  for  the  dilatation  of  the  cervix  than  that  which  has 


MORBID  ALTERATIONS  IN  THE  GENITAL  ORGANS. 


349 


been  described,  is  sometimes  resorted  to,  either  through  impatience, 
ignorance,  or  in  cases  which  demand  prompt  action  ;  as  the  other  measures 
require  a  certain  amount  of  time,  from  the  slowness  of  their  operation — 
though  perhaps  this  is  rather  an  advantage  than  otherwise. 

Forcible  dilatation  of  the  os  uteri  has  been  practised  in  human  obstetrics, 
and  special  instruments  have  been  devised  with  this  object.  Such  dila- 
tors have  been  constructed  by  Osiander,  Busch,  Mende,  and  Krause,  but 
they  have  not  been  much  used,  as  milder  measures  are  far  more  prefer- 
able. The  same  remark  is  applicable  to  veterinary  obstetrics,  in  which 
there  is  only  too  often  a  tendency  to  imagine  that  because  the  patient  is 
an  animal,  so  all  the  more  force  and  brusqueness  should  be  resorted  to. 

Forcible  dilatation  of  the  cervix,  which  is  not  to  be  recommended,  except 
perhaps  in  very  exceptional  instances,  has  its  advocates,  and  two  cases  re- 
ported by  Oschner,  a  Swiss  veterinary  surgeon,  prove  that  it  may  be  suc- 
cessful, notwithstanding  its  disadvantages.  In  these  cases,  every  other 
known  means  had  failed  ;  so  Oschner  procured  a  pair  of  large  fire  tongs 
used  by  blacksmiths,  and  wrapping  their  jaws  round  with  tow  which  was 
smeared  with  grease,  he  introduced  them,  closed,  through  the  os  j  then 
an  assistant  gradually  opened  the  shanks  or  handles  of  the  tongs,  and  so 
produced  the  desired  widening  of  the  passage.  The  inflammation  set  up 
by  this  manoeuvre  was  dissipated  by  the  employment  of  soothing  reme- 
dies, after  fifteen  days'  treatment. 

It  is  obvious  that  such  a  mode  of  dilatation  should  not  be  practised, 
unless  there  is  something  most  unusual  in  the  case  ;  as  it  is  a  most  pain- 
ful operation,  and  likely  to  produce  -contusions  and  lacerations  of  the 
cervix,  which  may  require  much  tijne  and  attention  to  repair. 

Incision  of  the  cervix  {vaginal  hysterotomy)  is  another  operation  which 
can  scarcely  ever  be  required  for  rigidity  or  spasm  of  this  part,  and  ought 
to  be  reserved  for  more  serious  conditions.  At  any  rate,  it  should  not 
be  practised  until  the  other  measures  we  have  enumerated  have  been 
fairly  tried,  as  it  is  an  operation  not  without  risk  of  ill  consequences. 

In  some  cases,  in  which  the  spasmodic  action  of  the  uterus  is  irregular, 
and  leads  to  occlusion  of  the  os,  it  might  be  advisable  to  resort  to  anaes- 
thesia, produced  by  the  inhalation  of  ether  or  chloroform.  Of  course 
the  anaesthesia  should  not  be  pushed  to  complete  insensibilit}^,  but  be 
limited  to  semi-consciousness  or  "  obstretrical  anesthesia."  This  is 
more  particularly  to  be  recommended  for  the  smaller  animals. 

In  the  majority  of  cases,  when  the  rigidity  has  been  dispelled,  or  the 
spasm  relaxed,  birth  will  take  place  without  further  assistance  being 
required  ;  though  it  may  be  well  that  the  obstetrist  assure  himself  that 
the  foetus  is  in  a  favorable  position  for  delivery.  If  there  appears  to  be 
atony  of  the  uterus,  or  the  mother  is  exhausted,  or  if  the  foetus  is  dead  or 
in  a  faulty  position,  then  it  will  be  necessary  to  afford  aid  in  parturition 
by  adjustment  and  traction. 

In  very  many  instances,  it  must  be  remembered,  that  this  rigid  condi- 
tion of  the  cervix  is  due  to  malpresentation  or  malposition  of  the  foetus  in 
the  uterus ;  and  even  when  the  os  has  been  sufficiently  relaxed,  the  young 
creature  cannot  pass  through  until  it  has  been  properly  placed,  and  not 
unfrequently  aided  through  the  genital  canal. 

3.  Induration  of  the  Cervix  Uteri. 

Induration  of  the  cervix  is  the  term  applied  to  this  part  when  its  tex- 
ture is  altered  in  any  way — whether  the  alteration  may  be  fibrous,  sar- 


35° 


MATERNAL  DYSTOKIA, 


comatous,  or  cancerous — so  that  its  elasticity  being  destroyed,   and  its 
structure  inextensible,  it  offers  an  obstacle  to  parturition. 

This  alteration,  or  "  scirrhus,"  as  it  has  sometimes  been  designated,  is 
not  at  all  unfrequent;  but  it  has  only  been  observed,  it  appears,  in  the 
Cow,  and  would  seem  to  be  almost,  if  not  quite,  peculiar  to  that  animal.* 
The  reason  for  this  partiality  has  been  variously  accounted  for,  but  prob- 
ably Bouley,  in  an  unpublished  note  to  Saint-Cyr,  has  afforded  the  most 
satisfactory  explanation.  He  remarks  that  "  irritation  produces  in  the 
bovine  species  phenomena  of  induration  much  more  durable  than  in  any 
other  species  ;  in  proof  of  this,  witness  the  plastic  engorgements — so  ad- 
verse to  suppuration,  and  so  slow  to  disappear — which  are  caused  by  a 
seton  introduced  beneath  the  skin  of  an  ox ;  witness,  also,  the  enormous 
swellings  observed  as  a  consequence  of  inoculation  for  pleuro-pneumonia 
(bovine),  and  those  indurated  tumors  vulgarly  designated  osteo-sarcoma- 
tous,  so  frequent  on  the  maxilla,  and  which  repeated  irritation  produced 
by  the  prick  of  a  needle  are  sufficient  to  produce.  This  seems  to  be  a 
general  organic  fact,  of  which  induration  of  the  cervix  uteri  is  only  a  par- 
ticular instance." 

This  induration  must  not  be  confounded  with  the  dense,  fibrous,  though 
normal,  consistence  of  the  cervix  of  the  Cow's  uterus,  which,  there  can  be 
no  doubt,  has  often  been  mistaken  for  a  diseased  condition,  and  particu- 
larly when  in  a  rigid  or  spasmodic  state.  The  distinction  between  what 
we  may  term  the  functional  dera?igement  an-d  the  pathological  alteration  of 
this  part  is  of  great  importance  from  an  obstetrical  point  of  view  ;  as 
the  first  maybe  remedied  by  the- mild  and  innocuous  measures  enume- 
rated, while  the  second  can  only  be  overcome  by  a  more  or  less  serious 
surgical  operation. 

In  some  cases,  perhaps  the  induration  is  congenital ;  but  it  must  be 
admitted  that,  as  a  rule,  it  is  due  to  the  influence  of  disease  or  injury — 
past  or  present — in  the  textures.  It  may,  therefore,  be  expected  to  be 
more  frequent  in  old  animals,  or  those  which  have  already  been  bred 
from,  than  in  those  which  are  young  or  are  pregnant  for  the  first  time, 
though  these  do  not  appear  to  be  exempt. 

Rancon  assured  Rainard  that  morbid  induration  of  this  part  was  wit- 
nessed more  frequently  in  the  ancient  Brian9onnais,  where  he  practised 
for  thirty-six  years,  than  in  other  regions  of  France.  We  are  not  aware 
whether  the  influence  of  breed  or  locality  has  been  observed  to  influence 
its  prevalence  in  other  countries. 

Symptoms. 

Owing  to  the  situation  of  the  cervix,  the  nature  of  the  tissues  entering 
into  its  composition,  as  well  as  to  the  slowness  with  which  the  pathologi- 
cal alterations  take  place,  this  condition  may  be  in  existence  for  a  long 
time,  without  any  appreciable  change  being  observable  in  the  animal's 
health.  Therefore  it  is  that  Cows  which  are  so  affected  do  not  exhibit 
any  thing,  during  the  whole  period  of  pregnancy,  which  might  lead  any 
one  to  suspect  the  existence  of  uterine  disease. 

*  I  can  only  find  one  case  mentioned  as  occurring  in  any  other  animal,  and  that  happened  in  a  Ewe.  It 
is  reported  by  Shentone  ( Veterinarian,  vol.  xxix.  p.  36),  who  says  that  the  creature  had  been  in  labor 
since  the  previous  night,  but  had  made  no  progress,  and  was  very  much  exhausted.  "  It  was  a  case  of 
scirrhous  os  uteri-  1  told  him  (the  owner)  I  would  divide  the  stricture  as  the  only  means  of  saving  her, 
but  in  her  <;ase  it  was  almost  a  'forlorn  hope.'  However,  I  did  divide  it,  cutting  in"two  places,  parallel  to 
each  other,  and  with  a  good  deal  of  difficulty  extracted  a  large  lamb  that  had,  from  its  appearance,  been 
dead  for  some  time."    The  Ewe  recovered. 


MORBID  ALTERATIONS  IN  THE  GENITAL  ORGANS.    351 

In  some  cases,  however,  towards  the  termination  of  pregnancy  there 
has  been  remarked  a  lisllessness  or  gradually  increasing  debility,  which 
has  been  so  great  at  last  that  the  animal  assumed  the  recumbent  position  : 
and  could  not  get  up  without  assistance.  This  general  weakness  has 
been  mistaken  for  paraplegia,  and  has  sometimes  been  supposed  to  be 
due  to  lumbago ;  but  it  may  have  been  merely  a  symptom  of  generalized 
cancerous  infection,  the  part  itself  being  the  seat  of  cancer. 

But  in  the  great  majority  of  cases,  the  existence  of  induration  is  not 
suspected  until  parturition  sets  in,  when  the  labor  pains,  which  may  con- 
tinue for  a  long  time,  attract  more  than  ordinary  attention,  as  birth  does 
not  take  place.  And  not  unfrequently  during  the  pains,  and  more  espe- 
cially when  the  animal  is  lying,  a  livid,  irregular-shaped,  and  nodulated 
kind  of  tumor  appears  between  the  labia  of  the  vulva  ;  this  is  the  undi- 
lated  cervix  uteri. 

In  other  instances,  however,  nothing  is  observable  externally,  and  a 
vaginal  exploration  is  necessary.  The  cervix  is  then  discovered  to  be 
more  or  lass  protruded  into  the  vagina,  and  to  form  a  voluminous,  irregu- 
lar, nodulated  tumor  which  in  some  cases  feels  as  hard  as  wood,  and  in 
others  it  has  a  rugged,  soft,  and  ulcerated  surface.  Some  veterinary 
obstetrists  have  described  transverse  rugae,  composed  of  a  solid,  unyield- 
ing, fibro-cartilaginous  material,  in  the  os. 

The  OS  is  not  always  easily  found,  and  it  is  sometimes  so  contracted, 
that  one  finger  cannot  be  introduced  into  it  ;  at  other  times  it  is  not  so 
constricted,  and  the  foetus  may  be  felt  through  it.  But  in  every  case  it  is 
irregular  and  deformed,  deviated  from  its  usual  direction,  and  its  walls 
are  greatly  thickened,  perhaps  corrugated.  Its  degree  of  hardness  and 
thickness  will  indicate  whether,  and  to  what  extent,  it  can  be  dilated  ;  and 
this  condition  may  not  only  involve  the  whole  of  the  cervix,  but  also  the 
walls  of  the  uterus  itself,  as  w^ell  as  those  of  the  vagina. 

When  the  cervix  is  ulcerated,  the  hand  will  be  found  covered  with 
blood  after  the  examination. 

Diagnosis. 

The  diagnosis  or  this  condition  must  be  left,  to  a  large  extent,  to  the 
tactile  impressions  derived  from  a  vaginal  exploration.  In  some  cases 
an  ocular  inspection  of  the  cervix  may  be  possible,  and  the  previous  his- 
tory of  the  case  may  also  be  useful  in  this  direction. 

Prognosis. 

The  influence  of  the  induration  on  the  act  of  parturition,  will  depend 
upon  the  degree  and  extent  of  the  alteration.  If  this  is  not  very  serious, 
and  does  not  implicate  the  organ  very  much,  and  particularly  if  the  in- 
duration is  localized  in  some  unimportant  part,  parturition,  though  pro- 
tracted, may  nevertheless  be  accomplished  without  assistance.  Often, 
however,  the  results  are  troublesome  ;  one  of  these  being  laceration  of 
the  cervix,  from  its  unequal  dilatation. 

Though  there  is  a  great  difference,  pathologically  speaking,  between 
the  various  alterations — for  example,  between  simple  fibrous  transforma- 
tion and  cancerous  degeneration — yet  it  is  admitted  that  the  most  benig- 
nant alteration'  is  infinitely  more  serious,  from  an  obstetrical  point  of 
view,  than  simple  rigidity  of  the  cervix,  either  in  its  immediate  or  remote 


352 


MATERNAL  DYSTOKIA. 


results.  This  Saint-Cyr  has  proved  to  be  the  case  in  nineteen  recorded 
observations.  Of  these,  seven  were  more  or  less  unfortunate  in  their  re- 
sults ;  in  three  instances,  the  mother  and  foetus  succumbed  ;  in  other 
three,  the  mother  died,  but  the  progeny  was  saved  ;  and  in  the  seventh, 
the  calf  died  but  the  Cow  lived.  This  is  a  very  high  rate  in  mortality, 
and  yet  Saint-Cyr  is  not  quite  certain  that  in  these  nineteen  observations 
there  were  not  some  which  were  rather  cases  of  simple  rigidity  than  indura- 
tion of  the  cervix.  For  as  Rainard  remarks — and  the  remark  would  also 
apply  to  the  observations  recorded  in  English  veterinary  literature — it  is 
not  always  easy,  for  lack  of  sufficient  details,  to  discern  clearly  to  which 
category  belongs  such  or  such  an  observation  given  by  writers  under  the 
title  of"  indurated  cervix,"  "  scirrhous  cervix,"  "  stricture  of  the  os  uteri." 
In  arriving  at  a  prognosis  in  a  case  of  this  description,  the  immediate 
results  are  not  alone  to  be  taken  into  consideration  ;  as  pregnancy  and 
the  manipulatory  operations  necessary  to  effect  delivery — which  is  always 
tedious  and  difficult — give  to  morbid  alterations  of  these  parts — even  when 
quite  benignant  in  their  nature — an  exceptional  gravity  ;  so  that  many 
animals,  even  after  a  comparatively  easy  delivery,  succumb  soon  after- 
wards to  the  diseased  condition.  The  uterus  may  be  ruptured  through 
the  efforts  at  delivery. 

Pathological  Anatomy. 

The  lesions  found  after  death  are  generally  alluded  to  as  "fibrous  de- 
generation," "  scirrhus,"  or  "  cancer  "  of  the  cervix  ;  and  it  is  usually 
mentioned  that  this  part  was  "  hard  and  like  cartilage,"  "  creaking  under 
the  knife  like  cutting  an  unripe  apple  or  a  turnip  ;  "  or  that  there  was 
"scirrhus  "  or  "  cancer,"  "  nodular  and  hard  like  cartilage." 

Macgillivray  states  that  when  the  contraction  of  the  os  uteri  is  the  re- 
sult of  prior  disease,  it  will  generally  be  found  of  a  hard  fibroid  nature  ; 
while,  on  the  other  hand,  where  the  contracted  parts  are  soft  and  very 
much  thickened,  acute  disease  will  commonly  be  found  accompanying  the 
stricture.  "  In  hard  stricture,  the  transverse  rugae  or  folds  appear  gener- 
ally to  be  transformed  into  a  compact,  unyielding  fibro-cartilaginous  ma- 
terial ;  in  one  very  serious  case  I  found  six  of  these  hardened  unyielding 
transverse  rugae  or  folds  between  the  os  tmcce  and  os  mternum.  In  soft 
stricture,  without  any  actual  disease  being  present,  the  contraction  is 
generally  confined  to  the  os  and  the  vaginal  portion  of  the  cervix  uteri. 
In  cases  of  complicated  stricture,  or,  in  other  words,  stricture  accompanied 
by  some  active  disease,  it  will  often  be  found  that  the  stricture  is  merely 
the  concomitant  effect  of  the  disease,  and  such  causative  disease  will  al- 
most invariably  prove  to  be  either  ulcerative,  scirrhous,  really  cancerous, 
or  fungous  in  its  nature.  .  .  .  Deposits  of  a  fibrinous  nature  are  only  too 
common  in  patients  of  rheumatic  constitution." 

Lecoq,  GelM,  Horsburgh,  Berger,  Bruckmiiller  and  Macgillivray  have 
each  recorded  autopsies  of  animals  which  died  from,  or  were  killed  be- 
cause of,  this  condition.  These  are  all  the  writers,  to  my  knowledge, 
who  have  done  so. 

I.  Called  upon  to  assist  a  Cow  which  could  not  calve,  Lecoq  [Journal  Pratique  de 
Med.  Veterinaire,  1828,  p.  88),  on  inti'oducing  his  hand  into  the  vagina,  found  that  the 
neck  of  the  uterus  was  thickened  and  hard,  and  the  os  quite  closed;  that  a  round  body 
of  the  same  density  was  present  at  the  upper  part  of  the  vagina,  and  was  prolonged  to- 
wards the  anus.     When  he  withdrew  his  hand  it  was  stained  with  blood. 


MORBID  ALTERATIONS  IN  THE  GENITAL  ORGANS.     353 

Dilatation  of  the  os  being  deemed  impossible,  and  the  animal  being  nearly  dead, 
Lecoq  had  it  destroyed  ;  at  the  autopsy  he  discovered  the  following  lesions  :  "  The 
lining  membrane  of  the  uterus  was  of  a  dark-red  color,  which  became  black  towards  the 
cervix ;  while  the  os  was  so  contracted  that  the  finger  could  scarcely  be  passed  into  it. 
The  walls  of  the  cervix  presented  a  yellow  scirrhous  engorgement,  so  hard  that  it  creaked 
under  the  scalpel  ;  its  thickness  varied  from  one  to  two  inches,  and  in  its  centre  were 
several  small  purulent  centres  the  size  of  a  cherry-stone.  A  cylindrical  body  of  the  same 
character,  about  five  inches  in  length,  and  gradually  diminishing  in  volume,  was  lodged 
at  the  upper  part  of  the  vagina. ' 

2.  In  a  Cow  w.iich  had  died  about  three  weeks  after  parturition,  but  which,  it  appears, 
had  hien  suffering  for  fifteen  months,  and  had  succumbed  to  the  effects  of  calving,  Gelle 
[Pathologie  Bovine,  vol.  iii.,  p.  618)  found  the  following,  among  other  lesions:  "The 
vagina  was  in  its  normal  condition,  but  the  neck  of  the  uterus  was  invaded  by  an  enor- 
mous hard,  unequal,  and  lobulated  cancerous  tumor,  softened  at  several  points,  and  from 
several  openings  in  which  escaped  a  pultaceous,  greyish-white  cerebriform  matter,  mixed 
with  blood-streaks,  and  which  blackened  the  silver  probe.  A  little  of  this  matter  flowed 
into  the  vagina;  but  in  the  cavity  of  the  uterus  there  was  a  large  quantity,  which  was 
also  more  colored  by  the  blood  that  had  passed  with  it  through  the  fistulous  openings 
in  the  tumor.  The  large  violet  and  slaty-colored  patches  on  the  lining  membrane  of  the 
uterus,  testifv  to  the  chronic  character  of  the  inflammation. 

3.  Horsbu'rgh  relates  (  Veterinarian,  vol.  xiv.,  p.  605)  the  case  of  a  Cow  in  labor, 
which  had  been  very  ill  for  two  days,  and  which  had  been  attended  by  an  old  shepherd. 
When  Horsburgh  saw  the  poor  animal  it  was  dying,  and  the  os  was  completely  con- 
tracted and  undilatable.  He  attempted  to  incise  the  cervix,  but  this  caused  so  much 
pain  that  he  desisted,  and  awaited  the  death  of  the  animal,  in  order  to  perform  the  Cae- 
sarean  section  and  extract  the  calf.  In  a  short  time  the  Cow  succumbed  and  the  opera- 
tion was  performed,  but  the  fcetus  was  dead.  On  examination,  the  latter  was  found  in  a 
natural  position,  but  the  uterus  was  much  inflamed.  A  stricture  of  the  os,  about  four 
inches  in  length,  existed ;  this  was  "  corrugated  longitudinally,  and  of  a  cartilaginous 
hardness — so  much  so  that  I  could  not  force  a  passage  with  the  finger,  but  found  a  blunt- 
pointed  stick  to  answer  the  purpose.  I  removed  the  uterus  by  dividing  the  vagina  about 
four  inches  posterior  to  the  stricture,  and,  with  the  hooked  bistoury,  made  an  incision 
longitudinally  through  one  of  the  sides  of  the  cartilaginous  substance.  The  parts  were 
immediately  dilated,  until  I  could  with  ease  introduce  my  hand.  On  making  the  incis- 
ion on  the  other  side,  the  corrugations  gave  way." 

4.  Macgillivray  [Ibid.,  vol.  xlv.,  p.  718)  attended  an  aged  Cow,  almost  reduced  to  a 
skeleton  from  the  effect  of  a  rheumatic  fever.  The  animal  had  not  been  able  to  get  up 
for  three  weeks,  and  was  now  in  the  pangs  of  impotent  labor.  "  On  examination,  I 
found  this  a  case  of  hard  stricture,  the  worst  case  I  ever  met  with,  there  being  no  less 
than  six  transverse  hardened  bands,  each  completely  encircling  the  cervix  uteri.  The 
OS  uteri  was  also  firmly  rigid.  I  found  it  utterly  impossible  to  complete  the  incisive  ope- 
ration in  this  case,  and  only  succeeded  in  cutting  through  three  of  the  transverse  rugae 
or  hardened  bands;  and  as  the  Cow  was  evidently  a  worthless  subject,  and  there  being 
no  doubt  that  the  Calf  was  alive,  I  proposed  performing  the  Cassarean  operation,  in 
order  to  save  the  life  of  the  latter.  The  owner  at  once  consented,  and  appeared  highly 
delighted  with  the  Calf,  which  was  alive  and  ultimately  did  well.  The  Cow  was  killed 
immediately  after  the  operation. 

^  Treatment. 

The  condition  of  the  cervix  uteri  being  ascertained,  there  should  be  no 
delay  in  resorting  to  active  measures,  as  it  is  impossible  for  delivery  to  be 
effected,  in  the  great  majority  of  cases,  without  such  interference.  Here 
the  necessity  for  a  correct  diagnosis  is,  as  we  have  already  insisted,  of 
the  greatest  moment ;  for  if  the  obstacle  to  birth  is  only  rigidity  or  spasm 
of  the  uterus,  this  can  generally  be  overcome  by  mild  measures  and  with- 
out risk  or  injury  to  the  animal ;  whereas,  in  induration,  these  measures 
would  be  ineffective,  and  valuable  time  would  be  lost  in  trying  them. 

Delivery,  in  induration  of  the  cervix,  must  be  effected  by  one  of  two 
serious  operations.  This  must  be  either  vaginal-hysterotomy  or  gastro- 
hysterotomy.  We  shall  again  allude  to,  and  describe  these,  in  speaking  of 
obstetrical  operations. 

It  may  only  be  necessary  in  this  place  to  say  that  vaginal-hysterotomy 

23 


354  MATERNAL  DYSTOKIA. 

— by  which  is  meant  incising  the  cervix,  either  completely  or  partially,  in 
one  or  more  places — does  not  offer  any  very  dangerous  consequences 
when  the  textures  are  healthy;  though  when  they  are  much  degenerated, 
the  operation  may  be  followed  by  troublesome,  if  not  fatal  results.  Nev- 
ertheless, dilating  the  cervix  by  incision  is  rarely  so  serious  for  the 
mother  as  the  Caesarean  section  ;  though  the  foetus  may  incur  more  risk, 
as,  after  the  cervix  has  been  relaxed,  it  is  often  a  tedious  and  difficult  op- 
eration to  effect  delivery,  and  strong  traction  may  even  be  necessary. 
As  this  measure  offers  a  chance  of  saving  both  mother  and  foetus,  it 
should,  as  a  rule,  be  preferred  to  gastro-hysterotomy  ;  and  this  preference 
is  still  further  warranted  by  the  fact  that  the  life  of  the  mother  is  of  more 
value  than  that  of  the  foetus,  and  if  one  must  be  sacrificed,  it  should  be 
the  latter.  Should  the  foetus  happen  to  be  dead,  then  there  is  an  addi- 
tional motive  in  preferring  incision  of  the  cervix. 

When  the  os  has  been  considered  sufficiently  dilated  for  the  introduc- 
tion of  the  hand  and  arm  into  the  uterus,  then  the  foetus  should  be  placed 
in  position  for  extraction — the  most  favorable  being,  of  course,  the  verte- 
bro-sacral,  with  the  head  and  fore  limbs  towards  the  os.  Should  it  be 
found  impossible  to  engage  these  in  the  passage,  then  more  incisions 
may  be  made  in  the  cervix,  and  this  can  be  done  without  displacing  the 
foetus. 

It  is  well  to  remember  that  it  is  very  much  better  to  dilate  the  os  by 
incision  than  by  laceration,  through  unduly  forcing  the  foetus  into  it.  At 
the  same  time,  judicious  traction  should  be  made  during  the  maternal 
efforts. 

Aubry,  Van  Dam,  and  some  others,  have  witnessed  fatal  haemorrhage 
resulting  from  the  incisions ;  while  metro-peritonitis  has  also  been  re- 
ported as  an  equally  unfortunate  sequel. 

But  these  cases  are  exceptional.  Those  veterinary  obstetrists  in  this 
country  and  on  the  Continent,  who  have  had  most  experience  in  the  op- 
eration, are  unanimous  in  asserting  that,  provided  certain  precautions  are 
adopted  in  making  the  incisions,  no  such  results  are  likely  to  follow. 

Donnarieix  states  that,  in  thirty  years,  he  has  performed  vaginal  hys- 
terotomy in  sixteen  cases  of  schirrus,  and  other  kinds  of  induration'  of 
the  cervix  leading  to  occlusion  of  the  os  uteri,  and  of  these  only  one  died, 
though  the  cause  of  death  was  not  ascertained.  Recovery  is  the  rule  and 
death  the  exception. 

Of  course  recovery  must  always  be  doubtful  if  the  disease  of  the  cervix 
is  of  a  malignant  nature,  as  the  operation  and  the  irritation  caused  by  the 
extraction  of  the  foetus  will,  in  all  probability,  hasten  its  progress. 

In  some  rare  instances  it  may  be  advisable  to  have  recourse  to  the 
Caesarean  section  at  once.  When,  for  example,  labor  has  been  severe 
and  prolonged — when  some  days  have  elapsed  since  parturition  com- 
menced, and  the  veterinary  surgeon  is  not  sent  for  until  amateurs  have 
exhausted  their  efforts  and  the  animal  is  sinking  ;  or  when,  from  a  va- 
ginal exploration,  it  is  ascertained  that  uterine  or  vaginal  disease  is  so 
extensive  and  advanced  that  the  mother  cannot  live  much  longer,  and  the 
foetus  is  alive  ;  then  this  formidable  operation  should  be  adopted  without 
delay. 

Though  very  many  cases  of  induration  of  the  cervix,  with  stenosis  of  its  canal,  are 
recorded  in  Continental  veterinary  literature,  yet  we  do  not  find  lialf-a-dozen  instances 
in  English  journals. 

Of  these  we  select  the  following : 


MORBID  ALTERATIONS  IN  THE  GENITAL  ORGANS. 


355 


1.  Hall  [Vetcrbiarian,  vol.  xxviii.,  p.  272)  attended  a  Cow  which  had  been  in  labor 
for  twenty-six  hours,  and  was  so  much  exhausted  that  the  labor  pains  had  almost  sub- 
sided. The  OS  uteri  was  found  to  be  impermeable.  Stimulants  and  ecbolics  were  ad- 
ministered, but  they  produced  no  effect  pn  the  uterus.  It  was  then  "  determined  to  cut 
through  the  ligaments  or  bands  which  encircle  the  inner  margin  of  the  os  uteri,  and 
having  done  this  with  great  difficulty,  it  afforded  only  slight  relief;  for  it  was  more  like 
cutting  bone  than  elastic  tissue.  I  could  even  now  only  get  three  fingers  in  ;  but  this 
giving  me  more  room  to  work,  with  a  curved  knife  fitted  to  my  finger  I  made  four  inci- 
sions— one  above,  another  below,  and  one  at  each  side.  With  great  caution  I  had  to 
proceed,  for  the  Cow  was  now  making  violent  throes ;  but  I  had  more  room,  and  with  the 
assistance  or  five  men  I  brought  the  calf  into  the  world  alive."     The  Cow  recovered. 

2.  Macgillivray  (Ibid.,\o\.  xlv.,  p.  717)  was  called  to  a  seven-year-old  Cow  which  had 
been  trying  to  calve  for  twenty-four  hours.  The  foetal  membranes  had  ruptured,  but  an 
amateur  who  had  been  interfering  could  only  succ'eed  in  passing  one  finger  into  the  os 
uteri.  The  labor  pains  were  tolerably  severe,  and  the  entrance  to  the  uterus  was  found 
to  be  quite  rigid  and  closely  contracted,  admitting  only  two  fingers  with  great  difiiculty. 
The  cervix  was  soft,  but  within  the  os  were  three  transverse  bands,  exceedingly  firm 
and  unyielding,  and  no  manipulation  could  relax  them.  It  was  resolved  to  cut  through 
these  apparently  cartilaginous  rings  ;  but  as  the  cervix  could  not  be  brought  sufficiently 
back  into  the  vagina  to  be  seen  and  manipulated  externally,  cutting  through  it  was  diffi- 
cult and  required  extreme  care.  A  partially  covered  knife  was,  however,  introduced 
into  the  os,  and  two  lateral  incisions,  "  up  and  out,"  were  made  through  the  transverse 
bands.  "  The  effect  was  wonderful,  the  whole  parts  relaxing  almost  instantly,  and  the 
fore-legs  of  a  foetus  made  their  way  into  the  vagina ;  but  it  required  considerable  trac- 
tion to  get  the  head,  and  subsequently  the  whole  body,  away.  There  were  twins  pres- 
ent, and  both  were  born  alive  and  did  well.  Very  little  assistance  was  required  in 
bringing  the  second  calf  away.     There  was  scarcely  any  haemorrhage." 

3.  The  same  writer  mentions  the  case  of  a  two-year  old  Cow  in  its  first  pregnancy. 
This  animal  had  been  unwell  for  some  days ;  there  was  anorexia,  and  occasionally  se- 
vere labor  pains.  "  The  whole  uterus  and  its  contents  were  seemingly  at  times  forced 
into  the  pelvic  cavity,  and  at  such  times  the  walls  of  the  vagina  became  inverted."  On 
exploration,  the  cervix  was  found  firmly  contracted,  the  os  only  admitting  a  finger.  Di- 
latation by  "  emollients"  and  other  means  having  been  tried,  an  interval  of  twenty-four 
hours  was  allowed  to  elapse  before  incision  was  attempted.  The  operation  was  per- 
formed as  in  the  other  instance,  and  delivery  was  effected.  "  In  this  case,  however,  the 
calf  was  of  great  size,  and  it  required  a  tremendous  amount  of  traction  to  effect  a  sep- 
aration between  the  mother  and  foetus.  The  calf  was  alive  and  did  well ;  and  the 
mother,  notwithstanding  much  unavoidable  laceration,  with  good  nursing  and  treatment 
came  all  right." 

4.  Another  case  alluded  to  by  Macgillivray  as  one  of  "  soft  stricture,"  was  also  that 
of  a  primiparous  two-year-old  Cow  which  had  occasionally  been  seized  with  labor  pains 
during  five  days.  These  were  at  times  so  severe  as  to  bring  the  cervix  uteri  into  view, 
when  "  it  presented  a  very  inflamed  appearance,  was  extremely  ragged  in  outline,  and 
considerable  fungous  excrescences  had  become  developed  around  the  margin.  .  .  . 
The  cervix  was  quite  soft,  and  attended  with  much  inflammatory  action  and.  surrounding 
thickening."  Vaginal  hysterotomy  was  performed  as  in  the  previous  cases,  and  with 
much  difficulty  a  living  calf  was  extracted.  But  the  mother  was  so  "  frightfully  torn," 
owing  to  the  large  size  of  the  foetus,  that  it  was  deemed  advisable  to  have  it  slaughtered. 
The  owner  would  not  then  consent,  but  after  the  creature  had  lingered  for  ten  days,  it 
had  to  be  killed. 

5.  Migliano  {II  Medico  Veterinario,  1875)  is  the  latest  writer  who  treats  of  dystokia 
from  induration  or  stenosis  of  the  cervix  uteri.  The  first  case  of  dystokia  recorded  by 
him  occurred  in  a  Cow  three  years  old,  which  had  already  produced  a  calf  without  any 
difficulty.  When  seen  by  Migliano,  the  animal  was  in  the  act  of  parturition :  it  was 
lying  on  the  right  side,  manifested  indications  of  uneasiness  or  pain,  and  a  small  quan- 
tity of  a  slightly  fetid  fluid  escaped  from  the  vulva.  The  proprietor  stated  that  the 
Cow  had  eaten  a  little  food,  but  much  less  than  usual.  To  inform  himself  as  to  the 
position  of  the  foetus,  Migliano  made  a  vaginal  exploration,  when  he  encountered  an  ob- 
stacle that  prevented  further  investigation,  in  the  form  of  occlusion  and  rigidity  of  the 
cervix  uteri.  In  presence  of  the  collective  symptoms  in  this  case,  he  thought  it  better 
to  wait. 

On  the  following  day,  another  attempt  at  exploration  proved  the  existence  of  the 
same  obstacle,  the  character  of  which  it  was  now  determined  to  ascertain.  Migliano 
found  it  possible  to  assure  himself  that  it  was  composed  of  three  dense  fibrous  rings, 
each  the  thickness  of  the  little  finger,  very  slightly  elastic,  disposed  transversely,  and 
so  firmly  closing  the  uterine  opening  as  to  render  every  effort  to  introduce  the  hand  futile. 


356      .  MATERNAL  DYSTOKIA. 

The  diagnosis  Migliano  arrived  at  was  the  existence  of  new  formations  of  a  fibrous 
nature,  arranged  in  a  circular  form  around  the  cervix  uteri;  and  he  asked  if  the  quasi 
atresia  might  not  by  chance  be  due  to  a  spasmodic  contraction  or  torsion.  It  did  not 
appear  logical  to  attribute  the  condition  of  the  uterus  to  spasm,  because  of  the  long 
duration  of  parturition  without  any  interval  of  relaxation  in  this  insurmountable  obstacle, 
which  would  scarcely  allow  two  fingers  at  most  to  be  introduced ;  and  torsion  could 
scarcely  be  admitted,  because  in  that  condition  the  ridges  are  never  transversal,  but  always 
spiral  or  oblique.  For  these  reasons,  and  seeing  that  the  efforts  of  the  animal  could  not 
overcome  the  obstacle,  it  was  proposed  to  cut  through  the  fibrous  rings  by  means  of  a 
probe-pointed  bistoury.  But  the  owner  would  not  consent  to  this  operation,  and  obtained 
the  opinion  of  other  two  veterinary  surgeons ;  these  recognized  the  presence  of  the 
impediment,  but  did  not  share  in  the  opinion  given  as  to  its  nature,  attributing  it  to 
mere  hyperaemia,  with  erethismus  of  the  cervix;  they  bled  the  animal  thrice  at  short 
intervals,  and  prescribed  emollient  drinks. 

Migliano  retired  from  the  case,  and  he  afterwards  learned  that  the  owner,  alarmed 
at  the  illness  of  his  Cow,  and  not  having  any  one  at  hand  who  could  promptly  relieve 
it,  sought  the  assistance  of  a  milkman,  who,  notwithstanding  the  prostration  of  the 
animal  because  of  a  second  sanguine  emission,  attempted  to  operate  by  force.  With 
the  aid  of  his  hails  he  lacerated  the  primary  obstacles,  with  his  hand  destroyed  the 
fibrous  rings,  and  succeeded  in  producing  a  tear  of  some  four  or  five  inches  in  the  left 
side  of  the  cervix,  and  another  of  less  importance  on  the  right  side.  The  hand  could 
then  be  introduced  into  the  uterus,  and  the  Cow  was  delivered  of  a  live  calf.  An  hour 
afterwards  the  placenta  came  away,  followed  by  clots  of  blood  weighing  nearly  seven 
pounds,  evidently  derived  from  the  lacerations. 

The  dilatation  which  was  thus  accomplished  irrespective  of  the  rules  of  surgery, 
rendered  parturition  possible ;  otherwise  this  could  not  have  taken  place. 

Some  months  subsequently,  this  veterinarian  encountered  the  same  anomaly  in  an 
equally  young  Cow,  which,  the  first  time  also,  brought  forth  a  calf  without  any  difficulty. 
In  this  instance,  the  calf  had  been  dead  in  the  uterus  for  forty  days  at  least,  according 
to  the  history  elicited  from  the  proprietor. 

But  here  the  fibrous  rings  were  incised,  and  by  their  resistance  and  inextensibility 
they  bore  a  great  resemblance  to  those  found  in  the  other  Cow.  The  fcetal  membranes 
being  ruptured,  the  foetus  appeared  ;  but  it  was  so  distended  by  gas  developed  beneath 
the  skin,  and  in  the  thorax  and  abdomen,  that  long  and  deep  scarifications  had  to  be 
made  in  it.  When  reduced  to  a  smaller  volume  in  this  way,  it  was  in  a  short  time,  and 
by  means  of  gentle  traction,  withdrawn  from  the  uterine  cavity  without  occasioning 
any  great  amount  of  suffering  to  the  Cow,  and  without  producing  the  slightest  haemor- 
rhage. 

It  is  to  be  observed  that  in  this  case  recovery  took  place  in  fifteen  days,  and  that,  in 
the  preceding  instance,  it  required  a  month.  On  the  twenty-fifth  day  the  animal  was 
sent  to  pasture,  but  could  not  be  sold  in  perfect  health  until  a  month  and  a-half  after 
the  extraction  of  the  foetus. 

The  author  thinks  it  well  to  relate  these  facts,  with  a  view  to  demonstrate  that,  in 
the  bovine  species,  there  sometimes  really  exists  constriction  of  the  os  uteri  by  new- 
formations  of  fibrous  or  cicatricial  tissue,  notwithstanding  the  opinion  of  those  who 
pretend  that  it  is  only  due  to  a  simple  spasm,  which  may  be  cured  by  belladonna  or  the 
forcible  introduction  of  the  hand  ;  and  also  that  probably  in  the  two  cases  narrated 
above,  the  constriction  may  have  been  consecutive  to  the  lesions  produced  in  the  cervix 
in  the  preceding  parturition  of  the  animals,  which  were  too  young  for  breeding  with 
safety. 

4.  Complete  Obliteration  (Atresia)  of  the  Os  Uteri. 

Congenital  atresia  of  the  os  uteri  may  at  once  be  admitted  as  an  impos- 
sibility in  obstetrics,  as  if  this  canal  is  completely  closed  impregnation 
cannot  take  place.  But  between  fecundation  and  parturition,  certain 
alterations  may  occur  which,  by  leading  to  more  or  less  persistent  closure 
of  this  passage,  will  prove  an  obstacle  to  birth.  These  alterations  may, 
indeed,  exist  at  the  period  of  fecundation,  but  then  the  uterine  opening 
,must  be  only  partially  closed  ;  and,  in  fact,  at  parturition  the  os  may  be 
superficially,  and  partially,  as  well  as  completely  occluded.  This  condition 
been  has  observed  in  the  Mare,  Cow,  and  Sheep. 


MORBID  ALTERATIONS  IN  THE  GENITAL  ORGANS.     357 

Causes. 

This  occlusion  may  be  due  to  agglutination  of  walls  of  the  os,  the  for- 
mation of  fibrinous  membranes  or  bands,  the  development  of  cicatricial 
tissue  from  wound  or  injuries  sustained  in  previous  pregnancies,  etc. 

Symptoms. 

The  symptoms  are,  of  course,  the  usual  external  symptoms  of  retarded 
parturition.  Internally,  the  hand,  on  being  introduced  into  the  vagina 
and  pushed  towards  the  cervix,  comes  in  contact  with  a  round,  smooth, 
and  tense  but  fluctuating  tumor  at  a  variable  distance  from  the  vulva,  or 
even  between  its  labia  ;  the  foetus  can  be  felt  through  this  tumor,  and 
this  might  lead  to  the  supposition  that  this  is  the  "  water-bag."  But  on 
passing  the  hand  to  the  base  of  the  tumor,  instead  of  finding  the  bor- 
ders of  the  OS — as  we  should  do  if  it  was  the  foetal  membranes — there 
is  discovered  a  circular  furrow,  one  side  of  which  is  the  extremity  of  the 
vagina,  and  the  other  is  continuous  with  the  tumor — which  is  the  pos- 
terior segment  of  the  uterus  pushed  into  the  vaginal  canal.  On  the  sur- 
face of  this  tumor  may  be  found  a  small  imperforate  depression  ;  in 
other  instances  there  is  a  kind  of  prominent  ring,  like  the  top  of  the  neck 
of  a  bottle,  but  without  an  opening  ;  this  is  the  cervix.  In  other  cases 
no  trace  of  the  cervix  or  os  can  be  distinguished. 

Results. 

If  relief  is  not  aflEorded,  the  mother  may  die  from  exhaustion  or  rupture 
of  the  uterus  ;  or  a  rupture  may  occur  through  which  the  foetus  and  its 
membranes  will  pass,  and  the  mother  survive  for  a  longer  or  shorter 
period,  constituting  a  case  of  extra-uterine  pregnancy.  Or  neither  of  these 
results  may  happen,  but  after  a  certain  time  the  labor  pains  and  the 
other  indications  of  parturitipn  subside,  the  dead  foetus  is  gradually 
dessicated  as  the  fluids  surrounding  it  become  absorbed,  and  the  animal 
does  not  appear  at  all  amiss  ;  its  condition  being  perhaps  only  accident- 
ally discovered,  either  when  it  dies  or  is  killed  long  afterwards,  or  when 
the  remains  of  the  foetus  begin  to  be  expelled  in  a  vicarious  manner. 

Diagnosis. 

The  diagnosis  of  this  condition  must  be  based  on  the  signs  just  alluded 
to.  The  only  other  anomal}^  perhaps,  with  which  it  might  be  confounded 
is  deviation  of  the  uterus,  in  which  the  cervix  may  be  tilted  up  towards 
the  vertebro-sacral  angle,  even  almost  beyond  the  reach  of  the  hand. 
The  position  of  the  cervix  and  os  tincae  should  be  the  guide  in  diagnosis. 

Treatment. 

As  in  induration  of  the  cervix,  so  in  atresia  delivery  must  be  effected 
by  incision,  or  puncture  if  the  os  is  found  to  be  obstructed  by  superficial 
fibrinous  bands  or  membranes.  For  the  latter  object,  the  extremity  of  the 
finger  or  a  metal  catheter  may  suffice,  the  pressure  being  gradual  and 
the  movement  semi-rotatory.  The  bands  may,  in  rare  instances,  be  rup- 
tured by  means  of  the  finger-nails  or  divided  by  scissors.  If,  however, 
the  resistance  is  too  great,  and  the  os  is  closed  either  through  the  produc- 
tion of  cicatricial  tissue  or  other  morbid  alteration,  then  it  will  be  neces- 
sary to  incise  it  as  for  induration,  and  in  the  way  to  be  hereafter  described. 


358       .  MATERNAL  DVSTOKIA. 

But  if  the  osis  obliterated  and  tlie  cervix  cannot  be  found,  then  the 
portion  of  the  uterus  which  protrudes  into  the  vagina  must  be  incised, 
and  the  fcetus  removed  by  this  artificial  opening.  With  this  object, 
Hubert  recommends  a  convex  bistoury,  the  blade  of  which  is  covered  to 
within  a  few  lines  of  its  point.  The  instrument  is  to  be  directed  to  the 
part  where  the  os  is  supposed  to  be ;  then  the  coats  of  the  uterus  are  to 
be  carefully  incised  to  a  small  extent — layer  after  layer,  until  the  escape 
of  the  liquor  amnii  announces  that  the  foetal  membranes  are  opened. 
The  small  slit  thus  made  is  to  be  enlarged  by  a  probe-pointed  bistoury — 
the  enlargement  being  either  crucial  or  T-shaped.  Then  the  foetus  is  to 
be  extracted. 

Hubert  has  performed  this  operation  once  on  a  Sheep,  and  a  shepherd 
by  his  direction  also  performed  it  on  another  Sheep,  and  in  both  cases 
the  result  was  favorable  for  mother  and  offspring. 

The  number  of  instances  of  atresia  of  the  os  uteri  are  extremely  few,  and  Saint-Cyr 
has  only  been  able  to  mention  three.     These  are  as  follows  : 

1.  Lecoq  [Mem.  de  la  Societe  Veterinaire  du  Calvados  et  de  la  Manche,  Nos.  v.,  vi.), 
called  to  attend  upon  a  Cow  in  parturition,  had  much  difficulty  in  finding  the  place  where' 
the  cervix  uteri  should  be,  the  os  being  only  a  slight  depression  without  any  opening. 
The  Cow  could  not  calve,  and  Lecoq  therefore  decided  to  perform  gastro-hykerotomy. 
A  living  calf  was  extracted,  but  it  was  so  weak  that  it  died  on  the  same  night,  and  the 
Cow  also  succumbed  next  day.     Unfortunately,  an  autopsy  could  not  be  made. 

2.  In  1844,  Leconte  {Mem.  de  la  Societe  Centrale  de  Med.  Veterinaire,  vol.  v.)  met  with 
a  similar  case  to  the  last  The  Cow  had  been  in  labor  for  twelve  hours,  and  on  explor- 
ing the  vagina  and  uterus  he  felt  a  kind  of  "  septum  "  which,  examined  in  every  way, 
only  offered  a  vestige  of  the  os.  "  On  the  uterine  wall  of  the  vagina,"  he  writes,  "  was 
a  kind  of  cervix,  a  sort  of  ring,  hollow  in  its  centre  and  similar  to  the  mouth  of  a  bottle. 
The  opening  did  not  seem  to  be  more  than  one-third  to  three-quarters  of  an  inch  in 
depth,  and  about  an  inch  in  width,  the  bottom  being  closed  by  a  solid  membrane  which 
resisted  every  effort  to  force  it.  The  fcetus  could  be  distinctly  felt  through  the  walls  of 
the  uterus,  but  no  issue  could  be  found  for  it  except  this  rudimentary  os. 

Vaginal  hysterotomy  was  practised,  and  the  fcetus  was  easily  extracted  ;  but  it  was 
dead,  arid  the  Cow  died  in  an  hour  and  a  half  after  the  operation.  Nothing  is  said  as  to 
an  autopsy  having  been  made.  « 

3.  Hubert,  a  Belgian  veterinary  surgeon,  has  published  three  observations  on  this 
condition  {Annales  de  Med.  Veterinaire  de  Br nx'elles,  1856,  p.  143).  The  first  refers  to  a 
Mare,  the  other  two  to  Sheep.  Doubts  are  entertained,  however,  as  to  the  correctness 
of  his  diagnosis,  and  particularly  with  regard  to  the  Mare,  from  the  fact  that  this  animal 
gave  birth  to  a  living  foal,  and  without  operation,  after  violent  and  repeated  straining. 

What  is  remarked  as  still  more  extraordinary,  perhaps,  is  the  statement  that  no  un- 
favorable results  followed  birth,  and  that  in  the  succeeding  year  the  Mare  brought  forth 
another  foal  without  any  assistance. 


CHAPTER  IV. 

Other  Causes  of  Maternal  Dystokia. 

There  are  some  other  causes  of  Dystokia  which,  though  comparatively 
rare,  yet  deserve  attention  from  the  Veterinary  Obstetrist,  and  will  com- 
plete our  notice  of  the  maternal  obstacles  to  parturition.  These  are  :  (i) 
Anomalies  of  the  placenta ;  (2)  Morbid  adhesion  between  the  fostus  and 
uterus;  (3)  Stricture  of  the  uterus  by  external  bands  ;  {^\)  Persistent  hymen  ; 
(5)   Vaginal  and  vulvular  atresia. 

Anomalies  of  the  Placenta. 

We  are  but  little  acquainted  with  the  morbid   alterations  of  the  foetal 
membranes  of  animals,  and  of  those  changes  which  lead  to  the  more   or 


OTHER  CAUSES  OF  MATERNAL  DYSTOKIA.  359 

less  permanent  adhesion  of  these  to  the  foetus  and  to  the  uterus.  The 
subject  appears  to  have  received  very  little  attention,  and  the  observa- 
tions are  so  few  that  Saint-Cyr  makes  no  mention  of  these  adhesions  as  a 
cause  of  difficult  or  impossible  birth. 

It  is  very  probable  that  animals  are  less  subject  to  disease  of  the  uterus 
and  the  placental  membranes  than  the  human  species,  and  this  will  no 
doubt  account  to  a  certain  extent  for  the  absence  of  notices  of  such 
occurrences.  Nevertheless,  that  animals  are  disposed  to  metritis,  endom- 
etritis, and  perimetris.  no  one  can  deny  ;  and  that  we  may  also  have  such 
anomalies  as  hyperplasia  of  the  chorion,  as  well  as  myxomata  of  that 
membrane,  in  addition  to  new  formations  of  the  placenta  and  placentitis, 
might  be  expected.  But,  as  we  have  observed,  there  is  indeed  but  litde 
direct  evidence  to  prove  that  any  of  these  morbid  conditions  ever  exist, 
though  some  of  them  at  least  may  lead  to  abortion,  while  others  give  rise 
to  obstacles  which  may  retard  or  altogether  prevent  birth. 

Scirrhous  Chorion. 

According  to  Cox  {Veterinary  Journal,  Februar}-,  1877),  scirrhous 
chorion  is  occasionally  met  with  in  animals,  and  proves  an  obstacle  to 
parturition. 

The  membrane  is  found  to  be  separated  from  the  uterus,  and  envelops 
the  foetus,  as  it  were,  in  a  leather  bag,  no  part  of  the  creature  being  dis- 
tinguishable. This  is  probably  the  condition  known  in  woman  as  7nyxoma 
fi'ibrosum  placentce. 

The  labor  pains  are  seldom  violent,  though  the  foetal  membranes 
(water-bag)  cannot  be  expelled  into  the  vagina,  even  when  the  os  uteri 
offers  no  obstacle. 

An  early  examination  is  necessary,  as  the  foetus  soon  perishes.  An 
incision  must  be  made  through  the  chorion,  and  the  foetus  extracted. 

Morbid  Adhesion  between  the  Fcetus  and  Uterus. 

Adhesion  between  the  uterus  and  its  contents  maybe  due  to  inflamma- 
tion of  a  portion  of  the  mucous  membrane,  to  hyperplasia  of  the  chorion, 
or  to  disease  of  the  ovum  or  placenta,  by  which  the  two  latter  are  brought 
into  direct  contact  with  the  interior  of  the  organ.  Or  it  may  be  owing  to 
a  deficient  quantity  of  liquor  amnii  when-  the  foetus  begins  to  be  formed  ; 
for  if  the  amnion,  in  the  course  of  its  development,  is  not  separated  from 
the  growing  foetus  by  a  sufficient  quantity  of  fluid,  connection  between 
them  is  almost  certain  to  be  established  either  in  isolated  spots  (Simon- 
art's  "  bands  "),  or  over  a  wide  surface.  Adhesion  between  the  amnion, 
chorion,  and  lining  membrane  of  the  uterus,  is  then  not  only  possible  but 
probable,  and  in  this  way  the  foetus  is  brought  into  a  solid  union  with 
the  maternal  organ.  It  will  readily  be  understood  that  such  an  occurrence 
will  prove  a  very  serious  obstacle  to  birth,  and  greatly  endanger  the  life 
of  the  mother. 

Rainard  {Traite  Cojnplet  de  la  Parturition,  vol.  i.,  p.  461)  furnishes  us 
with  two  observations,  a  writer  in  the  Veterinary  Journal  ("  Nemo '') 
with  another,  and  Naylor  with  two.  These  are  the  only  illustrations  I 
can  find  in  veterinary  literature. 

I.  Two  pupils  of  the  Lyons  Veterinary  School — Patusset  and  Chabral — were,  in  1840, 
sent  to  attend  a  Cow,  between  seven  and  eight  years  old,  which,  according  to  the  cal- 
culations of  its  owner,  was  ten  days  beyond  its  ordinary  period  of  gestation.     It  was  in 


360  MATERNAL  DYSTOKIA. 

fair  condition,  and  up  to  a  recent  date  had  been  in  apparent  good  health.  At  the  usual 
time  of  parturition,  it  exhibited  a  few  symptoms  of  labor  ;  but  they  disappeared,  though 
only  to  manifest  themselves  in  eight  days — the  evening  previous  to  the  arrival  of  the 
pupils.  For  more  than  twenty-four  hours  the  animal  lay  on  its  litter,  straining  so  vio- 
lently and  continuously,  that  it  was  then  nearly  exhausted.  There  was  anorexia,  the 
pulse  was  small  without  being  quick  ;  and  the  mammae,  which  had  previously  been  dis- 
tended with  milk,  were  empty  and  flaccid. 

Palpation  in  the  right  flank,  as  well  as  an  examination /^r  r^<r/z/w,  led  to  the  belief 
that  the  foetus  was  dead.  Vaginal  exploration  proved  the  cervix  to  be  contracted,  but 
moderately  tense  ;  the  "  water-bag  "  had  not  appeared.  A  stimulating  draught  was  pre- 
scribed, friction  was  applied  to  the  skin,  and  the  animal  was  walked  about  in  order  to 
excite  the  uterine  contractions,  which  were  now  weak.  In  about  half  an  hour  the  con- 
tractions were  stronger,  but  birth  did  not  progress. 

It  was  then  decided  to  forcibly  dilate  the  os  uteri,  and  as  this  dilatation  could  not  be 
effected  by  the  hand,  the  cervix  was  incised  in  a  crucial  manner  by  four  cuts.  The 
animal  appeared  scarcely  to  feel  the  incisions.  Then  one  of  the  pupils  introduced  his 
hand  to  extract  the  fcetus,  and  in  doing  so  ruptured  the  membranes,  when  a  quantity  of 
foetid  liquor  amnii  escaped.  The  foetus  was  placed  in  the  dorso-lumbar  position,  and 
every  means  of  extraction  employed,  but  without  success.     The  Cow  died. 

The  autopsy  showed  that  a  portion  of  the  placenta  had  become  fibrous  and  resisting, 
and  adhering  firmly  to  the  uterus,  near  the  cervix,  had  prevented  the  dilatation  of  the 
OS  and  the  passage  of  the  shoulders  of  the  foetus. 

Rainard  remarks  that  in  such  a  case,  serious  though  it  was,  there  might  have  been  a 
different  termination  had  an  experienced  Veterinarian  attended  it ;  as  he  would  have 
recognized  the  nature  of  the  obstacle  by  passing  his  hand  around  the  inner  surface  of 
the  uterus,  and  finding  the  indurated  adhering  placenta,  he  would  have  torn  it  away  or 
incised  it,  so  that  delivery  would  have  been  easy. 

2.  Vincent,  cited  by  the  same  authority  {Op.  cit.,  p.  463),  was  consulted  by  a  col- 
league in  a  similar  case  of  difficult  labor  occurring  in  a  Mare.  The  skin  covering  the 
first  and  second  phalanges  of  the  right  anterior  limb  had  contracted  a  strong  adhesion 
with  the  uterine  mucous  membrane,  not  far  from  the  os.  The  skin  of  the  foetus  was 
also  attached  to  the  membranes,  which  themselves  adhered  to  the  internal  surface  of 
the  uterus.  These  adhesixjns  offered  a  formidable  obstacle  to  delivery,  which  could 
only  be  accomplished  after  they  had  been  fully  recognized  ;  they  were  destroyed  by  the 
fingers,  without  using  a  cutting  instrument. 

3.  "  Nemo  "  ( Veterinary  Journal,  October,  1876)  was  sent  for  to  attend  a  valuable 
short-horn  pedigree  Cow,  reported  unable  to  calve.  Labor  had  commenced  more  than 
four  hours  previous  to  his  arrival,  and  on  examination  it  was  found  that  the  foetus  was 
dead,  though  the  presentation  was  natural.  After  futile  attempts  at  extraction,  embry- 
otomy was  resorted  to  ;  the  fore  extremities,  head,  and  part  of  the  neck  being  detached. 
The  traction  hooks  were  then  inserted  into  the  integument,  close  to  the  spine,  and  as 
far  back  as  could  be  reached  on  both  sides,  so  that  evisceration  could  be  accomplished. 
Having  obtained  the  assistance  of  three  men  to  each  hook-cord,  an  attempt  was  made 
to  extract  the  remainder  of  the  foetus,  but  it  could  not  be  moved.  Even  lashing  the 
Cow  by  a  rope  round  its  horns  to  the  stall-posts,  and  using  a  lever,  failed  to  bring  it 
away. 

The  case  being  deemed  hopeless,  the  animal  was  killed  and  an  autopsy  made.  All 
the  organs  were  healthy,  except  the  uterus  and  vaginal  canal.  On  opening  the  uterus, 
surprise  was  excited  in  finding  the  placental  membranes  firmly  attached  to  the  foetus 
from  the  shoulders  to  the  sacrum,  and  "forming,  in  addition,  a  solid  mass  with  the  ute- 
rine parietes,  thereby  suspending  the  calf."  "  So  close  and  compact  was  the  union,  that 
a  sharp  scalpel  had  to  be  employed  to  dis.sect  them  from  each  other  ;  thus  proving  that 
no  traction  or  other  means  could  have  severed  them  during  the  life  of  the  Cow.  My 
only  wonder  was  that  we  did  not  pull  away  the  uterus  from  its  attachments  altogether, 
in  our  efforts  to  extract  the  foetus  before  the  animal  was  killed.  The  lining  membrane 
of  the  uterus  exhibited  depressions  like  sulci,  denoting  the  former  site  of  ulcers  :  there 
was  also  considerable  thickening  of  the  floor  of  the  vagina,  evidently  of  some  dura- 
tion." 

It  was  elicited,  on  inquiry,  that  the  Cow  had  been  put  to  a  Bull  suffering  from  gon- 
orrhoea, and  about  twelve  or  fourteen  days  afterwards  a  vaginal  discharge  was  perceived, 
which  soon  became  purulent ;  the  Cow  frequently  micturated,  and  occasionally  strained 
and  moaned  previous  to  doing  so.  This  condition  continued  for  at  least  a  month. 
Hence  "  adhesion  of  the  placental  membranes  to  the  embryo  and  uterus  during  gesta- 
tion." 

Naylor  (  Veterinarian,  yo\.  xxiii.,  p.  324),  attending  a  Mare  in  parturition,  found  both 
fore-feet  of  the  foetus  protruding,  but  no  head  ;  the  latter  was  discovered  to  be  lying 
back   towards  the  side  of  the  foal,  though  it  was  immovable.     While  attempts  were 


OTHER  CAUSES  OF  MATERNAL  DYSTOKIA. 


361 


being  made  to  adjust  the  fcetus,  the  Marc  threw  itself  down,  and  strained  so  violently 
that  the  fore  limbs  and  shoulders  of  the  foal  were  expelled ;  though  the  amount  of 
traction  exercised  by  two  strong  men  could  bring  it  no  farther.  More  help  was  obtalined, 
and  the  foal  was  advanced  a  little.  "  At  length  a  noise,  as  of  something  cracking  in- 
side the  Mare,  was  heard,  and  out  came  the  foal  with  the  placenta  and  the  uterus ;  the 
latter  being  attached  to  the  foetus,  around  its  abdomen  and  loins.  In  a  short  time  the 
bowels  followed — having  escaped  through  a  lesion  in  the  womb  ;  the  poor  animal  soon 
sank.  On  inquiry,  I  was  told  that  the  Mare  had  received  a  hurt  in  the  autumn  of  the 
preceding  year,  from  the  giving  way  of  a  bridge  when  she  was  upon  it.  She  was  got 
out  of  the  water  with  difificulty,  but  did  not  appear  to  be  much  injured."  "  I  have  seen 
a  calf  adhering  in  a  similar  manner,  but  could  not  learn  any  thing  of  the  previous  his- 
tory of  the  Cow." 

Rainard  does  not  mention  whether  the  foetus  in  Vincent's  case  was 
alive  ;  but  this  could  scarcely  be  possible.  Neither  does  he  state  whether 
the  Mare  lived.  He,  however,  justly  remarks  that  Veterinary  Surgeons 
should  be  aware  of  the  possibility  of  such  adhesions,  either  with  the  pla- 
centa or  the  envelopes,  and,  through  them,  with  the  uterus  ;  and  that 
they  are  otherwise  easier  recognized  than  those  external  to  the  uterus. 

The  hand,  introduced  into  the  uterine  cavity,  is  passed  over  its  inner 
surface,  around  the  foetus,  as  it  were  :  and  by  this  means  the  existence, 
seat,  extent,  and  resistance  of  the  adhesions  will,  in  the  majority  of  cases, 
be  ascertained.  When  the  adhesions  are  situated  towards  the  fundus  of 
the  organ — its  most  distant  part,  and  where  the  hand  cannot  reach,  then 
there  will  be  difficulty  ;  but  this  must  be  overcome  by  raising  the  uterus 
and  throwing  it  backwards,  by  elevating  the  front  part  of  the  animal's 
body,  and  lifting  the  abdomen  by  means  of  a  plank,  blanket,  or  sack. 

Most  frequently  the  adhesions  can  be  broken  up  by  the  fingers  ;  but  if 
they  are  too  strong,  then  a  bistoury  or  other  convenient  instrument  will 
have  to  be  employed.  Their  incision  must  be  carefully  made,  and  the 
''  crutch "  or  "  repeller "  (to  be  hereafter  described)  will  be  usefid  in 
keeping  the  foetus  away  from  the  part  where  the  separation  is  being 
effected.  The  cutting  should  be  done  gradually  and  steadily,  the  point 
of  the  instrument  being  kept  at  an  equal  distance  between  the  foetus  and 
the  mucous  surface  of  the  uterus. 

In  alluding  to  these  zV/Ar;/^?/ adhesions,  we  may  observe  that  some  very 
rare  cases  are  recorded,  in  which  parturition  was  opposed  by  external  ad- 
hesions between  the  peritoneal  covering  of  the  uterus  and  the  sac  of  a 
hernia,  or  neighboring  viscera. 

Stricture  or  Occlusion  of  the  Uterus  by  External  Bands  or 

Membranes. 

Several  writers  have  described  the  presence  of  bands  or  membranes 
external  to  the  uterus — either  in  the  peritoneal  cavity  or  vagina — obstruct- 
ing the  passage  of  the  foetus  and  rendering  birth  almost,  if  not  quite  im- 
possible without  an  operation. 

Gunther,  Gelle,  Rainard,  Cartwright,  Herman,  Mignon,  Rolland,  and 
Colme  have  observed  this  cause  of  dystokia. 

1.  Gunther  [Lehrbiich  der  Pradischen  Veterinar-Geburtshiilfe)  mentions  a  band  about 
the  length  and  thickness  of  a  finger  between  the  vagina  and  cervix  uteri  of  a  Cow,  and 
which  impeded  delivery.  It  was  readily  discovered,  and  after  its  division  birth  took 
place. 

2.  Gelle  [Journal  Pratique  de  Med.  Veterinaire,  p.  72)  states  that  in  the  early  part  of 
March,  1829,  a  Cow,  in  its  eighth  month  of  pregnane}',  received  a  blow  from  the  horn 
of  another  Cow,     From  that  time  it  was  observed  to  be  unwell,  being  dull   and   not 


362  MATERNAL  DYSTOKIA. 

feeding  so  freely  as  usual.  This  condition  continued  until  April  4,  when  it  became 
worse.  Next  day  it  showed  symptoms  of  colic,  followed  by  expulsive  efforts  as  if  in 
labor,  and  which  continued  on  the  6th  and  7th.  It  was  sent  to  the  Toulouse  Veteri- 
nary School  on  the  nth,  and  on  its  arrival  it  appeared  to  be  weak  and  lay  down. 
Allowed  to  rest  for  some  time,  it  was  got  up  for  the  purpose  of  making  an  examination. 
The  pulse  was  "  concentrated  "  and  accelerated,  and  the  abdomen  somewhat  distended. 
Introducing  the  hand  into  the  vagina,  Gelle  found  the  os  uteri  contracted,  and  thinking 
that  the  non-dilatation  of  the  os  tincae  and  the  absence  of  labor  pains  indicated  that 
parturition  was  not  likely  to  occur  soon,  he  decided  to  wait  (eight  days  had  already 
elapsed),  though  it  was  noted  that  the  calf  was  dead.  Medical  treatment  was  adopted, 
but  on  the  12th  the  Cow  died  from  exhaustion. 

An  examination  revealed,  besides  somewhat  intense  peritonitis,  a  foetus  in  the  right 
horn  of  the  uterus.  The  body  of  that  organ  was  engaged  in  an  abnormal  opening  in  the 
mesentery  belonging  to  the  small  intestine  ;  the  borders  of  the  tear  were  rounded  and 
thickened,  and  fibrous  in  appearance,  and  the  opening  itself  was  five  or  six  inches  in 
diameter ;  it  strangulated  the  body  of  the  uterus  about  seven  or  eight  inches  in  front  of 
the  cervix.  Behind  the  strangulation  the  organ  was  thickened  and  swollen  ;  and  imme- 
diately in  front  of  it,  there  was  a  vast  ecchymosis.  The  foetus  had  its  head  turned  back 
on  the  right  side  of  the  neck  ;  the  two  front  limbs  being  carried  forwards  and  crossing 
each  other.  The  macerated  condition  of  the  foetus  and  the  facility  with  which  its  hair 
could  be  removed  from  its  skin,  proved  that  it  had  been  dead  for  some  time.  The  mem- 
branes and  liquor  amnii  exhaled  a  very  foetid  odor. 

It  was  the  strangulation  of  the  body  of  the  uterus  through  this  rent  in  the  mesentery, 
which  rendered  birth  impossible. 

3.  Rainard  {Op.  Cit.,  vol.  i.,  p.. 456)  describes  the  case  of  a  Cow  seven  or  eight  years 
old,  extremely  emaciated,  and  having  a  hernia  in  the  right  flank.  Before  he  saw  it, 
the  animal  had  been  for  some  hours  in  labor,  and  the  *'  waters  "  had  escaped  after 
attempts  at  delivery  by  a  quack.  It  was  lying,  and  continually  straining  in  the  most 
violent  manner.  An  examination  proved  the  os  to  be  so  contracted  that  the  fingers 
could  scarcely  be  passed  into  it,  and  it  was  necessary  to  have  recourse  to  incision  before 
the  hand  could  be  admitted.  The  foetus  was  alive,  but  evidently  very  weak  ;  one  of  the 
fore  limbs  presented,  the  other  was  bent  backwards,  and  the  head  was  curved  downwards 
in  front  of  the  pubis.  These  parts  were  put  right,  the  creature  being  in  the  dorso- 
lumbar  position.  Cords  wfere  attached  to  them,  and  traction  made  when  the  mother 
strained.  But  no  progress  could  be  made,  and  at  last  the  Cow  emitted  some  plaintive 
moans,  ground  its  teeth,  its  breathing  became  hurried,  the  body  was  covered  with  a 
cold  perspiration,  the  eye  dull,  and  the  labor  pains  suddenly  ceasing,  the  poor  beast 
died  in  a  few  seconds. 

Examining  the  body,  it  was  observed  that  the  hernial  tumor  at  the  flank,  and  consti- 
tuted by  the  omentum  which  adhered  at  this  point,  sent  off  a  thick  inelastic  fibrous  cord, 
which  passed  over  the  upper  face  of  the  uterus,  compressing  that  organ,  and  preventing 
its  dilating. 

Rainard  also  states  that  he  knew  of  another  case  of  this  description,  in  which  a  kind 
of  cord  encircled  the  uterus  ;  it  was  thick,  very  resisting,  and  formed  at  the  expense  of 
the  lateral  ligaments  of  the  uterus.  The  calf  could  not  be  extracted,  and  the  Cow  per- 
ished. 

4.  Cartwright  ( Veterinarian,  vol.  xxi.,  p.  494)  was  called  to  attend  a  Cow  which  was 
reported  unwell.  The  owner  informed  him  that  it  should  have  calved  some  months 
before,  and  that  at  that  time  it  showed  the  usual  signs  of  approaching  parturition  :  these, 
however,  disappeared,  but  much  offensive  matter  subsequently  continued  to  escape  from 
the  vulva  On  "  touching  "  the  animal  for  the  calf,  an  inert  tumor  could  be  distin- 
guished, and  a  rectal  exploration  could  not  detect  a  live  calf.  Examining  the  Cow  per 
vaginam,  the  hand  encountered  "  a  ligamentary  band  close  to  the  os  uteri,  extending 
from  the  upper  to  the  lower  side  of  the  vagina,  of  the  thickness  of  a  penny  cord."  "  It 
was  quite  firm  in  its  texture,  and  on  pulling  at  it,  I  drew  the  vagina  back  and  the  band 
in  sight,  so  that  the  bystanders  could  see  it :  I  divided  it."  The  animal  was  affected 
with  pleuro-pneumonia,  and  was  killed. 

"  The  uterus  was  about  the  size  of  a  peck  measure.  It  contained  a  quantity  of  red- 
dish-colored matter,  bones,  and  putrid  flesh.  The  matter  lay,  in  a  great  measure,  in  the 
posterior  parts  of  the  horns.  The  posterior  parts  of  the  foetus  were  completely  denuded 
of  flesh,  and  lay  floating  in  the  matter.  The  ribs  were  also  bare.  The  contents  of  the 
abdomen  and  thorax  were  not  converted  entirely  into  matter.  The  head  and  neck  were 
the  least  denuded  of  flesh.  The  foetus  could  not  have  been  more  than  five  or  six  months 
old.  The  back  of  the  neck  lay  against  the  os  uteri,  which  was  perfectly  sound  and 
contracted.  The  internal  surface  of  the  uterus  varied  in  color,  and  in  many  places 
it  looked  as  if  it  had  been  torn  or  bruised ;  but,  taking  everything  into  consideration,  it 
was  remarkably  healthy,  if  we  estimate  the  pressure  it  must  have  received,  and  also  its 


OTHER  CAUSES  OF  MATERNAL  DYSTOKIA.  363 

contact  with  so  much  purulent  matter.  The  contents  were  not  at  all  offensive  in  smell. 
The  vagina  was  next  laid  open  :  it  was  healthy.  The  band  of  ligament  spoken  of  took 
its  rise  from  folds  of  apparently  glandular  structures  of  the  vagina,  near  to  the  os  uteri, 
and  was  inserted  into  the  opposite  side  of  the  vagina.  It  was  of  the  thickness  of  a  penny 
cord,  of  a  fibrous  texture,  whitish  color,  and  about  three  inches  long." 

5.  The  same  authority  {Ibid.,  vol.  xxii.,  p.  395)  met  with  a  similar  case  in  a  Mare  which 
had  gone  its  full  period  of  pregnancy.     A  person  who  first  assisted  it  found  the  head 
and  only  one  fore-leg  of  the  foetus  presenting  ;  the  animal  was   straining   violently,  and 
had  forced  out  nearly  half  a  yard  of  the  rectum,  which  could  not  be  returned.     The  other 
fore-leg  was  discovered  to  be  over  the  neck  of  the  foetus.     By  pushing  back  the  body,  . 
this  leg  was  put  right,  and  then  a  small  foal  was  extracted  without  difficulty.     The  pro-       V 
lapsed  rectum  was  now  reduced.     After  this  the  Mare  was  very  ill  and  uneasy,  and  died      /  • 
in  about  thirty-six  hours.     On  an  autopsy  being  made,  it  was  observed  that  the  mesen- 
tery was  torn  away  from  the  rectum  for  at  least  a  yard  in  extent.     On  laying  open    the 
vagina  and  uterus,  a  strong  band,  the  thickness  of  one's  little  finger,  and  about  a  foot  in 
length,  was  found  stretching  across  the  former,  about  six  inches  from  the  os  uteri.  Cart- 
wright  had  no  doubt  that  at  the  time  of  parturition  the  non-presented  fore-leg  of  the ' 
foal  was  retained  by  this  band,  and  this  led  to  the  protracted  parturition  and  rupture  of 

the  mesentery. 

6.  This  authority  found  an  analogous  cause  of  dystokia  in  a  Sow  \yhich  could  not 
bring  forth  its  whole  litter.  It  had  delivered  itself  of  several  and  then  stopped,  though 
the  straining  was  continuous.  One  pig  was  extracted  with  much  difficulty,  but  in  frag- 
ments. The  animal  was  killed,  and  about  five  inches  from  the  entrance  to  the  vagina  X 
there  were  two  distinct  passages  formed  by  a  strong  band  or  septum,  which  was,  to  all 
appearance,  muscular  in  structure,  though  covered  with  mucous  membrane  ;  it  was  at- 
tached to  the  upper  and  lower  part  of  the  vagina,  though  inclined  a  little  to  one  side  ; 

the  attachment  was  about  three  mches  long,  and  the  vagina  was  divided  into  two  distinct 
cavities  for  about  seven  inches  of  its  length. 

7.  The  same  excellent  authority  describes  another  case  (iS'(//«^//r^>^  Veterinary  Review, 
vol.  ii,  p.  285)  in  which  there  was  a  vertical  band  across  the  os  uteri  that  prevented        ^ 
birth.     This  was  divided,  parturition  took  place,  and  the  animal  did  well. 

8.  Goubaux  {Recueil  de Med.  Veterinaire,  1873-74,  Archives  Veterinaire,  November, 
1876,  p.  562)  has  drawn  particular  attention  to  the  existence  of  these  bands  as  a  cause 
of  dystokia  in  the  domestic  animals,  but  particularly  in  the  Mare  and  Cow.  He  refers 
more  especially  to  the  two  following  instances :  Rolland,  in  1874,  attended  a  Cow,  a 
primipara,  in  which  there  was  a  vertical  septum,  three  centimetres  wide  in  the  middle, 
between  the  vulva  and  vagina :  this  prevented  birth,  and  the  Cow  calved  when  the 
band  was  incised  ;  the  specimen  is  now  in  the  Museum  of  the  Alfort  School.  In  May, 
1867,  Colme  was  called  to  assist  a  three  years  old  Heiferwhich  could  not  calve  ;  the  two 
fore-limbs  of  the  foetus  only  presented.  An  exploration  discovered  a  fibrous  band,  three 
centimetres  broad,  its  extremities  attached  horizontally  to  each  side  of  the  cervix  uteri, 
the  OS  being  perfectly  dilated;  it  divided  the  latter  into  two  openings,  through  each  of 
which  one  of  the  foetal  limbs  had  passed.  The  band  was  divided,  scarcely  any  haemor- 
rhage resulted,  and  birth  took  place  in  the  ordinary^vay,  and  without  any  troublesome 
consequences. 

Goubaux  also  gives  some  interesting  details  of  a  post-mortem  examination  of  a  Cow 
which  had  a  similar  band  immediately  behind  the  cervix,  and  sums  up  as  follows:  Some 
of  these  bands  are  situated  between  the  vulva  and  vagina,  and  are  vertical ;  others  are 
placed  at  the  bottom  of  the  vagina,  close  to  the  cervix,  and  may  be  vertical  and  hori- 
zontal ;  they  are  very  strong  and  resisting.  They  may  not  constitute  an  obstacle  to 
copulation,  whatever  their  situation,  but  they  may  prove  an  obstacle  to  parturition;  their 
division  does  not  occasion  haemorrhage  or  any  serious  result,  and  this  operation  allows 
parturition  to  take  place  in  the  usual  manner. 

It  may  be  that  some  of  these  bands  are  nothing  more  than  the  hymen,  alluded  to 
below. 

With  regard  to  the  treatment  of  these  cases,  but  little  can  be  said. 
When  the  bands  are  in  the  vagina,  their  division  is  the  principal  object, 
after  which,  if  no  other  obstacle  is  present,  delivery  can  take  place.  When, 
however,  the  uterus  is  constricted  by  an  external  abdominal  band — though 
this  condition  will  be  difficult  to  diagnose — then  no  course  can  promise 
any  thing  like  a  successful  result  except  the  Caesarean  section. 


364  MATERNAL  DYSTOKIA. 

Persistent  Hymen. 

At  page  29,  we  have  described  a  wide  duplicature  of  the  lining  mem- 
brane of  the  vagina,  which  covers  the  meatus  urinarius,  and  which  looks 
like,  while  it  acts  as,  a  valve  (valvida  vagince)  to  that  opening.  This 
membrane,  which  stretches  across  the  passage  and  separates  the  vulvular 
from  the  vaginal  canal,  is  the  analogue  of  the  hymen  of  woman  ;  and,  as 
in  her,  it  may  persist  after  the  impregnation  of  primiparae — having  escaped 
rupture  during  coitus — and  becoming  abnormally  rigid,  may  prove  an 
impediment  to  birth  in  some  instances — though  it  must  be  confessed 
they  appear  to  be  exceedingly  rare. 

This  cause  of  dystokia  should  be  very  much  less  frequently  met  with  in 
the  equine  and  asinine  species  than  other  of  the  domesticated  animals,  in 
consequence  of  the  size  and  conformation  of  the  male  organ  of  copulation, 
from  which  the  membranous  vaginal  partition  can  scarcely  escape  rupture 
when  it  is  present,  which  is  only  occasionally.*  With  the  bovine,  caprine, 
ovine,  and  porcine  species,  however,  the  case  is  different ;  as  the  penis, 
from  its  volume  and  shape,  is  far  less  likely  to  lacerate  the  hymen  ;  and 
it  is  in  the  bovine  species  alone  that  the  persistence  of  the  latter  at  par- 
turition has  been  found — at  least  so  far  as  published  observations  show  ; 
and  in  all  the  instances  the  animals  have  been  young  and  primiparae. 

It  is  just  possible  that  in  many  animals  of  these  species,  the  hymen 
may  be  more  or  less  intact  until  parturition  sets  in,  when  the  foetus,  in  its 
passage  through  the  vagina,  ruptures  and  effaces  it  without  much  delay 
resulting,  or  other  cause  which  might  attract  attention. 

But  in  others — few  though  they  be — the  membrane  would  appear  to 
offer  a  rather  serious  amount  of  resistance  to  the  expulsion  of  the  young 
creature,  and  demand  the  services  of  the  obstetrist. 

The  cases  recorded  are  exceedingly  few,  and  none  are  to  be  found  in 
English  Veterinary  literature. 

I.  On  March  28,  1863,  Mignon  [Recueil de  Med.  Veterinaire,  1863,  p.  767)  attended  a 
two  and  a  half  years  old  Cow  in  an  advanced  stage  of  pregnancy,  and  which  exhibited 
all  the  signs  of  approaching  delivery,  with  the  exception  of  the  labor  pains,  which  were 
not  yet  manifested.  They  however  appeared  on  April  ist,  and  continued  for  about 
fifteen  hours,  but  without  any  progress  being  made  towards  birth.  On  the  2d,  Mignon 
endeavored,  by  abdominal  taxis,  to  assure  himself  if  the  calf  was  still  alive,  but  this 
failing  he  had  recourse  to  vaginal  exploration,  when,  to  his  surprise,  his  fingers  met  an 
obstacle  almost  at  the  vulvular  orifice.  He  was  soon  convinced  that  this  obstacle  was 
nothing  more  than  a  wide  band — a  real  duplicature  of  the  mucous  membrane — placed  at 
the  entrance  to  the  vagina,  which  it  incompletely  closed  as  a  vertical  septum,  being 
attached  by  its  extremities  to  the  walls  of  the  canal.  This  vaginal  band — a  veritable 
hymen — was  flattened  on  both  sides,  wider  at  the  ends  than  in  the  middle,  and  had 
curved  borders ;  it  measured  two  and  a  third  inches  in  length,  three-quarters  of  an  inch 
in  depth  at  its  extremities,  but  only  about  one-third  inch  at  its  central  portion.  The 
calibre  of   the   vagina  was  considerably  diminished  by  this   band ;  the  canal  had  two 

*  The  hymen  appears  to  be  only  exceptionally  present  in  the  Mare,  though  it  is  an  error  to  assume  that 
it  is  always  absent-  Not  only  is  it  sometimes  to  be  found,  and  occasionally  of  large  size  and  extraordinary 
tenacity,  but  it  may  even  become  a  source  of  trouble  in  unimpregnated  Mares.  Of  this  we  have  an 
example  by  Mr.  Thomson,  of  Beith  {Veterinarian,  vol.  vii.,  p.  147).  That  Veterinarian  was  called  to  see 
a  young  Mare,  said  to  have  inversion  of  the  bladder.  On  his  arrival,  he  saw  protruding  from  the  vulva  a 
membranous  sac  containing  about  a  quart  of  fluid  in  its  cavity.  An  examination  proved  the  sac  to  be 
a  simple  membrane,  extremely  vascular  and  much  inflamed.  It  was  easily  pushed  back  into  the  vaginal 
cavity,  where  it  was  found  to  be  attached  to  the  posterior  part  of  the  urethra  and  all  around  the  vaginal 
canal,  so  that  the  passage  to  the  os  uteri  was  completely  obstructed  ;  the  membrane  could  not  be  pushed 
so  far  forward  as  the  cei-vix.  On  romoving  the  hand,  it  again  protruded  whenever  the  Mare  made  an 
effort. 

In  another  instance — a  year  and  a  half  old  Filly — Mr.  Thomson  observed  an  intact  hymen,  but  there  was 
a  small  opening  in  it,  immediately  behind  the  urethra. 


OTHER  CAUSES  OF  MATERNAL  DYSTOKIA.  365 

orifices — an  inferior  and  a  superior,  and  nearly  of  equal  dimensions  ;  three  fingers  could 
scarcely  be  passed  into  either  of  them. 

This  obstacle  to  birth  having  been  recognized,  the  necessity  for  removing  it  by  inci- 
sion was  apparent.  It  was  divided  in  the  middle  by  a  bistoury,  and  the  constricted 
vagina  then  became  widely  dilated,  when  a  well-formed  living  Calf  was  soon  produced, 

2.  Hermann,  a  Swiss  Veterinary  Surgeon  {Journal  de  Med.  Veterinaire  de  Lyon,  1851, 
p.  73),  met  with  a  similar  case  in  1849.  In  a  quey,  he  found  a  thick  resisting  membrane 
in  the  vagina,  which  offered  an  obstacle  to  parturition,  and  which  partitioned  that  canal 
into  two  portions.     When  incised,  delivery  took  place. 

3.  Hamm  [Magizinfiir  Thierheilkimde,  1842,  p.  185)  attended  a  Cow  which  had  gone 
nine  days  beyond  its  time  for  calving,  when  it  commenced  to  show  symptoms  of  that  act. 
With  the  early  labor  pains,  there  appeared  at  the  vulva  a  round  tumor  as  large  as  a 
man's  head,  and  which  appeared  to  be  covered  by  the  vaginal  mucous  membrane.  On 
pressure,  this  tumor  fluctuated,  and  on  a  careful  examination  it  was  perceived  that  the 
membrane  covering  the  tumor  was  the  hymen.  On  incising  this,  a  large  quantity  of 
mucus,  which  had  collected  between  it  and  the  cervix  uteri,  escaped.  The  os  was  con- 
tracted at  this  time,  but  it  soon  dilated,  and  birth  occurred  without  any  trouble. 

4.  Vincenzo-Luatti  [Recueil  de  Med.  Veterinaire,  1859)  alludes  to  a  Cow — a  primipara 
and  three  years  old,  which,  otherwise  in  good  health,  was  affected  by  complete  proci- 
dence  of  the  vagina.  On  examining  the  parts,  this  Veterinarian  found  a  white  ligamentous 
band,  two  or  two  and  a  half  inches  wide,  and  the  third  of  an  inch  in  thickness,  very  strong, 
and  attached  above  and  below  to  the  walls  of  the  vagina,  so  as  completely  to' occlude 
the  canal — at  least  so  far  as  exploration  was  concerned.     Both  surfaces  were  quite  free. 

Luatti  introduced  a  straight  probe-pointed  bistoury  as  high  as  possible  between  the 
band  and  cervix,  and  at  a  single  cut  divided  the  former  to  near  its  inferior  insertion. 
Then  the  prolapsed  vagina  was  reduced,  a  retaining  bandage  was  applied,  and  the  labor 
pains,  which  had  not  yet  shown  themselves,  were  waited  for.  In  six  or  seven  days,  Luatti 
was  informed  that  the  Cow  had  calved,  and  that  it  and  the  offspring  were  well. 

TreatmeJit. 

The  indications  for  treatment,  when  the  hymen  is  present  and  an 
obstacle  to  birth,  are  obvious  :  divide  it  at  once.  This  division  may  be 
made  in  the  middle  of  the  membi;ane,  and  does  not  demand  any  particular 
care  or  surgical  knowledge  ;  though  it  is  well  to  make  a  close  examination 
before  the  incision  is  made,  in  order  to  avoid  making  a  mistake  should  the 
membrane  appear  as  a  tumor. 

Vaginal  and  Vulvular  Constriction  or  Atresia. 

Stenosis  and  Atresia  of  the  vulva  and  vagina  have  not  unfrequently 
been  recorded  as  either  delaying,  or  altogether  preventing,  parturition  in 
animals,  according  as  the  obstruction  is  incomplete  or  complete. 

This  condition  may  exist  previous  to  impregnation,  and  to  such  an 
extent  as  to  offer  no  obstacle  whatever  to  that  act ;  or  it  may  become 
developed  in  the  interval  between  impregnation  and  parturition.  Of 
course,  if  atresia  is  complete,  and  of  such  a  character  that  the  spermatic 
particles  cannot  pass  into  the  os  uteri,  impregnation  cannot  take  place, 
and  the  animal  remains  sterile. 

The  condition  may,  therefore,  be  congenital  or  acquired.  Incomplete 
congenital  stenosis  of  these  passages  is  not  at  all  uncommon  in  young  ani- 
mals, in  which  the  vulva  and  vagina  are  often  so  constricted  and  inelas- 
tic, that  during  copulation  they  are  injured,  and  this  injury  tends  still 
more  to  diminish  their  calibre  and  dilatability  during  pregnancy.  Con- 
genital stenosis  to  a  very  abnormal  degree  may  sometimes  exist,  how- 
ever, without  any  apparent  traumatic  influence. 

A  recent  case  of  this  description  is  recorded  by  Macgillivray  ( Veterinary  Jotirnal, 
December,  1876).  Called  in  to  see  a  two-year-old  Heifer  which  was  reported  to  be 
suffering  from  constipation  of  the  bowels,  he  found  the  creature  very  uneasy,  straining 
every  few   minutes,  and  voiding  small  pellets  of  dung.     The  urine  was  natural ;  abdo- 


366  MATERNAL  DYSTOKIA. 

men  hard  and  tense  ;  breathing  much  hurried;  pulse  75  beats  per  minute,  and  tempera- 
ture 104°.  The  straining  being  a  suspicious  symptom,  inquiry  was  made  as  to  whether 
the  animal  had  been  put  to  the  bull,  but  the  reply  was  in  the  negative.  On  separating 
the  labice  valvce,  nothing  abnormal  could  be  detected ;  and  it  was  therefore  concluded 
that  obstruction  of  the  bowels  was  really  the  cause  of  illness.  Treatment  was  adopted 
accordingly.  During  fire  days  there  was  no  alteration,  though  the  bowels  had  acted 
freely ;  but  on  the  filth  day,  on  attempting  to  explore  the  vaginal  passage,  it  was  dis- 
covered that  the  hand,  or  even  a  finger,  could  not  be  got  beyond  the  vulva.  Thinking 
it  might  be  merely  an  extra  tightness  at  the  ostum  vagince,  considerable  force  was  used, 
but  only  one  finger  could  be  made  to  penetrate  about  an  inch.  No  vaginal  canal 
existed,  and  its  walls  seemed  to  have  grown  firmly  together. 

The  Heifer  was  now  straining  so  violently,  as  to  leave  but  little  doubt  that  irritation 
about  the  generative  organs  was  the  sole  cause  of  the  illness.  Continuing  patiently  to 
exert  steady  force,  two  fingers  were  finally  pushed  some  four  or  five  inches  through 
where  the  vagina  should  have  been,  when  there  all  at  once  escaped  a  dark-brown  fluid 
which  had  a  most  repulsive  odor.  This  fluid  came  away  in  variable  quantity  every 
time  the  creature  strained.  Next  day,  after  great  difficulty  and  laceration,  from  vulva 
to  uterus,  the  os  of  the  latter  was  reached ;  the  operation  was  like  "  forcing  one's  hand 
into  a  piece  of  raw  firm  muscular  tissue."  "  The  os  uteri  was  fully  dilated,  and  the 
uterus  itself  had  seemingly  been  pretty  much  distended  by  the  imprisoned  fluid." 

As  the  case  was  considered  hopeless,  and  the  animal  was  in  good  condition,  it  was 
killed.     An  examination  of  the  vagina  and  uterus  could  not  be  made. 

Macgillivray  was  of  opinion  that  this  case  goes  to  prove  the  existence  of  a  menstrual 
discharge  in  the  brute  female,  analogous  to  that  in  the  human  female,  the  symptoms  of 
retention  being  somewhat  similar.  "  The  cestral  products — however  many  times  the 
Heifer  had  been  in  *  heat ' — had  evidently  never  found  exit  from  the  uterus,  and  the  re- 
sult was  the  immense  collection  of  a  most  abominably-smelling  serosanguineous  fluid, 
which  escaped  after  the  forcible  opening  up  of  the  hitherto  impervious  vaginal  canal." 

A  very  similar  case  is  recorded  by  West  ( Veterinary  Journal,  February,  1877),  but  in 
this  instance  the  animal  recovered. 

Acquired  Stenosis  or  Atresia  is  generally  the  result  of  certain  diseases, 
or  injuries,  such  as  inflammation,  suppuration  and  ulceration,  and  lacera- 
tion, often  due  to  difficult  parturition.  These  may  lead  to  hypertrophy 
and  density  of  the  tissues,  hard  resisting  cicatrices,  solid  adhesions,  or 
partial  or  complete  obliteration. 

Malposition  of  the  vulva  may  also  lead  to  atresia.  I  witnessed  a  case 
of  this  kind  in  an  Arab  Mare  of  high  pedigree  in  Syria.  The  vulva  was 
partly  below  the  ischial  arch. 

In  primiparae,  cases  of  abortion,  cases  in  which  birth  occurs  in  a  hur- 
ried manner,  as  well  as  when  the  water-bag  is  ruptured  too  soon,  or  in 
those  breech  presentations  in  which  the  hind  legs  are  bent  forward  and 
only  the  hocks  offer — in  all  these  the  narrowness  of  the  vulva  and  vagina, 
from  lack  of  preparation,  is  often  an  obstacle  to  parturition,  their  tissues 
being  "hard." 

But  with  patience  and  warm  emollient  injections,  as  well  as  careful  and 
gradual  manual  dilatation,  this  obstacle  may  be  overcome.  When  birth 
is  taking  place  too  hurriedly,  Rainard  recommends  closing  the  animal's 
nostrils  and  opening  its  mouth,  pulling  out  its  tongue,  and  pressing  on 
the  loins  to  prevent  its  arching  the  back  and  straining.  It  is  very  rare  that 
the  resistance  is  serious,  and  in  the  great  majority  of  cases  birth  occurs 
spontaneously,  or  with  trifling  assistance. 

Some  authorities,  however,  have  met  with  instances  in  which  it  was 
necessary  to  dilate  the  vulvular  orifice  by  incision,  in  order  to  prevent 
this  part  being  lacerated,  and  to  spare  the  animal  pain  and  subsequent 
deterioration. 

When  the  dystokia  is  due  to  disease  or  a  traumatic  cause,  birth  is  more 
difficult ;  and  this  difficulty  is  increased  as  the  pathological  alteration  is 
extensive. 


OTHER  CAUSES  OF  MATERNAL  DYSTOKIA.  367 

1.  In  the  Zeitschrift  fiir  Thierheilkunde  imd  Viehzticht  (Band  7),  there  is  the  descrip- 
tion of  a  case  in  which  the  wall  of  the  vagina  was  some  inches  thick,  and  the  diameter 
of  the  canal  only  one  and  a  half  inch.     This  was  the  result  of  disease. 

2.  Leconte  (Mern.  de  la  Societe  de  MJd.  Veterinaire,  vol.  v.,  p.  185)  has  furnished  us 
with  a  very  interesting  case  of  this  description. 

He  attended  a  Mare  in  parturition,  which  had  previously,  and  while  at  pasture,  re- 
ceived an  injury  from  the  horn  of  a  Cow  ;  this  injury  was  inflicted  in  the  region  of  the 
perinaeum,  and  the  vulva  had  been  torn  as  far  the  recto-vaginal  septum.  The  cicatrices, 
still  visible,  proved  that  the  laceration  had  been  very  extensive,  and  the  vulva  was  so 
deformed  and  contracted  that  the  hand  could  scarcely  be  passed  into  it.  The  vagina, 
cervix  uteri,  etc.,  appeared  to  be  all  right. 

The  Mare  was  making  frequent  parturient  efforts ;  the  liquor  amnii  had  escaped — it 
was  not  known  how  long  before  ;  and  the  foetus  soon  presented  itself  in  a  good  position 
at  the  vulvular  orifice,  the  head  resting  on  the  two  fore  limbs.  At  this  part,  however, 
the  foetus  met  with  serious  resistance  to  its  outward  progress.  Nature  might  have  sur- 
mounted this  obstacle,  perhaps,  and  birth  might  consequently  have  taken  place  without 
assistance,  but  there  must  have  occurred  considerable  lacerations. 

Leconte,  therefore,  preferred  facilitating  the  exit  of  the  young  creature  by  operating 
as  in  vaginal  hysterotomy.  He  made  two  lateral  incisions — one  above  the  other — on 
each  side  of  the  vulva,  about  an  inch  and  a  half  apart,  and  about  an  inch  in  length  ;  these 
incisions  allowed  sufficient  space  for  birth  to  take  place.  Parturition  was  completed 
without  an  accident,  and  the  incisions,  treated  as  simple  wounds,  cicatrized  in  a  few 
days. 

The  treatment  of  stenosis  of  the  vulva  and  vagina  must  be,"  of  course, 
surgical,  and  will  vary  according  to  the  cause  producing  the  constriction. 
But  it  will  chiefly  consist  in  incisions  carried  to  a  depth  and  extent  com- 
mensurate with  the  exigences  of  each  case,  and  modified  according  to  the 
anatomy  of  the  part  which  forms  the  seat  of  stricture.  It  will  be  found 
that  lateral  incisions  are,  when  they  can  possibly  be  practised,  preferable 
to  those  made  either  superiorly  or  inferiorly,  as  they  are  less  likely  to  be 
followed  by  inconvenient  alterations  and  unfavorable  consequences ; 
while,  with  regard  to  the  vulva,  the  textures  at  the  sides  of  that  orifice 
have  more  vitality,  and  therefore  cicatrize  more  rapidly,  than  at  the 
superior  commissure. 


368 


FOETAL  DYSTOKIA, 

BOOK  II. 


FCETAL  DYSTOKIA. 

Though  the  obstacles  to  parturition  offered  by  the  maternal  organs  are 
somewhat  considerable  in  number,  yet  it  is  found  in  practice  that  those 
due  to  the  foetus  are  far  more  frequently  met  with,  and  are  much  more 
numerous  ;  though  all  of  them  may  not  constitute  real  or  serious  obstacles, 
some  being  easily  removed  or  overcome,  when  birth  takes  place  without 
any  difficulty.  , 

The  obstacles  which  the  foetus  may  offer  to  birth  are,  for  convenience 
of  study,  divided  into  two  natural  groups,  according  as  they  result  from 
some  physical  condition  of  the  young  creature  itself,  or  from  the  more  or 
less  irregular  manner  in  which  it  is  presented  at  the  pelvic  inlet.  Each 
of  these  groups,  again,  it  is  needless  to  add,  embraces  a  certain  number 
of  varieties  of  obstacles  ;  but  though  grouped  and  classified  in  this  way, 
we  must  remember  that  difficult  parturition  due  to  the  foetus  may  not  be 
owing  exclusively  to  any  one  of  these  obstacles  in  every  case,  but  in  some 
instances  may  result  from  a  combination  of  two  or  more  of  them. 

But  this  combination  does  not  preclude  us  from  studying  them  sep- 
arately ;  indeed,  their  separate  consideration  is  absolutely  necessary,  as 
it  is  only  by  analyzing  them  that  we  can  realize  their  influence  in  hin, 
dering  birth,  either  when  alone  or  combined. 

As  will  be  seen  from  the  following  synoptic  table,  these  obstacles  are 
very  numerous  and  -varied,  and  require  careful  consideration  from  the 
obstetrist :  opening,  as  they  do,  a  wide  field  for  investigation  and  reflec- 
tion, as  well  as  practical  deduction. 

The  two  groups  referred  to  consist  (i)  of  the  obstacles  independent  of 
presentations  and  positions,  and  (2)  of  the  malpresentations  and  positions 
of  the  foetus,  and  the  difficulties  resulting  from  them. 

Synoptic  Table  of  Fcetal  Dystokia. 

Excess  in  Volume  of  the  Fa:tus. 
Anomalies  in,  and  Diseases  of  the  Postal  Membranes 
Abnormal  Quantity  of  Placental  Pluid. 
Anomalies  in  the  Umbilical  Cord. 


Q^ 


Independent 
of  the  Pre- 
sentations. 


Diseases 


Resulting 
from   the 
Presenta- 
tions. 


Death. 

Monstrosities. 

Multiparity. 


'  Anterior  -  - 

Posterior.  -  • 
Transverse  • 


'  Hydrocephalus. 

Ascites,  Anasarca,  and  Hydrothorax. 
Emphysema. 
Polysarcia. 
Contractions. 
Tumors. 


Incompletely  Extended. 

Crossed  on  the  Neck. 

Flexed  at  the  Knees. 

Completely  Retained. 

Bent  Downwards  and  Backwards. 

Bent  Laterally. 

Bent  Upwards  and  Backwards. 
Hind  Quar-  j  Forced  Abduction  of  the  Limbs. 

ters  -  -  -   I  Croup  Bent  Under  the  Body. 
Lumbo-pubic  and  Lumbo-iliac  Positions. 

Flexed  at  the  Hocks. 

Completely  retained. 
Dorso- lumbar. 
Sterno-abdominal. 


Limbs 


Head  and 
neck    - 


Limbs  - 


EXCESS  IN  VOLUME  OF  THE  FCETUS.  369 

GROUP  I. 

OBSTACLES    INDEPENDENT  OF   PRESENTATIONS   AND 
POSITIONS. 

In  this  group,  the  maternal  organs  of  generation  and  those  parts  imme- 
diately concerned  in  parturition  may  be  perfectly  healthy,  and  the  foetus 
itself  may  be  in  a  favorable  position  for  expulsion  ;  yet  birth  is  either 
protracted,  or  rendered  impossible  without  assistance,  because  of  the  ex- 
cessive volume  of  the  fcetus,  anomalies  in,  or  diseases  of  its  enveloping 
membranes,  an  abnormal  quantity  of  placental  fluid,  anomalies  in  the 
umbilical  cord,  or  from  disease  or  malformation  of  the  young  creature,  or 
a  plurality  of  foetuses  in  animals  ordinarily  uniparous. 


CHAPTER    I. 

Excess  in  Volume  of  the  Fcetus. 

Excess  in  volume  of  the  foetus,  due  to  normal  or  abnormal  development 
of  either  the  whole  or  only  a  part  of  its  body,  is  far  from  constituting  an 
unfrequent  cause  of  dystokia  in  the  domesticated  animals  ;  rendering 
spontaneous  birth  more  or  less  difficult  or  altogether  impossible,  notwith- 
standing the  healthy  condition  of  the  maternal  organs,  and  the  regularity 
and  energy  of  the  uterine  contractions. 

Causes. 

Several  causes  may  be  in  operation  to  lead  to  excessive  development 
of  the  foetus — either  wholly  cr  partially.  Among  these  we  may  cite  the 
following  as  the  principal : 

Prolonged  Gestation.  It  has  been  shown  that  the  foetus  may  be  retained 
without  injury  for  several  weeks  beyond  the  period  usually  allotted  for 
its  expulsion,  and  there  can  be  little  doubt  that  during  this  interval  its 
development  is  continued.  This  extra  development  being  unprovided 
for  in  the  dimensions  of  the  genital  passages  of  the  mother,  leads  of 
course  to  protracted  or  difficult  parturition. 

There  are  instances  recorded  of  the  foetus  of  the  Cow  and  Mare  weigh- 
ing 117,  165,  and  189  pounds.  It  may,  therefore,  be  readily  understood 
that  the  greatly  exaggerated  volume  which  this  weight  represents,  must 
meet  with  much  resistance  in  passing  through  a  canal  which,  in  ordinary 
circumstances,  gives  exit  to  a  foetus  weighing  from  56  to  80  pounds. 

Instances  of  this  exaggerated  development,  through  prolonged  retention,  are  far 
from  uncommon.     We  will  therefore  only  give  one  example. 

A  correspondent  in  the  Veterinarian  (vol.  ix.,  p.  453)  was  called  to  see  a  Heifer,  three 
years  old,  and  which  was  supposed  to  be  long  beyond  its  time  for  calving.  On  examin- 
mg  it,  the  os  uteri  was  found  to  be  closed,  so  that  the  hand  could  not  be  introduced  in- 
to the  organ,  though  the  fcetus  could  be  felt.  It  seemed  to  be  so  enormous  in  size  that 
he  had  no  hope  of  extracting  it.  An  examination  per  rectum  confirmed  the  suspicion 
that  the  calf  was  larger  than  the  passage  would,  admit.  The  animal  was  killed,  and  the 
autopsy  verified  the  opinion  as  to  the  impossibility  of  delivery  taking  place. 

Reduced  Number  of  Foetuses.  —  With  multiparous  animals,  when   the 

24 


370  FCETAL  DYSTOKIA. 

number  of  foetuses  is  smaller  than  usual — as  with  the  Bitch  which  has  only 
one  or  two,  instead  of  five  or  six — the  excess  of  nutriment  they  receive 
increases  their  bulk  to  an  abnormal  degree  ;  and  as  almost  every  breeder 
of  dogs  knows,  this  often  leads  to  serious  results  in  parturition. 

Disproportion  i?i  Size  Between  the  Male  and  Female. — There  can  be  no 
doubt  that  a  disproportion  in  size  between  the  male  and  female,  in  many 
instances,  exerts  a  marked  influence  in  this  direction.  More  especially  is 
this  the  case  in  crossingwith  different  breeds^  or  in  attempting  to  breed  from 
too  young  females. 

Delorme,  quoted  by  Rainard(vol.  i.,  p.  474),  says  that  he  has  known  a 
certain  number  of  Camargue  Ewes  die  every  year  through  non -delivery, 
they  having  been  put  to  Dishley  Rams,  which  were  much  larger  than 
the  native  Sheep. 

The  case  of'  small  Bitches  crossed  by  larger  dogs  is  familiar  to  all 
dog-breeders.  There  appears,  indeed,  to  be  a  natural  tendency  in  some 
small-sized  Bitches  to  seek  intercourse  with  dogs  much  larger  than  them- 
selves, and  this  preference  not  unfrequently  leads  to  fatal  consequences  in 
parturition. 

But  in  many  instances  dystokia  is  due  to  exaggerated  development  of 
some  particular  region  of  the  foetus,  and  more  especially  of  the  head — a 
peculiarity  derived  from  crossing,  or  breeding  from  a  male  possessing 
this  character.  Indeed,  some  authorities  deny  that  crossing  small  female 
animals  with  males  which  are  generally  larger  is  likely  to  prove  a  source 
of  difficult  parturition,  provided  there  is  nothing  unusual  in  the  proportion 
of  any  region  of  the  latter.  It  is  pointed  out  that,  in  the  human  species, 
small  women  are  very  often  married  to  very  large  men,  and  yet  their 
accouchments  are  more  or  less  easy.  It  has  also  been  remarked  that 
Melingie,  in  order  to  form  the  breed  of  Sheep  known  in  France  as  the 
race  de  la  Charmoise.  coupled  the  small  Berrichonne  Sheep  with  the  great 
New  Kent  Rams ;  and  yet  in  two  thousand  births  only  one  was  difficult. 

A  German  veterinarian  surgeon,  Nathusius,  mentioned  by  Rueff  and 
Baumeister,  asserts  that  in  the  cross  between  the  small  Merino  Sheep  with 
the  huge  English  Rams,  he  has  observed  fewer  difficult  births  than  in 
flocks  composed  solely  of  Merinos.  And  Saint-Cyr  states  that  he  has 
often  seen  little  "  Bressanne  "  Mares,  which  were  put  to  big  Percheron  or 
Anglo-Norman  Stallions,  foal  without  difficulty  at  the  ordinary  period. 
We  might  also  adduce  the  small  female  Ass  coupled  with  the  Horse- 
Stallion,  and  which  rarely  suffers  during  birth.  Abortion  or  premature 
birth  may  be  more  frequently  the  consequence  of  such  "  mesalliances." 

Though  certain  facts  could  be  opposed  to  the  above  conclusions,  yet  it 
must  be  admitted  that  the  wiiformly  exaggerated  development  of  the 
foetus  is  not  a  very  common  cause  of  dystokia,  and  is,  as  a  rule,  only  so 
when  the  pelvis  of  the  female  is  smaller  than  usual.  So  that  we  must 
look  rather  to  special  conformation  than  exaggerated  development.  And 
so  far  as  conformation  is  concerned,  we  find  that  excessive  development 
of  the  croup,  chest,  or  head,  have  the  principal  influence. 

With  regard  to  the  head.,  it  is  indisputable  that  of  the  three  regions  this 
most  frequently  proves  an  obstacle  to  parturition.  In  the  Bitch  this  is 
more  particularly  remarked.     But  it  is  also  noted  in  other  animals. 

Price,  in  his  book  on  Sheep,  mentions  that  a  grazier  in  Appledore  em- 
ployed Leicester  Rams  for  several  years,  and  obtained  a  breed  with  very 
small  heads  and  "  kindly  disposition  ; "  but  he  did  not  approve  of  them, 
because  they  were  not  sufficiently  large,  and  did  not  fetch  a  good  price  in 


EXCESS  IN  VOLUME  OF  THE  FCETUS.  371 

the  market.  He  therefore,  in  the  summer  of  1804,  hired  some  large 
Kentish  rams,  in  order  to  give  size  to  his  flock.  In  the  following  lamb- 
ing season  he  lost  twelve  Ewes,  from  the  immense  size  of  the  lambs' 
heads,  and  he  was  obliged  to  "  draw  "  (extract  artificially)  nearly  all  his 
Ewe  lambs.  In  1806  he  had  the  same  difficulty,  and  lost  nine  Ewes 
in  a  flock  of  two  hundred  and  fifty  from  this  cause. 

Mr.  Cartwright  (Whitchurch)  casually  states  that  he  has  frequently 
known  of  some  bulls  "  getting  calves  with  very  large  heads,  and  causing 
great  difficulty  in  calving;  and  the  owners,  finding  what  trouble  there 
was  at  calving-time,  and  the  danger  of  losing  their  Cows,  have  sold  them, 
and  obtained  others  whose  breed  had  not  this  objection." 

Rueff  and  Baumeister  {Op.  cit.,  p.  247),  in  alluding  to  this  subject,  re- 
mark that  in  the  bovine  species  it  is  nearly  always  the  head  which  forms 
the  chief  obstacle  to  birth  ;  and  they  refer  for  proof  of  this  statement  to 
the  small  native  Cows  of  Wurtemberg,  which,  when  crossed  by  the  Origi- 
nal Simmenthalern  Bull,  have  often  difficult  labor,  as  the  latter  breed  has 
often  a  large  head. 

And  Schaack  writes  to  Saint-Cyr,  stating  that  for  thirty  years  the  Cows 
in  the  district  of  Lyons  were  all  put  to  a  Bull  remarkable  for  its  massive 
framework.  The  head  especially  was  very  developed,  and  as  the  animal 
transmitted  this  conformation  to  nearly  the  whole  of  its  progeny,  the  size 
of  the  head  of  the  foetus  very  often  rendered  parturition  difficult. 

Breeding  from  immature  undeveloped  animals  is  almost  certain  to  pro- 
duce laborious  births  ;  and  the  reason  for  this  is  not  difficult  to  find  :  the 
genital  canal,  and  particularly  the  pelvis,  is  not  sufficiently  developed  for 
the  passage  of  the  foetus.  A  very  striking  instance  of  this,  as  well  as  of 
very  remarkable  precocity  in  the  bovine  species,  is  given  by  Mr.  Barker 
(^Veterinary  jFournal^  November,  1876).  We  will  give  the  case  in  his  own 
words  : 

"  On  the  14th  of  May,  I  was  requested  by  the  bailiff  of  Greenshills  Farm  to  go  and 
assist  or  deliver  a  young  Cow  of  a  calf,  this  Cow  being  the  property  of  J.  T.  Wharton, 
Esq. 

"  On  arrival,  I  found  the  smallest  animal  to  be  a  mother  that  ever  T  witnessed  or  heard 
of.  This  creature,  a  black-polled  Scot,  nine  days  short  of  one  year  old,  had  made  per- 
fect preparation  for  parturition,  and  there  was  one  fore-foot  of  the  foetus  projecting 
about  two  inches  from  the  vulva. 

"  On  inquiry,  the  bailiff  told  me  that  she  had  been  accidentally  '  bulled  '  when  she  was 
ten  weeks  and  five  days  old,  while  sucking  her  mother  ;  the  Bull  of  the  same  breed  going 
with  the  herd  of  Cows,  the  calves  of  which  were  all  allowed  to  suck  their  mothers  so  long 
as  they  chose. 

"  The  above  statement  to  many  may  seem  incredible,  as  it  did  to  a  neighboring  eye- 
witness, who  was  asked  to  give  a  little  assistance  in  pulling  the  calf  away  ;  for  although 
he  saw  the  calf's  foot  projecting,  he  remarked  that  he  could  hardly  believe  his  own 
eyes,  and  asked  me  if  I  did  not  think  that  the  Bull  (the  father  of  the  mother)  had  got  two 
calves  at  once,  one  within  the  other — as  the  mother  was  only  a  calf  herself. 

"  On  examining  her,  I  found  the  other  fore-foot  and  head  back  in  the  uterus,  and  the 
calf  dead.  I  therefore  corded  the  projecting  foot  and  thrust  it  back,  and,  with  difficulty, 
corded  the  other  foot  and  brought  it  forward  as  far  as  I  could  ;  then  I  returned  both 
feet  and  corded  the  lower  jaw.  After  manipulating  a  short  time,  I  succeeded  in  getting 
both  fore-legs  and  head  straight,  when  I  met  with  a  great  obstacle — viz.,  the  pelvic 
orifice  being  by  far  too  small  to  admit  the  legs  and  head  together,  one  leg  filling  the 
vaginal  canal  almost  completely.  I  at  once  allowed  the  head  and  one  leg  to  fall  back, 
and  introduced  an  embryotomy  knife,  with  which  I  skinned  the  leg,  and  divided  it  from 
the  trunk  with  the  scapula.  I  then  brought  the  next  one,  and  divided  it  in  the  same  way, 
except  having  to  leave  the  scapula,  owing  to  so  little  room  to  work  in  ;  and  the  calf 
having  only  died  about  an  hour  before,  the  muscles,  etc.,  were  very  strong  and  difficult 
to  sever  without  using  very  great  traction.  After  the  above  reduction,  I  again 
corded  the  lower  jaw,  which   tad  slipped,  and  essayed  to  bring  the   head  forward  ;    but 


372  FCETAL  DYSTOKIA. 

this  I  found  could  only  be  done  as  far  as  the  eyebrows  the  entrance  into  the  bony  canal 
of  the  mother's  pelvis  refusing  admission  of  the  bulky  parts  of  the  foetus's  head.  But 
after  manipulating  the  head,  and  using  gentle  traction,  I  succeeded  in  getting  the  whole 
of  it  into  the  passage,  and  ordered  the  men  to  pull  simultaneously  with  her  throes.  The 
pelvic  brim  and  inferior  surface  of  the  vertebrae  here  again  refused  egress  to  the  sternum 
and  anterior  dorsal  vertebrae  of  the  calf;  and  very  strong  but  steady  force  was  employed 
to  move  the  foetus,  but  this  failed.  I  therefore  made  an  incision  through  the  skin 
in  the  calf's  throat,  and  subdermically  cut  a  hand-way  into  the  thoracic  cavity,  which  I 
emptied  of  its  contents.  We  then  continued  traction  during  her  throes,  and,  as  with  the 
head,  the  most  bulky  part  of  the  body  passed  over  the  brim  of  the  pelvis  with  a  sudden 
jerk,  and  entered  the  vagina. 

"  It  again  stuck  obstinately  at  the  pelvis,  but  was  overcome  by  perseverance — the 
calf  and  placental  membranes  coming  away  in  toto.  It  was  a  well-nourished  and  full- 
grown  calf  ;  and  had  not  Nature  endowed  the  mother's  pelvis  with  great  flexibility  and 
elasticity  of  its  ligaments,  nothing  short  of  the  Caesarean  operation  would  have  suc- 
ceeded in  delivering  it. 

"  I  was  not  very  much  surprised  at  the  incident,  as  last  year  I  delivered  some  of  the 
same  herd  in  a  similar  way,  and  these  exactly  one  year  old  on  the  day  they  calved.  I 
may  add  that  about  a  teacupful  of  'beastings  '  {Colostrum)  were  in  the  udder  of  each 
Cow  when  parturition  occurred,  but  no  more  was  secreted  in  any  of  these  precocious 
creatures." 

Influence  of  Food. — There  is  no  convincing  proof  before  us  that  the 
manner  of  feeding  or  kind  of  food  has  much  influence  on  pregnant  ani- 
mals, so  far  as  excessive  volume  of  the  foetus,  and  consequent  difficult 
parturition,  is  concerned. 

Cox  (  Veterinary  journal,  vol.  i.,  p.  265)  says  :  "  The  size  of  the  foetus 
depends  considerably  upon  the  condition  of  the  parent  and  the  kind  of 
food  given  to  it.  Fat  animals,  and  those  emaciated  from  the  continuous 
use  of  food  of  a  poor  nature  or  insufficient  in  quantity,  bring  forth  a  small 
foetus.  Where  the  debility  is  the  result  of  pregnancy,  and  food  has  been 
given  of  a  nutritious  character  and  in  sufficiency  during  that  period,  the; 
foetus  will  be  disproportionately  large,  the  extra  nutriment  having  been 
diverted  to  its  growth.  Green  food,  or  '  depasturing,'  causes  the  foetus 
to  grow  rapidly  and  attain  a  great  size  ;  but  Nature  compensates  for  this 
by  giving  with  such  diet  greater  relaxation  of  the  tissues  of  the  dam,  and 
an  increase  of  the  placental  fluids  to  lubricate  and  assist  at  delivery." 

Diagnosis. 

The  diagnosis  of  excessive  volume  of  the  foetus  is  difficult,  and  can 
only  be  established,  as  a  rule,  at  parturition  ;  for  we  do  not  possess  any 
certain  means  of  appreciating  the  dimensions  of  the  foetus  i7t  iitero  before 
its  enveloping  membranes  have  ruptured  and  the  os  is  dilated.  An  un- 
usual size  of  the  maternal  abdomen  towards  the  termination  of  pregnancy, 
is  an  uncertain  and  very  often  deceptive  sign. 

Nasse,  a  German  Veterinarian,  imagined  that  this  excess  in  develop- 
ment might  be  ascertained  by  weighing  the  animal  during  gestation.  With 
regard  to  the  Bitch,  he  thought  there  was  danger  when  the  weight  was 
increased  by  two-fifths  during  this  period,  the  normal  increase  being  only 
one-third.  But  it  is  evident  that  an  inordinate  increase  in  weight  may  be 
due  to  other  causes  than  the  foetus  or  foetuses — such  as  an  unusual  num- 
ber of  these,  an  excess  of  amniotic  or  allantoic  fluid,  greater  obesity  of 
the  Bitch,  etc.  Otherwise,  if  this  test  could  be  applied  to  the  Bitch  with 
practical  results,  the  conclusions  derived  from  it  could  not  be  made  ap- 
plicable to  the  other  animals. 
N  The  only  circumstance  which  might  give  rise  to  suspicion,  is   the  pro- 


EXCESS  IN  VOLUME  OF  THE  FCETUS. 


373 


longation  of  gestation  beyond  its  ordinary  period  ;  though  this  suspicion, 
as  we  have  seen,  will  not  always,  nor  yet  very  often,  be  confirmed. 

It  is  only,  then,  at  parturition  that  this  obstacle  on  the  part  of  the  foetus 
can  be  ascertained.  If  at  this  time,  in  spite  of  energetic  and  sustained 
uterine  contractions,  labor  is  protracted  and  does  not  advance,  and  if 
on  exploration  the  pelvis  and  genital  organs  are  found  to  be  well-formed 
and  normal,  the  os  dilated,  the  foetus  in  a  favorable  position  and  not 
malformed,  it  may  be  suspected  that  the  obstacle  to  birth  is  dependent 
on  the  large  size  of  the  latter.  A  closer  examination  will  probably  con- 
firm this  suspicion. 

With  the  Bitchy  the  principal  obstacle,  as  has  been  already  said,  is  gen- 
erally with  the  head  of  the  puppy,  which,  when  it  is  large,  is  lodged  at 
the  entrance  to  the  pelvic  inlet,  where  it  can  be  touched/*?/-  vaginam. 

The  common-bred  Bitch,  with  muzzle  more  or  less  elongated,  when 
fecundated  by  a  male  of  the  same  size  and  conformation,  and  bringing 
forth  from  five  to  eight  young,  has  usually  no  difficulty  in  pupping.  The 
tapering  or  conical  form  of  the  muzzle  of  the  puppies  allows  it  to  enter 
the  passage  and  pass  easily  through,  under  the  influence  of  the  uterine 
and  abdominal  contractions.  But  when  the  Bitch  is  of  small  size,  and 
has  been  impregnated  by  a  larger  and  young  vigorous  dog,  and  especially 
if  the  muzzle  of  either  or  both  of  the  parents  is  short  and  the  cranium 
brachycephalic — as  in  King  Charles'  spaniels,  pugs,  and  bull-dogs — par- 
turition is  oftentimes  extremely  difficult,  as  the  forehead  in  these  breeds 
is  very  large  and  cylindrical.  This  difficulty,  as  has  been  mentioned,  is 
increased  as  the  number  of  puppies  is  small,  as  then  the  latter  are  more 
developed. 

With  the  Cow,  the  head  of  the  calf  may  also  be  the  chief  impediment, 
and  provided  the  young  creature  is  otherwise  in  a  favorable  position, 
the  muffle  may  pass  through  the  inlet,  but  the  remainder  of  the  head  re- 
mains fixed  like  a  wedge  in  the  long  and  almost  undilatable  bony  canal. 
The  head  is  often  so  firmly  wedged  at  this  part  that  it  can  scarcely,  even 
with  much  force,  be  advanced  or  pushed  back,  and  this  "  wedging  "  is 
always  one  of  the  most  serious  difficulties  which  the  obstetrist  has  to 
overcome. 

With  the  Mare,  the  head  of  the  foal  is  smaller,  longer,  and  more  taper- 
ing than  that  of  the  calf,  and  meets  with  much  less  resistance  in  passing 
through  the  comparatively  short  and  wide  canal.  But  as  Saint-Cyr  points 
out,  and  as  we  have  previously  shown,  in  the  equine  and  bovine  species 
the  young  creature  finds  more  difficulty  when  the  anterior  part  of  its  body 
— chest  and  shoulders — begins  to  enter  this  part ;  and  from  their  respec- 
tive dimensions  it  is  evident  that,  even  under  ordinary  conditions,  the 
anterior  region  of  the  foetal  trunk  must  submit  to  a  certain  degree  of 
diminution  in  order  to  pass  the  pelvic  inlet  of  the  mother. 

The  limits  within  which  this  diminution  is  compatible  with  physiologi- 
cal parturition,  are  not  yet  perfectly  ascertained  ;  though  there  can  be 
no  doubt  whatever — for  we  have  facts  to  prove  it — that  the  development 
of  the  young  creature  may  be  so  exaggerated  that  sufficient  reduction 
cannot  be  effected  to  allow  of  its  being  born. 

Mignot,  of  the  Agricultural  School  at  Saulsaie,  France,  furnished  Saint- 
Cyr  with  the  following  notes  and  measurements  which  he  made  of  a  case 
of  protracted  parturition  due  to  this  cause. 

An  Ayrshire  Cow,  aged  three  years  and  ten  months,  i'30  metre  high,  and  weighing 


374    ^  FCETAL  DYSTOKIA. 

460  kilogrammes,  had  just  brought  forth  its  second  calf.  The  previous  year  it  aborted  ; 
this  time  it  went  its  full  period.  The  calf  was  in  a  favorable  position — anterior  ver- 
tebro-sacral — it  was  born  alive  and  well,  but  birth  was  laborious  because  of  the  exces- 
sive size  of  its  chest :  so  that  powerful  traction  had  to  be  exercised  to  complete  deliv- 
ery. The  calf  was  poor,  and  weighed  immediately  after  birth  30  kilogrammes.  Its 
dimensions  were  as  follows  : — 

Metres. 
Supero-inferior  diameter  of  the  head    -        -        -        .         .    0237 
Bi-temporal  "  -        -         -         --        -         -OT18 

Vertebro-sternal     "  of  the  chest 0'385 

Bi-scapulo-humeral  diameter       " 0-197 

With  the  Cow,  the  maximum  pelvimetric  elements  were  : — 

Metres. 
Height  -  -  -  I -030  X  0-182 =Sacro-pubic  diameter  -  -  0-236 
Width  of  croup  -         -       0-456  x  o-428=Bi-iliac  diameter    -        -        -    0-195 

These  figures  clearly  show  the  difficulty  to  be  overcome  in  parturition 
in  this  instance.  It  will  be  noticed  that  the  head  itself  could  scarcely  pass 
through  the  pelvis,  because  its  vertical  diameter  was  about  equal  to  that 
of  the  pelvic  cavity ;  that  the  thorax  had  to  submit  to  a  considerable 
reduction,  as  its  vertebro-sternal  diameter  (0*385  metres)  exceeded  by 
about  15  centiitietres  the  corresponding  diameter  (0-236)  of  the  pelvis ; 
while  the  two  transverse  diameters  were  about  equal.  If  the  circumfer- 
ence of  the  thorax  be  compared  with  that  of  the  pelvic  canal,  it  will  be 
found  that  the  large  circle  (the  foetus)  had  to  pass  through  the  small  circle 
(the  pelvis).  But  the  result  proved  that  this  can  be  done  in  these  con- 
ditions, and  without  injury  to  the  mother  or  foetus ;  though,  as  Saint-Cyr 
justly  says,  this,  ccr  very  near  it,  must  be  the  extreme  limit  of  possible 
physiological  reduction,  and  that  beyond  this  limit  the  life  of  the  foetus 
at  least  must  be  seriously  compromised. 

In  other  instances,  and  especially  with  the  foal,  the  passage  of  the 
croup  presents  the  greatest  obstacle,  and  the  difficulty  may  even  be 
serious. 

Progfiosis. 

In  such  cases  as  those  we  are  now  studying,  in  which  birth  is  delayed 
through  undue  development  of  the  foetus,  it  generally  happens  that  the 
membranes  have  ruptured,  and  the  liquor  amnii  has  escaped,  at  an  early 
stage ;  consequently,  the  maternal  passage  is  dry  and  tenacious,  and  per- 
haps swollen  and  irritated  ;  while  the  foetus,  no  longer  protected  in  its 
hydrostatic  bed,  is  directly  exposed  to  the  uterine  contractions,  and  in 
proportion  as  these  are  energetic,  so  does  it  the  more  rapidly  succumb. 
The  mother,  in  turn,  becomes  exhausted  through  unavailing  efforts  at 
expulsion,  and  if  judicious  assistance  is  not  opportunely  rendered,  is  not 
long  before  it  also  perishes. 

It  will,  therefore,  be  seen  that  a  prognosis  in  such  cases  of  dystokia 
cannot  always  be  of  a  favorable  kind,  as  very  often  the  death  of  the 
foetus,  if  npt  of  the  mother,  has  to  be  taken  into  consideration.  More 
particularly  is  this  the  case  with  the  smaller  animals — and  especially  the 
Bitch,  though,  as  has  been  shown,  the  larger  females,  if  they  do  not  die 
so  frequently,  yet  are  not  exempt  from  danger. 

Indications. 

The  indications  for  the  treatment  of  these  cases  are  similar  to  those 
given  for  constricted  or  contracted  pelvis:  (i)  Extraction  of  the  fcetus 
entire  by  manipulation  \  (2)  Removal  by  embryotomy. 


EXCESS  IN  VOLUME  OF  THE  FCETUS. 


375 


1.  Extraction  of  the  Foetus  entire. — If  the  "  waters  "  have  escaped  for 
any  length  of  time  and  the  parts  are  dry  and  viscid,  warm  emollient  fluids 
should  be  injected  into  the  vagina,  and  if  necessary  the  portions  of  the 
foetus  presenting  may  be  lubricated  with  glycerine,  oil,  unsalted  lard,  or 
any  other  lubricant.  The  hand  should  then  adjust  the  foetus,  if  this  is 
requisite,  and  attempts  made  to  extract  it  by  judicious  traction,  cords,  and 
other  accessory  means  to  be  hereafter  described,  being  employed  as 
occasion  demands. 

The  degree  of  traction  will  depend  upon  the  amount  of  resistance  to 
be  overcome  ;  it  being  carefully  borne  in,  mind  that  a  medium  degree  of 
force  well  directed  is  often  more  effective  than  severe  traction  misdirected 
and  inopportune. 

For  this  reason  it  is  that  a  careful  adjustment  of  the  foetus  should  be 
made  before  any  force  is  resorted  to,  the  "  wedged "  portions  being 
"  eased  "  and  well  smeared.  It  not  unfrequently  happens  that  a  very 
trifling  displacement  of  the  foetus  will  allow  it  to  pass  gradually  through 
the  pelvic  canal,  and  lead  to  the  successful  termination  of  a  case  which 
otherwise  many  would  consider  impossible  to  deliver. 

2.  Embryotomy. — When  forcible  extraction  is  deemed  impossible,  or 
dangerous  for  the  mother,  and  when  the  latter  has  ceased  to  aid  in  expel- 
ling the  foetus,  then  the  only  alternative  is  embryotomy,  which,  entailing 
as  it  does  the  destruction  of  the  progeny,  yet  affords  the  only  chance  of 
saving  the  parent.     The  operation  will  be  described  hereafter. 

Anomalies  In,  and  Disease  of,  the  Fcetal  Membranes. 

It  is  very  rare  indeed,  so  far  as  published  observations  are  evidence, 
that  anomalies  in,  or  disease  of,  the  foetal  membranes  prove  an  obstacle 
to  birth.  That  they  may  sometimes  do  so,  however,  is  evident  from  what 
we  have  previously  described.  As  Franck  justly  remarks,  it  is  not  un- 
likely that  the  retention  of  the  foetal  membranes  after  birth  is  due,  in 
many  cases,  to  inflammation  of  the  placenta  (placentitis).  A  not  unfre- 
quent  condition  of  the  membranes  is  congestion  of,  or  extravasation  into, 
the  placenta,  rupture  of  the  capillaries  {capillary  apoplexy),  and  haemor- 
rhage between  the  placenta  materna  and  placenta  uterina.  Partial  sepa- 
ration of  the  two  placentae  is  also  not  very  uncommon  in  the  Mare ;  and 
metrorrhagia  may  be  due,  at  times,  to  placenta  prcBvia.  Such  haemorrhage, 
when  it  occurs  in  the  uterus,  and  the  blood  mixes  with  the  uterine  milk, 
gives  rise  to  a  chocolate-colored  fluid  between  that  organ  and  the  foetal 
membranes,  and  in  the  asphyxia  and  intra-uterine  respiration  (pulmonary) 
of  the  foetus,  this  reddish-colored  fluid  is  often  present  in  the  lungs. 

Hartmann  describes  a  case  in  which  the  chorion  papillae  of  an  aborted 
foal  were  small,  pale,  hard,  and  cartilaginous ;  and  Broers  (Canstatt's 
yahresbericht,  1861,  p.  53)  describes  two  foetuses  in  the  uterus  of  a  Cat, 
and  on  the  inner  surface  of  the  membranes  of  one  were  numerous 
vesicular  extravasations,  while  the  other  could  scarcely  be  recognized. 
It  may  be  surmised  that  many  abortions  or  fcetal  deaths  are  due  to  dis- 
ease of  the  placentas. 

The  foetal  membranes  may  be  too  thick  and  resisting,  or  too  thin  and 
friable.  In  the  first  condition,  they  resist  the  labor  pains  too  long,  and 
after  the  os  uteri  is  completely  dilated  they  may  be  found  intact  outside 
the  vulva  ;  the  fcetus  may  even  be  expelled  in  them.  Such  tenacious 
membranes  may,  to  a  certain  extent,  hinder  delivery,  though  seldom,  if 
ever,  produce  dangerous  consequences,  except  to  the  foetus. 


376  FCETAL  DYSTOKIA. 

Very  thin  membranes  may,  on  the  contrary,  not  resist  the  uterine  con- 
tractions for  a  sufficient  length  of  time,  and  therefore  rupture  before  the 
OS  is  sufficiently  dilated.  The  consequent  escape  of  the  "  waters  "  will 
render  labor  longer  and  more  difficult.  The  utero-vaginal  canal  is  dry 
and  retentive,  and  the  contractions  of  the  uterus  are  weaker  and  much 
less  effective. 

The  treatment  for  both  of  these  conditions  has  been  already  indicated. 

At  page  359  we  alluded  to  adhesions  between  the  foetus,  its  membranes, 
and  the  uterus,  as  a  cause  of  protracted  or  impotent  labor.  We  have 
now  to  refer  to  adhesion  of  the  membranes  to  each  other,  or  to  the  foetus 
only,  as  a  cause  of  difficult  labor. 

These  adhesions  are  generally  of  the  nature  of  fibrinous  bands  passing 
between  the  membranes,  or  from  the  surface  of  the  young  creature's  body 
to  the  interior  of  its  envelopes,  due  to  the  development  of  some  local  in- 
flammation. Such  cases  are  certainly  rare,  but  their  occurrence  must 
nevertheless  be  taken  into  account. 

One  of  the  most  interesting  instances  of  this  occurrence  is  given  by  Millot,  and  quoted 
by  Rainard  {Op.  cit.,  vol.  i.,  p.  492).  The  animal,  a  Cow,  was  eight  years  old,  and  had 
been  in  the  pangs  of  labor  for  eight  days.  Some  months  before  it  had  received  a  kick 
on  the  abdomen  from  a  horse,  which  caused  it  to  show  all  the  symptoms  of  impending 
abortion.  After  eight  days  suffering,  the  symptoms  subsided  and  the  appetite  returned  ; 
but  emaciation  persisted  until  the  period  for  parturition.  When  this  occurred  the  an- 
imal was  quickly  exhausted,  and  Millot  found  it  lying  on  the  left  side  ;  the  eyes  sunken  ; 
the  visible  mucous  membranes  pale  ;  the  pulse  frequent,  small,  and  weak ;  the  respira- 
tion hurried  and  plaintive  ;  the  labicc  vulvce  tumified  and  the  mucous  membrane  ecchy- 
mosed,  while  a  reddish-colored  and  foetid  serum  escaped  from  this  opening.  The  fore- 
feet of  the  calf  presented,  and  on  opening  the  vulva  the  head  could  be  perceived. 

As  every  attempt  to  make  the  Cow  stand  on  its  feet  had  proved  useless,  it  was  de- 
cided to  remove  the  foetus  while  the  mother  was  in  the  recumbent  position ;  but  the 
debility  was  so  great  that  three  bottles  of  hot  wine  had  to  be  administered  before  ex- 
traction could  be  attempted.  And  even  then  the  Cow  gave  but  little  assistance,  as  the 
pains  had  nearly  subsided.  Traction  having  proved  ineffectual  to  advance  the  foetus, 
the  hand  was  introduced  to  discover  the  obstacle  which  hindered  its  progress.  In  pass- 
ing it  over  the  anterior  surface  of  the  head,  a  kind  of  flattened  cord  was  felt  passing  be- 
tween that  part  and  the  membranes.  Nothing  else  being  met  with,  this  cord  was  cut, 
when  the  foetus,  which  was  dead,  came  away  immediately. 

An  examination  of  the  calf  showed  that  death  had  not  occurred  recently,  as  the  hair 
came  off  readily,  and  there  was  a  foetid  odor.  The  subcutaneous  connective  tissue  of 
the  head  was  infiltrated  with  a  yellow  serosity,  which  greatly  increased  its  size.  On  the 
left  frontal  region — that  to  which  the  cord  was  attached — there  was  an  indentation  ex- 
tending to  below  the  orbit,  and  the  bone  was  thickened  ;  while  the  corresponding  part 
of  the  brain  was  diminished  in  volume,  the  ventricle  being  nearly  effaced,  and  the  cere- 
bral tissue  had  the  color  of  yellow  wax  and  the  consistence  of  suet.  No  alteration  was 
noticed  on  the  other  side  of  the  head.  There  was  no  doubt  as  to  these  lesions  having 
been  produced  by  the  kick  from  the  horse  a  month  previously. 

The  cord  attaching  the  head  of  the  foetus  to  its  envelopes,  showed  a  peculiarity 
worthy  of  attention  in  an  anatomo-pathological  point  of  view.  It  had  the  aspect  of  the 
skin,  and  was  covered  with  hair  for  more  than  an  inch  in  extent,  beyond  which  it  was 
composed  of  the  normal  layers  of  the  envelopes.  Where  it  was  inserted  into  the  head, 
the  skin  was  notably  attenuated  in  a  horse-shoe-like  form.  It  seemed  probable  that  a 
shred  of  skin  had  become  detached  by  the  injury,  and  contracted  adhesions  with  the 
foetal  membranes ;  in  this  way  constituting  the  cord  covered  with  hair,  which  proved  so 
serious  an  impediment  to  birth. 

Vincent  describes  a  very  interesting  case,  in  which  the  skin  covering 
the  joints  of  the  first  and  second  phalanges  of  the  right  fore-leg  of  the 
foetus  had  contracted  close  and  strong  adhesions  with  the  envelopes,  and 
these  with  the  uterine  mucous  membrane — in  a  somewhat  similar  manner 
to  that  recorded  by  "  Nemo,"  at  page  360.     These  adhesions  opposed  a 


EXCESS  IN  VOLUME  OF  THE  FCETUS.  377 

serious  obstacle  to  birth,  which  could   not  be  accomplished  until  they 
were  broken  up  by  the  fingers. 

A  curious  case  is  given  by  Lhomme  {journal  des  Veterinaires  dii  Midi, 
1868,  p.  372)  which  shows,  among  other  things,  that  adhesion  of  the 
membranes  to  the  uterus  does  not  always  prove  an  obstacle  to  sponta- 
neous delivery. 

This  Veterinarian  was  called  to  attend  a  pregnant  Mare,  reported  to  be  suffering  from 
colic.  The  animal  was  lying  extended  on  the  ground,  breathing  heavily,  struggling,  and 
making  expulsive  efforts.  A  portion  of  the  foetal  envelopes  was  observed  to  protrude 
beyond  the  vulva,  which  led  to  the  belief  that  abortion  was  about  to  take  place.  The 
colic  was  allayed  by  medicines,  hygienic  measures  were  recommended,  and  Lhomme  re- 
tired, persuaded  that  the  expulsion  of  the  foetus  would  soon  occur.  Two  days  passed, 
however,  and  he  was  again  sent  for  ;  as  although  the  pains  had  disappeared  and  there 
had  been  no  abortion,  yet  the  membranes  still  hung  from  the  vulva. 

An  examination  proved  that  the  foetus  was  still  alive,  and  that  the  os  uteri  was  firmly 
closed  on  the  extruded  envelopes,  so  that  a  finger  could  not  be  introduced.  There  ap- 
peared to  be  a  veritable  strangulation  of  the  membranes  which,  having  undergone 
change,  irritated  the  vagina,  and  made  the  Mare  restless. 

By  means  of  curved  scissors,  these  extruded  membranes  were  removed  as  close  to 
the  cervix  uteri  as  possible.  The  Mare  was  immediately  relieved,  as  the  pawing,  stamp- 
ing, and  whisking  of  the  tail  ceased.  No  opinion  could  be  given  as  to  the  result,  the 
case  being  so  unusual.  It  was  certain  that  the  embryonal  sac  had,  by  this  operation, 
been  opened  ;  but  then  there  was  no  escape  of  liquor  amnii,  owing  to  the  closure  of  the 
OS  on  the  remaining  portion  of  the  envelopes.  But  the  question  was  whether  the  fluids 
would  yet  escape,  or  whether  this  would  be  prevented  by  cicatrization  of  the  membranes 
on  the  distal  side  of  the  strangulation.  It  was  still  three  months  to  the  time  for  partu- 
rition, and  the  owner  of  the  Mare  was  recommended  to  report  whenever  the  slightest 
sign  of  illness  appeared  ;  and  if  abortion  should  take  place,  he  was  requested  to  keep 
the  foetus  and  membranes  for  Lhomme's  inspection. 

The  animal  continued  to  enjoy  perfect  health,  however,  and  at  eleven  months  and 
twelve  days — three  months  and  two  days  after  the  operation — it  brought  forth  a  strong 
and  perfectly-formed  mule.  The  foetal  envelopes  were  carefully  examined,  and  a  cica- 
trix was  discovered  which  corrugated  and  united  them  together ;  from  this  part  they 
were  in  plaits  to  the  extent  of  several  inches,  and  these  plaits  were  destitute  of  villi. 
The  opening  in  the  membranes  through  which  the  foetus  had  passed  was  between  two 
and  three  inches  from  the  cicatrix. 

xA.dhesions,  when  they  exist  and  are  a  cause  of  dystokia,  and  when  they 
can  be  reached,  must  be  broken  up  or  cut  through.  In  the  majority  of 
cases,  the  fingers  will  suffice  ;  if  not,  then  a  bistoury  must  be  used. 

Difficulty  in  parturition  in  the  Cow  is  sometimes  experienced  from  the 
envelopes  being  torn  in  several  places,  and  the  head  or  limbs,  or  both, 
passing  through  these  fissures. 

In  such  cases  the  entangled  parts  of  the  foetus  must  be  sought  for,  re- 
leased, and  brought  into  a  favorable  position  by  tearing  or  cutting  through 
the  obstacles. 

Frornage  de  Feugre  {Cours  Complet,  vol.  i.,  p.  87)  reports  an  observation  furnished 
by  Lacueille.  A  Heifer  was  in  labor  for  five  hours,  and  was  much  exhausted  by  the 
manipulations  of  amateurs.  The  calf  presented  the  head  and  one  fore-leg.  Lacueille, 
instead  of  acting  with  precipitation,  allowed  an  interval  to  occur  between  each  of  his 
attempts  at  extraction  ;  but  an  hour  elapsed  before  he  could  discover  the  elbow  of  the 
other  fore  limb,  which  was  entangled  in  the  torn  envelopes.  Delivery  was  soon  after 
effected,  and  the  membranes  came  away  with  the  calf. 

Abnormal  Quantity  of  Placental  Fluid. 

We  have  already  described  the  condition  known  as  "  hydramnios,"  and 
have  pointed  out  that  when  it  exists  abortion  nearly  always  takes  place. 
When  the  accumulation  of  fluid  interferes  with  parturition,  labor  is  slow 


378  FCETAL  DVSTOKIA. 

s 

and  delivery  difficult,  owing  to  the  great  distention  of  the  uterus  and  the 
pendulous  state  of  the  abdomen. 

The  indications  for  treatment  have  been  given  at  p.  i8o. 

An  unusually  small  quantity  of  the  liquor  amnii,  when  it  is  not  due  to 
premature  rupture  of  the  envelopes,  has  not,  to  my  knowledge,  been  men- 
tioned as  a  cause  of  dystokia  ;  though  there  is  no  reason  why  this  de- 
ficiency should  not  lead  to  protracted  labor,  if  we  call  to  mind  what  has 
been  said  as  to  the  uses  of  this  fluid. 

The  indications  will  be  the  same  as  for  those  cases  in  which  the  fluid 
has  escaped  prematurely. 

Anomalies  in  the  Umbilical  Cord. 

Anomalies  in  the  umbilical  cord  are  not  a  very  common  cause  of 
dystokia. 

The  cord  may  be  unusually  short;  but  this  deficiency  does  not  appear 
to  operate  prejudicially  in  parturition,  as  the  natural  twist  in  it  admits  of 
its  elongation  to  a  certain  extent,  while  during  the  act  of  expulsion  the 
walls  of  the  body  of  the  uterus  approach  the  cervix  as  the  foetus  advances 
into  the  vagina.  Even  if  the  cord  happened  to  be  too  short,  it  is  ques- 
tionable whether  it  would  constitute  a  serious  obstacle  to  birth,  as  it 
would  most  probably  either  rupture  or  the  placenta  would  separate  from 
the  uterus. 

If  by  chance  the  foetus  should  not  be  expelled  until  it  was  discovered 
that  the  cord  was  not  sufficiently  long,  this  might  easily  be  cut  in  the 
vagina,  as  far  as  possible  from  the  foetus,  the  ends  being  compressed  by 
the  fingers  and  ligatured  after  delivery. 

In  the  domesticated  animals  the  cord  is  never  so  long  as  to  occasion 
what  has  been  designated  in  human  ohsietxics  prolapsus  of  the  cord,  i.e., 
its  descent  into  the  os,  vagina,  or  outside  the  vulva,  after  rupture  of  the 
membranes,  and  alongside  the  presenting  part  of  the  child  :  an  accident 
attended  sometimes  with  great  danger  to  the  latter,  from  compression  of 
the  funis. 

The  comparatively  short  cord  of  the  domesticated  animals  also  ex- 
empts them  to  some  extent  from  another  frequent  cause  of  difficult 
labor  met  with  in  woman  :  the  coiling  of  the  funis  around  some  part  or 
parts  of  the  foetus.  Nevertheless,  this  coiling  has  been  observed  in 
animals — more  often  with  the  Mare  than  the  Cow.  Havon,  Delwart, 
Hurtrel  D'Arboval,  Rueff,  and  Sacchers  have  seen  it  coiled  around  the 
neck,  and  more  especially  when  the  foetus  was  in  a  wrong  position — bent 
towards  the  flanks,  near  the  cord.  Gaven  has  found  it  round  the  loins  ; 
and  numerous  observers  have  noted  it  encircling  one  or  more  of  the  limbs. 
Daubenton  had  remarked  the  frequency  of  leg  coils  in  Sheep. 

Coiling  of  the  funis  around  any  part  of  the  foetus  is  not  in  itself  a  com- 
mon cause  of  dystokia,  although  it  may  render  delivery  protracted  and 
fatiguing.  It  is  more  likely  to  induce  asphyxia  in  the  young  creature, 
from  the  stretching  and  diminished  calibre  of  the  blood-vessels  composing 
it,  and  consequent  check  to  the  flow  of  blood. 

Rainard  is  of  opinion  that  the  obstacle  to  parturition  from  coiling,  is 
less  serious  in  the  Mare  and  carnivorous  animals  than  other  creatures, 
because  of  the  readiness  with  which  the  placenta   is   detached  in  them. 

The  dangers  of  strangulation  are  also  much  less  when  the  foetus  pre- 
sents anteriorly ;  when  the  presentation  is  posterior,  there  is  risk  of 
suffocation,  because  it  is  difficult  to  ascertain  the  situation  of  the  cord 


DISEASES  OF  THE  FCETUS. 


379 


in  order  to  divide  it ;  and  the  uterine  contractions,  as  well  as  the  artificial 
traction,  tend  to  tighten  the  funis  around  the  neck. 

In  the  human  species,  it  has  often  been  remarked  that  children  are 
sometimes  born  with  their  limbs  deficient,  and  the  spontaneous  amputa- 
tion has  been  attributed  to  the  constriction  produced  by  this  coiling  or 
twisting  of  the  umbilical  cord  around  the  part,  during  the  development  of 
the  foetus.  Vrolig,  Hillairet,  and  Goubaux  have  recorded  similar  muti- 
lations in  animals. 

Indications. 

When  coiling  of  the  funis  is  ascertained  to  be  the  cause  of  difficult 
parturition,  the  indications  are  to  uncoil  it ;  or  if  this  cannot  be  effected, 
then  it  must  be  divided  either  by  the  fingers,  scissors,  or  a  probe-pointed 
bistoury — hastening  delivery  as  much  as  possible  afterwards. 

There  is  not  much  to  be  feared  from  haemorrhage  after  section  of  the 
vessels,  as  they  seldom  bleed. 


CHAPTER  II. 
Diseases  of  the  Foetus. 


While  in  the  uterus  the  foetus  may  be  affected  with  disease,  which, 
causing  its  death,  will  lead  to  abortion  or  premature  expulsion,  or  perhaps 
undue  retention.  Other  abnormal  conditions,  more  or  less  allied  to 
disease,  may  give  rise  to  vicious  conformation  or  excess  of  volume, 
generally  or  locally,  and  thus  prove  a  cause  of  difficult  parturition 
These  conditions  may  produce  hydrocephalus,  ascites  and  anasarca,  em- 
physema, polysarcia,  muscular  contractions,  and  tumors  of  various  kinds. 

Hydrocephalus. 

As  the  term  implies,  "  hydrocephalus "  signifies  dropsy  of  the  brain, 
the  dropsy  being  constituted  by  the  accumulation  of  a  more  or  less 
considerable  quantity  of  fluid  in  the  cranium  of  the  foetus,  leading  to  a 
proportionate  enlargement  of  that  region. 

This  diseased  condition  is  not  at  all  uncommon  in  the  bovine  and 
equine  species,  and  some  of  the  specimens  of  craniums  found  in  mu- 
seums are  wonderfully  deformed,  through  the  accumulation  of  fluid  in 
their  interior. 

Pathological  Anatomy. 

This  diseased  condition  is  recognized  by  a  more  or  less  exaggerated 
development  or  volume  of  the  cranium,  the  vault  of  which  has  been 
elevated  and  distended  by  the  fluid  collected  in  the  brain  ventricles. 

In  some  cases,  the  distention  has  been  so  slight  that  the  frontal  bones 
are  not  much  raised  ;  while  in  others  the  collection  of  serum  has  been  so 
great  that  these  and  other  bones  of  the  cranium  are  displaced,  and  the 
forehead,  rising  almost  at  right  angles  to  the  face,  suddenly  reaches  an 
extraordinary  height,  giving  the  creature  a  startling  appearance.  The 
hydrocephalic  tumor  varies  in  figure  as  well  as  in  volume.  It  is  some- 
times quite  globular,  and  protrudes  so  high  and  so  much  over  the  face  as 
to  give  the  physiognomy  a  strangely  human  appearance  (Fig.  81)  ;  in 
rare  cases  it  is  narrow,  but  excessively  protuberant,  involving  only  a  part 


38p  FCETAL  DYSTOKIA, 

of  the  cranium  (Fig.  83)  ;  at  other  times  it  is  bilobular,  and  the  divisions 
may  be  either  alike  or  unequal  in  volume.  Not  unfrequently  the  diam- 
eter of  such  a  tumor  in  the  calf  measures  more  than  a  foot.  The  tumor 
is  soft  and  depressible  in  parts,  hard  and  resisting  in  others,  owing  to 
the  bones  of  the  cranium  being  altered  and  separated  in  places.  These 
bones — and  particularly  the  frontal,  temporal  and  parietal — are,  as  a  rule, 
considerably  deformed  and  thrown  out  of  their  natural  direction,  and  in 
places  so  expanded  and  rarefied  as  to  be  i\o  thicker  than  tissue-paper ; 


Fig.  78. 

Skull  of  a  Hydrocephalic  Calf:   the  Cranial  Bones  are  partially  destroyed 
and  defective. 

when  the  internal  distention  has  been  very  considerable,  their  borders  do 
not  meet  as  in  their  normal  condition,  but  are  often  widely  separated, 
leaving  between  them  vast  fontanellae  occupied  only  by  a  thin  translucid 
membrane — the  dura  mater — which  is  in  immediate  contact  with,  and 
adheres  closely  to,  the  skin. 

In  some  instances — especially  in  the  calf — the  bones  in  their  upper 
part  do  not  join  at  all,  and  the  roof  of  the  cranium,  or,  rather,  of  the 
cranial  tumor,  is  entirely  absent  (Fig.  79).  In  other  instances,  and 
particularly  in  the  foal,  a  kind  of  bony  arch  extends  from  the  nasal  to  the 
occipital  bones,  in  the  direction  of  the  saggital  suture,  with  only  here  and 


Fig.  79. 
Skull  of  a  Hydrocephalic  Calf:    the  Roof  of  the  Cranium  is  absent. 

there,  on  each  side,  small  osseous  patches  from  the  parietal  or  temporal 
bones,  and  adhering  to  the  dura  mater. 

The  tumor  is  always  entirely  covered  by  intact,  though   sometimes 
very  thin  skin,  to  which  the  hair  is  ordinarily  attached,  and  is  indeed  at 


DISEASES  OF  THE  FCETUS.  381 

times  longer  than  usual,  especially  at  the  sides.     This  often  makes  the 
animal  appear  as  if  it  wore  a  high  fur  cap  (Fig.  81). 

Owing  to  the  great  development  of  the  forehead  the  upper  jaw  appears 
to  be  shorter  than  usual ;  and,  indeed,  it  will  be  found  that  it  is  really  so 
(Fig.  78). 


Fig.  80. 
Skull  of  a  Hydrocephalic  Foal:  the  Cranial  Roof  is  Deficient  at  the  Sides. 

When  the  cranial  cavity  is  opened,  and  the  dura  mater  incised,  there  is 
found  a  quantity — varying  with  the  dimensions  of  the  tumor — of  limpid, 
colorless,  or  slightly  yellow  or  greenish  serum. 

The  quantity  of  fluid  varies  considerably,  but  it  is  generally  from  two 


Fig.  81. 
Calf  affected  with  Hydrocephalus:  its  Skull  is  represented  in  Figure  79. 

to  four  pints  in  the  foal  and  calf.  Rainard  estimated  the  quantity  of  fluid 
that  had  been  contained  in  the  skull  of  the  Calf  sent  to  him,  at  two  and 
a  quarter  litres — the  largest  quantity  he  had  met  with.  Drouard,  how- 
ever, in  1842,  published  the  details  of  a  case  of  a  foal  whose  cranium 
held  four  and  a-half  litres  (about  eight  imperial  pints). 

Figure  80  represents  a  Foal's  skull,  now  in  the  museum  of  the  Lyons 
Veterinary  School,  and  which  from  its  dimensions,  Saint-Cyr  calculates 
to  have  contained  eight  litres  (about  thirteen  pints).  Kopp  not  long 
since  exhibited  the  head  of  a  Foal  before  the  Veterinary  Society  of  Alsace, 


>3«2  FCETAL  DYSTOKIA. 

the  diameter  of  whose  dropsical  cranium  was  fourteen  inches,  and  which 
it  was  computed  would  contain  about  twelve  litres  of  fluid  (more  than  two 
and  a-half  gallons).  And  Quesnel  has  also  shown  a  skull  of  about  the 
same  dimensions,  to  the  Veterinary  Society  of  Calvados  et  de  la  Manche. 

Mr.  Olver  (  Veterinarian,  1874,  p.  481)  describes  the  cranium  of  a  hydro- 
cephalic Foal  which  measured  thirty-six  inches  in  circumference,  ten 
inches  from  one  orbit  to  the  other,  and  twenty-seven  inches  from  the 
occipital  crest  to  the  nasal  bones.  At  least  twelve  pints  of  fluid  were 
contained  in  the  cavity,  and  the  cerebral  substance  remaining  was  quite 
disorganized,  the  durmater  being  much  thickened.  The  cranial  cavity 
was  almost  wholly  surrounded  by  bone  ;  the  only  portion  which  was  solely 
enclosed  by  skin  was  a  space  about  four  inches  in  circumference  at  the  top. 

In  the  Museum  of  the  Munich  Veterinary  School  is  a  skull,  the  cranium 
of  which  measures  nine  by  eleven  inches  in  diameter. 

Professor  Lombardini  {Giornale  di  Veterinaria,  1873)  speaks  of  the  head 
of  a  Calf,  the  cranium  of  which  was  more  than  fourteen  inches  high  ;  it 
was  eight  and  a-half  inches  long,  and  four  and  a-half  broad.  This  Calf, 
with  two  others,  well-formed,  was  aborted  at  six  months,  without  any 
injury  to  the  Cow,  which  was  six  years  old.  There  can  be  no  doubt  that 
if  the  full  period  of  pregnancy  had  been  reached,  this  Calf  would  have 
proved  troublesome  to  extract. 

But  these  latter  are  quite  exceptional  instances,  and  are  three  or  four 
times  larger  than  those  usually  met  with. 

This  accumulation  of  fluid  takes  place  in  the  ventricles  of  the  brain, 
as  has  been  ascertained  from  dissection  by  Rainard,  Taiche,  Chouard, 


Fig.  82. 
Head  ok  a  Foal  affected  with  Hydrocephalus. 

Axe,  and  others,  who  have  found  the  tumor  formed  externally  by  the 
skin,  and  internally  by  the  membranes  of  the  brain,  to  which  adhered  a 
thin  layer  of  cerebral  substance.  The  spinal  cord,  plexus  choroides,  and 
cerebellum,  have  been  generally  observed  to  be  intact,  and  ou\f  the 
cerebral  hemispheres  are  destroyed  more  or  less  completely. 

Though  this  alteration,  or  rather  destruction,  of  the  brain  is  of  so  serious 
a  character,  and  though  it  must  have  begun  at  an  early  period  of  uterine 
life,  yet  it  does  not  appear  to  have  much  influence  on  the  development  of 
the  foetus,  as  this  is  usually  found  to  be  full  grown,  its  skin  covered  with 
hair  and  well-formed  everywhere  except  in  the  head.     Exceptional  cases 


DISEASES  OF  THE  FCETUS.  383 

occur,  however,  in  which  development  is  arrested  ;  as  in  some  mentioned 
by  Lecoq,  of  hydrocephalic  Calves,  in  which  the  limbs  were  atrophied 
and  the  bones  of  these  cartilaginous. 

If  intra-uterine  existence  can  be  maintained  by  the  hydrocephalic 
foetus  until  the  period  of  parturition,  it  generally  perishes  during  birth  or 
soon  after — usually  after  one  or  two  respirations.  In  some  exceptional 
cases,  however,  such  creatures  have  lived  to  the  eighth  day  after  birth, 
and,  as  Saint-Cyr  remarks,  they  might  survive  even  longer  if  the  dropsy 
is  not  very  extensive. 

In  the  most  favorable  cases,  nevertheless,  there  is  little  profit  to  be 
expected  from  keeping  such  animals  alive,  as  they  are  ordinarily  week 
and  thrive  badly  ;  they  can  rarely  stand,  and  they  refuse  the  teat,  being 
usually  in  a  semi-comatose  state  ;  if  the  tumor  chances  to  he  pressed 
upon,  the  young  creature  becomes  completely  unconscious  and  lies  in 
convulsions. 

Very  few  cases  of  recovery,  even  in  the  mildest  form  of  the  malady, 
are  recorded. 

Dystokia. 

The  obstacle  this  congenital  condition  of  the  foetus  presents  during 
birth,  must,  of  course,  depend  upon  the  volume  of  the  cranial  tumor. 
The  birth  of  a  hydrocephalic  fcetus  often  takes  place  spontaneously, 
though  perhaps  only  after  much  straining.  If  the  cranium  is  not  very 
large,  and  provided  the  labor  pains  are  sufficiently  energetic  and  the 
position  favorable,  the  tumor  yields,  and  the  head  becomes  elongated 
in  its  passage  through  the  os  and  the  pelvis,  or  it  may  rupture  internally 
and  the  fluid  escape  by  the  ears,  nostrils,  and  eyes.  When  extremely 
large,  the  cranium  may  offer  an  invincible  obstacle  to  spontaneous  de- 
livery, notwithstanding  the  most  powerful  labor  pains. 

And,  besides,  the  mechanism  of  parturition  in  such  cases  varies  with 
the  presentation — anterior  or  posterior.  The  head  of  the  hydrocephalic 
foetus  being  more  or  less  spherical — instead  of  conical,  as  in  the  normal 
condition — it  results  that  this  part,  when  the  young  creature  is  pressed 
upon  by  the  uterus,  no  longer  acts  as  a  wedge  to  gradually  dilate  the  os 
uteri.  The  head  certainly  commences  the  work  of  dilatation,  but  in  a 
very  incomplete  manner,  and  when  the  jaws — particularly  the  upper  one 
— have  cleared  the  os,  further  progress  is  checked  by  the  voluminous 
.forehead.  If  the  hand  is  introduced  into  the  vagina,  the  cervix  uteri  is 
found  to  be  contracted  on  the  nose  or  jaws  of  the  foetus  ;  and  the  delay 
in  further  expulsion  depends  upon  the  size  of  the  cranium,  the  protrusion 
of  the  uterus  into  the  pelvic  cavity,  and  the  exhaustion  of  the  organ  by 
futile  contractions. 

In  the  posterior  presentation,  birth  takes  place  in  the  manner  already 
described ;  the  hinder  extremities  advance  through  the  os,  then  the  body 
and  neck,  and  birth  is  apparently  takin'g  place  satisfactorily  until  the  head 
reaches  this  aperture,  when  further  advancment  is  stopped — the  resistance 
to  expulsion  being  in  proportion  to  the  volume  of  the  head. 

Not  unfrequently,  with  such  a  condition  of  the  fcetus,  we  have  also  a 
malposition  to  complicate  matters. 

Diagnosis, 
In  the  anterior  position,  there  is  not  riiuch  difficulty  in  diagnosing  the 
presence  of  hydrocephalus  :  as  the  hand  can  feel  the  voluminous  spherical 


384  FCETAL  DYSTOKIA. 

cranium  beyond  the  muzzle  and  eyes,  with  the  ears  on  each  side,  and  its 
unequally  resisting  surface — hard  in  some  parts,  soft  or  fluctuating  in 
others.  When,  however,  there  is  a  malposition  of  the  foetus,  then  it  is 
sometimes  more  difficult  to  discover  the  hydrocephalus  j  and  often  this 
cannot  be  done  until  the  position  is  remedied.  The  head  should  be 
sought  for  in  every  case,  and  it  will  be  recognized  by  the  mouth,  eyes, 
and  ears ;  after  which  the  size,  consistence,  and  form  of  the  cranium  can 
be  estimated  by  passing  the  hand  over  it. 

In  the  posterior  presentation,  hydrocephalus  has  been  recognized  while 
the  foetus  was  still  in  the  uterus.  The  greatly  enlarged  head  may  be  felt 
per  rectum,  or  even  through  the  abominal  walls.  But,  as  a  rule,  it  is  only 
at  an  advanced  period  of  labor,  and  when  the  body  of  the  young  creature 
is  already  beyond  the  os,  and  perhaps  without  the  vulva,  that  a  difficulty 
is  discovered  and  the  cause  sought  for. 


Fig.  83. 
Extraordinary  Development  of  the  Cranium  of  a  Hydrocephalic  Calf.* 

In  such  a  case  manual  exploration  is  necessary,  and  this  should  be 
effected,  if  possible,  by  passing  the  hand  between  the  foetus  and  the  wall 
of  the  vagina.  This  is  difficult  if  the  body  is  still  in  the  passage,  and  it 
may  be  requisite  to  have  recourse  to  traction  to  withdraw  it  therefrom. 
If,  however,  it  is  beyond  the  vulva,  then  the  hand  can  be  easily  passed 
along  the  neck  as  far  as  the  head,  when  the  real  state  of  affairs  can  be 
discovered. 

Indications,    , 

The  indications  for  treatment  in  cases  of  dystokia  from  hydrocephalus 
alone,  without  reference  to  such  a  complication  as  malposition  of  the 
foetus,  are  simple  and  few. 

When  the  hydrocephalus  is  not  considerable,  judicious  traction  will 
often  accomplish  delivery  \  and  several  cases  are  on  record  in  which  foals 
and  calves  whose  cranium  was  of  large  size  and  full  of  fluid,  have  been 
delivered  by  this  means,  some  of  them  alive,  and  in  the  posterior  as  well 

*  For  the  photograph  oi  Figs.  82,  83,  and  99,  I  am  indebted  to  my  friend,  Mr.  Shipley,  M.R.C.V.S., 
of  Yarmouth. 


DISEASES  OF  THE  FCETUS. 


385 


as  the  anterior  presentation.  In  such  a  case,  suppose  the  fore  feet  pre- 
sent, these  should  be  secured  by  cords>  the  ends  of  which  may  be  given 
to  an  assistant ;  then  the  hand  should  be  introduced  into  the  vagina,  and 
if  necessary  the  os  should  be  dilated  sufficiently  to  allow  of  another  cord 
being  fastened  on  the  upper,  or,  perhaps  better,  the  lower  jaw,  which  is 
often  wider.  Traction  can  then  be  made  during  the  throes  of  the 
mother. 

When,  however,  traction  will  not  effect  delivery,  because  of  the  size  of 
the  head,  and  the  mother  is  becoming  exhausted,  the  cranium  must  be 
punctured — an  easy  operation  when  the  presentation  is  anterior,  but  more 
difficult  when  it  is  posterior. 

The  puncture  may  be  made  by  means  of  a  bistoury,  a  scalpel  or  ordi- 
nary knife,  or,  which  is  preferable,  a  somewhat  large  trocar  and  canula, 
curved  if  possible.  The  most  fluctuating  part  of  the  tumor  should  be 
penetrated,  and  the  fluid  having  escaped,  the  cranial  parietes  collapse,  or 
give  way  to  pressure;  the  head  is  thus  greatly  reduced  in  size,  and' de- 
livery can  be  completed. 

Rainard  recommends  the  puncture  to  be  made  on  the  side  of  the  cra- 
nium ;  and  should  it  be  necessar34  to  still  further  reduce  the  size  of  this 
part  by  bone-forceps  or  other  means,  the  side  of  the  cranium  will  be  found 
most  suitable.  In  the  posterior  presentation,  the  back  of  the  head  may 
be  punctured,  and  the  weight  of  the  young  creature's  body,  hanging  be- 
yond the  vulva,  will  sufficiently  steady  the  head  for  this  purpose  ;  but  in 
the  anterior  presentation,  traction  should  be  made  by  means  of  the  cords 
while  the  cranium  is  being  opened. 

Rainard  informs  us  that  Conte,  being  called  in  to  assist  a  Mare  in  foal- 
ing, found  a  posterior  presentation,  and  having  diagnosed  hydrocephalus, 
he  was  able  by  version  to  convert  it  into  an  anterior  presentation,  when 
the  head  was  easily  punctured. 

Embryotomy  has  been  recommended  in  such  cases  ;  but,  beyond  re- 
ducing the  size  of  the  head,  if  that  is  the  only  obstacle,  there  is  no  neces- 
sity for  resorting  to  further  breaking  up  of  the  body  of  the  foetus.  In- 
deed, it  will  be  found  that,  in  ordinary  cases,  patience  and  judicious 
manipulation  will  often  enable  the  obstetrist  to  dispense  with  craniotomy. 
This  is  well  exemplified  in  the  following  instance. 

Drouard  {Renieil  de  Med.  Veterinaire,  1842,  p.  40)  was  requested  to  attend  a  Mare 
laboring  under  difficult  parturition.  The  animal  was  nine  or  ten  years  old,  in  good  con- 
dition and  well-formed,  and  had  produced  and  reared  three  or  four  foals.  The  presen- 
tation was  posterior,  with  the  hind  legs  bent  forward  under  the  body.  The  breech  oc- 
cupied the  passage,  and  could  not  be  moved  forward  to  allow  the  hand  to  seize  the 
thighs  and  so  bring  up  the  legs  ;  the  labia  of  the  vulva  were  becoming  swollen,  and  the 
Mare,  being  exhausted  by  fruitless  straining,  was  in  a  dangerous  condition.  There  ap- 
peared to  be  only  two  methods  of  delivering  the  animal :  by  practising  embryotomy,  or 
forcibly  extracting  the  hind  extremities.  For  this  purpose  a  strong  hooked  instrument 
was  fixed  in  the  right  hip  of  the  foetus.  Six  or  seven  persons  pulled  energetically  at 
this  instrument,  while  others  supported  the  Mare  and  prevented  her  falling.  As  soon 
as  the  skin  and  muscles  began  to  give  way,  the  femur  became  disarticulated,  and  was 
drawn  out.  After  this  it  was  thought  that' the  other  parts  of  the  foetus  might  be  ex- 
tracted by  ordinary  means  ;  but  tumefaction  of  the  parts  increased  so  rapidly  that  the 
other  extremity  had  to  be  removed  in  the  same  way.     A  hook  was  then  in.serted  into 

'  each  of  the    acetabular  cavities,  and  the  body  of  the  foetus  was  easily  drawn  into  the 
vagina  when,  the  head  having  arrived  at  the  pelvic  inlet,  all  further  progress  was  stopped. 
The  hand  was  introduced  into  the  uterine  cavity,  and  a  monstrous  head  was  recognized  ; 
in  this  considerable  fluctuation  could  be  detected,  and  hydrocephalus  was  diagnosed. 
Drouard  was  preparing  to  puncture  the  head,  when  the  assi.stants,  taking  advantage 

lOf  an  effort  of  the  Mare,  pulled  all  together  so  stronglv,  that  they  extracted  the  trunk 

25 


386  FCETAL  DYSTOKIA. 

and  head  of  the  foetus — a  cranium  of  such  monstrous  size  had  scarcely  ever  been  seen 
before.  The  foetus  altogether  was  small  and  emaciated,  but  the  enormous  head  was 
larger  on  the  right  side  then  on  the  left.  On  the  slightest  displacement,  the  fluctuation 
of  the  contained  fluid  could  be  both  seen  and  felt. 

Macgillivray  {Veterinary  yournal,  January,  1877)  attended  a  Cow  which  had  been 
showing  symptoms  of  calving  for  some  hours,  the  waters  having  escaped,  etc.  He 
found  parturition  further  advanced  then  was  expected,  for  a  pair  of  feet  were  protruding 
from  the  vulva.  Observing  that  the  soles  of  the  two  feet  were  shown  uppermost,  he 
concluded  that  it  was  a  hind-leg  presentation,  or  something  worse.  It  proyed  to  be  a 
hind-quarter  presentation,  and  very  slight  traction  sufficed  to  bring  away  the  foetus  as 
far  as  the  fore-quarters,  but  there  it  came  to  a  complete  standstill.  He  introduced  his 
arm  into  the  passage,  expecting  to  find  a  fore-leg  turned  back  ;  but  could  discover  no 
such  obstacle — his  hand  slipping  quite  easily  all  round  the  body  of  the  foetus.  He  now 
attached  cords  to  the  hind-legs  above  the  fetlocks,  and  with  the  assistance  of  five  or  six 
people  drew  away  a  living  foetus.  The  cranium  was  of  an  immense  size,  and  precisely 
similar  in  shape  to  Fig.  78. 

What  rendered  the  extraction  of  the  foetus  so  difficult,  and  the  case  so  uncommon, 
interestingj-  and  complicated,  was  that  one  of  the  fore-legs  passed  right  over  the  top  of 
the,  enlarged  cranium  (from  occiput  to  muzzle),  and  was.  in  fact,  partially  imbedded  in 
a  groove  during  its  whole  course  along  the  abnormally  large  foetal  cranium.  This  mal- 
positioned  leg  must  have  been  there  for  months,  as  the  bones  of  the  cranium  were  quite 
firm  and  unyielding ;  and  the  erratic  leg  persisted  in  keeping  its  cranial  \>o?h\!\o\\  even 
after  delivery.  This  malpostured  foetal  monster  remained  alive  for  a  few  minutes  only  ; 
which  the  farmer's  wife  thought  a  very  lucky  cfrcumstance,  as  she  was  just  asking  him  to 
make  away  with  it  when  it  went  away  of  itself  ! 

Every  case,  however,  does  not  terminate  successfully. 

Olver  (  Veterinarian,  vol.  xlvii.,  p.  481),  in  a  case  of  difficult  parturition  in  a  cart  Mare, 
found,  on  examination /^r  t/(2^/«a;«,  the  fore  limbs  of  the  foal  in  the  passage,  with  the 
head  turned  back  out  of  reach.  The  presenting  limbs  being  detached  from  the  body  of 
the  foetus,  an  enormously  enlarged  head  was  discovered,  the  enlargement  being  surmised 
to  be  due  to  hydrocephalus.  Attempts  were  made  to  puncture  the  cranium,  but  unsuc- 
cessfully— though  the  reason  for  the  failure  is  not  stated ;  consequently  the  Mare  was 
killed.     We  have  given  the  dimensions  of  the  cranium  at  p.  382. 

Ascites,  Anasarca  and  Hydrothorax. 

"  Ascites  "  (fluid  in  the  abdominal  cavity)  and  "  Anasarca"  (fluid  be- 
neath the  skin),  either  partial  or  complete,  do  not  appear  to  be  such  fre- 
quent diseases  of  the  foetus  as  hydrocephalus.  The  cases  recorded  are 
comparatively  few. 

Anasarca  has  been  observed  in  the  foal,  calf,  and  kid,  and  ascites 
chiefly  in  the  calf.  These  pathological  conditions  have  generally  been 
confounded. 

With  regard  to  ascites,  it  appears  that  in  all  the  recorded  observations, 
the  foetus  was  in  what  we  have  designated  the  "  natural  presentation  and 
position  ;  "  though  twice  these  were  complicated  :  the  head  being  turned 
back  on  the  left  side  in  one,  and  in  the  other  all  the  limbs  presented  with 
the  head,  the  left  fore-limb  being  contracted. 

Sometimes  the  foetus  has  ceased  to  live  before  the  full  period  of  preg- 
nancy has  expired,  and  is  expelled  from  the  uterus ;  at  other  times  it 
reaches  maturity,  and  living  through  a  few  of  the  early  pains,  it  succumbs 
before  parturition  is  completed,  either  from  the  effects  of  protracted  la- 
bor or  from  the  manoeuvres  adopted  to  extract  it.  None  appear  to  have 
been  born  alive  ;  nor  would  they  be  likely  to  live  if  by  chance  they  were 
extracted  before  death  seized  them.  In  addition  to  the  abdominal  cavity, 
the  scrotum  is  often  enormously  enlarged  through  its  communication  with 
the  latter,  of  which  it  is  only  a  kind  of  diverticulum.  Hydrothorax  is 
often  combined  with  ascites. 


DISEASES  OF  THE  FOETUS.  387 

With  regard  to  anasarca,  Noyes  (Rainard,  Op.  ctt.,  p.  476)  has  witnessed 
a  number  of  cases  of  general  anasarca  in  the  course  of  a  year,  in  the  nfeigh- 
borhood  of  Mirepoix,  France.  He  states  that  the  calves  were  born  at 
least  three  weeks  before  their  time,  and  always  dead.  The  connective 
tissue  of  the  entire  body — from  the  head  to  the  croup — was  infiltrated 
with  serum,  the  young  creatures  being  double  or  treble  the  size  of  ordi- 
nary calves ;  the  head  especially  was  enormously  large.  During  preg- 
nancy the  abdomen  of  the  Cows  was  so  developed,  that  their  owners 
thought  they  were  bearing  twin  calves. 

Que'tier  has  published  details  of  analogous  cases  of  general  infiltra- 
tion, in  which  the  foetus  was  at  least  twice  its  natural  size. 

This  condition  has  been  witnessed  in  the  foetus  of  the  Mare  by  Pauli 
(Gurlt  and  Hertwig's  Magazin,  vol.  viii.),  and  by  Lehnhardt  {Ibid.,  vol. 
ix.)  and  Herran  {Journal  de  Vet.  du  Alidu  1864)  in  the  Goat.  The  lat- 
ter authority  made  an  autopsy  of  a  Goat  which  had  died  from  injuries  in- 
flicted on  its  head,  and  found  in  it  twin  foetuses,  whose  body  was  com- 
pletely infiltrated. 

Cause. 

The  cause  of  this  dropsical  condition  is  not  well  ascertained.  In  some 
cases  it  may  be  due  to  uterine  dropsy  of  the  mother  or  to  constitutional 
hydraemia  ;  but  in  other  instances  it  cannot  be  so,  as  the  mother  is  in 
good  health,  and  it  would  then  appear  to  be  owing  to  derangement  of  the 
foetal  circulation,  and  particularly  of  the  venous  system — probably  conges- 
tion of  the  umbilical  cord.  At  times,  disease  of  such  organs  as  the  kid- 
neys may  produce  it. 

Arloing  informed  Saint-Cyr  [Op.  cit.^  p.  544)  that  Guilhempey,  veterinary  surgeon  at 
Cologne  (Gers),  met  with  tliree  cases  of  foetal  ascites  which  proved  a  cause  of  dystokia 
in  the  Cow.  The  foetus  in  each  case  was  in  the  normal  position  (vetebro-sacral  of  the 
anterior  presentation) ;  but  though  the  feet  were  in  the  vagina,  delivery  could  not  be 
effected,  notwithstanding  the  most  skilful  and  energetic  traction.  In  the  first- cases, 
after  many  difficulties  and  much  examination,  it  was  ascertained  that  the  abdomen  of  the 
foetus  was  enormously  distended;  and  at  the  moment  the  mother  strained,  or  when  trac- 
tion was  made,  this  region  seemed  to  divide  into  two  masses,  separated  by  the  spins  of 
the  young  creature.  Recognizing  it  as  a  case  of  ascites,  the  abdomen  was  punctured  by 
means  of  a  long  knife,  the  blade  of  which  was  guarded  with  tow  except  at  the  point ;  a 
great  quantity  of  fluid  escaped,  and  the  mother  then  straining  violently,  delivery  was 
effected.  The  second  case  was  of  a  similar  character,  and  in  the  third  case,  though 
puncture  diminished  the  difficulty,  yet  it  did  not  permit  it  to  be  entirely  overcome,  as  in 
the  others.  This  was  because,  in  addition  to  the  ascites,  there  was  hypertrophy  of  the 
liver  and  kidneys.  One  of  the  latter  weighed  nearly  eighty-two  ounces  (2,300  grammes), 
the  other  about  seventy  ounces  (1,990  grammes) ;  the  liver  weighed  ninety-two  ounces. 
The  peritoneum  was  thickened,  and  showed  traces  of  chronic  inflammation.  One  of  the 
kidneys  sent  to  Arloing  for  examination  weighed  only  fifty-six  ounces,  but  a  large  quan- 
tity of  blood  had  escaped  from  it  into  the  vessel  in  which  it  had  been  carried.  It  ap- 
peared to  be  five  or  six  times  larger  than  the  kidney  of  a  calf  ready  for  the  butcher,  and 
its  surface  still  allowed  its  usual  lobulated  arrangement  to  be  seen.  Its  proper  capsule, 
covered  by  its  thickened  peritoneal  envelope,  was  easily  removed,  and  beneath  it  ap- 
peared a  great  number  of  somewhat  translucid  greyish  points.  On  section  through  the 
middle,  the  two  structures  of  the  kidney  were  distinguishable,  but  their  tint  was  pale  ; 
everywhere,  but  more  particularly  in  the  cortical  substance,  were  observed  the  greyish 
points,  the  contents  of  which  could  be  readily  removed,  leaving  a  small  cavity  in  their 
place.  After  hardening  in  chromic  acid,  sections  were  made,  when  the  greyish  points, 
on  being  submitted  to  microscopic  examination,  appeared  to  be  so  many  kysts  filled  with 
the  d}bris  of  epithelium  from  the  uriniferous  tubes. 

The  connective  stroma  was  also  hypertrophied,  and  particularly  abundant  in  the  neigh- 
borhood of  the  papillae. 

This  \vas  evidently  a  case  of  kystoid  degeneration  of  the  kidney,  from  atresia  of  the 
papillse — a  kind  of  degeneration  observed  in  the  human  species,  and  described  in  Vir- 
chow's  "  Pathology  of  Tumors." 


388  FCETAL  DYSTOKIA. 

Franck  remarks  {Handbuch  dcr  Thierdrztlichen  Geburtshiilfe,  p.  429), 
that  the  fact  that  sometimes  a  Cow  will  for  a  number  of  years  bring  forth 
these  dropsical  calves  (  Wasserkdlher)  in  succession,  while  other  Cows  in 
the  same  shed  produce  healthy  calves,  shows  that  there  is  probably,  in 
these  cases  at  least,  some  anomaly  in  the  uterine  vessels  ;  the  fact,  also, 
that  sometimes  along  with  general  anasarca  and  ascites,  there  are  rhachitic 
alterations  of  the  bones,  points  to  mal-assimilation,  or  deficient  supply  of 
the  protein  substances  and  phosphorus  salts,  the  deficiency  being  presum- 
ably due  to  disease  on  the  part  of  the  mother,  or  to  some  anomaly  in 
the  composition  of  the  uterine  milk. 

Dystokia 

The  amount  of  difficulty  met  with  during  delivery  in  these  cases  will 
depend  upon  the  quantity  of  fluid  effused  into  the  abdominal  cavity,  chest, 
or  superficial  connective  tissue. 

Sometimes  delivery  is  possible  with  the  aid  of  traction.  But  in  the 
great  majority  of  instances,  when  the  head  and  fore-feet  have  passed 
through  the  os,  further  progress  appears  to  be  impossible.  In  these  cases 
we  have  extreme  distention,  but  even  in  some  of  them  delivery  by  traction 
is  not  hopeless.  Cazeaux  Traite  Theoretique  et  Practique  de  VArt  des 
AccoHchmenis,  p.  659)  says  of  this  condition  in  the  human  foetus  :  "  The 
abdominal  parieteshave  been  observed  to  yield  in  such  a  way  that  a  large 
portion  of  the  tumor  remained  above  the  inlet,  while  the  trunk  gradually 
descended  into  the  pelvis  ;  and  when  once  a  part  of  the  abdomen  had 
cleared  the  passage,  the  fluid  escaped  into  it  and  towards  the  point  where 
there  was  least  resistance,  the  volume  of  the  part  still  in  the  pelvis  pro- 
gressively diminishing,  and  delivery  beingfinally  accomplished  naturally." 

Saint-Cyr  is  of  opinion  that  it  is  probable  delivery  has  been  effected  in 
a  similar  manner,  in  those  cases  in  which  the  dropsical  foetus  of  animals 
has  been  extracted  without  operation  or  mutilation. 

Sometimes  the  walls  of  the  abdomen  give  way,  as  in  the  case  recorded 
by  Courjon  (Rainard,  Oj>.  cif.,  p.  485).  This  veterinarian  attended  a  Cow, 
three  years  old,  which  was  in  the  act  of  parturition.  The  foetus  was  in 
the  natural  position,  and  the  head  and  fore  limbs  were  external  to  the 
vulva.  Strong  traction  was  employed  to  extract 'it,  during  which  the 
abdomen  ruptured,  and  it  was  estimated  that  more  than  twenty  litres  of 
fluid  escaped.     The  Cow  was  in  great  danger  for  a  month  afterwards. 

Diagnosis. 

The  nature  of  the  obstacle  can  only  be  ascertained  by  vaginal  or  uterine 
exploration,  though  an  examination  per  rectum  may  assist  in  leading  to  a 
correct  diagnosis. 

In  vaginal  exploration  the  great  size  of  the  abdomen  in  ascites,  the  dis- 
tention of  its  parietes,  and  the  fluctuation  on  pressure,  should  reveal  the 
state  of  affairs.  Not  unfrequently,  however,  the  body  of  the  foetus  so  com- 
pletely blocks  up  the  passage  that  it  is  impossible  to  pass  the  hand,  and 
it  may  be  necessary  to  remove  the  protruding  limbs  by  embryotomy  in 
order  to  diminish  its  volume.  Hesitation  in  resorting  to  this  operation  is 
usually  unjustifiable,  as  the  foetus  is  nearly  always  dead,  and  if  alive  it 
cannot  exist  after  birth. 

It  has  been  recommended,  in   addition,  to  remove  the  two  first  ribs,  in 


DISEASES  OF  THE  FCETUS.  389 

order  to  allow  the  hand  to  explore  the  interior  of  the  foetus.  If  the  ob- 
stacle is  due  to  ascites,  the  convex  condition  of  the  diaphragm,  and  the 
fluctuation  of  the  fluid  on  the  abdominal  side  of  it,  will  be  remarked. 

When  the  dystokia  is  owing  to  anasarca^  this  will  be  distinguished  by 
the  general  roundness  of  the  surface  of  the  body,  owing  to  the  subcuta- 
neous fluid,  which  effaces  all  the  prominences,  and  to  the  oedematous 
sensation  communicated  to  the  fingers  by  pressure. 

Indicatmis . 

When  the  condition  of  the  foetus  is  once  ascertained,  the  principal 
indication,  if  delivery  by  traction  cannot  be  effected,  is  to  diminish  its 
volume,  by  producing  the  evacuation  of  the  fluid  which  distends  it,  as 
promptly  and  effectually  as  possible. 

In  ascites,  puncture  of  the  abdomen  through  the  parietes  of  that  cavity, 
if  they  can  be  reached,  or  puncturing  the  diaphragm  through  the  chest,  if 
they  cannot,  must  be  practised.  In  the  first,  a  bistoury  or  any  kind  of 
convenient  knife,  or  a  trocar,  will  suffice  j  in  the  second,  a  long  trocar  or 
long-bladed  knife,  wrapped  round  with  tow  to  near  the  point,  will  answer 
the  same  purpose  ;  or  if  the  hand  can  be  introduced  into  the  thorax,  the 
fingers  alone  will  rupture  the  diaphragm.  As  the  fluid  escapes,  the 
abdomen  collapses,  and  delivery  is  then  easy. 

When  anasarca  is  present,  the  fluid  must  be  got  rid  of  by  deep  incisions 
through  the  skin  wherever  the  hand  can  reach.  The  mechanical  extrac- 
tion of  the  foetus  should  then  be  easy.  In  a  case  reported  by  Anacker, 
however  {Thierarzt,  1868,  p.  85),  the  foetus  was  so  large  that  it  had  to  be 
removed  by  gastro-hysterotomy. 

1.  In  181 5,  Rouchon  communicated  the  following  case  to  Rainard  {Op.cit.,  p.  484). 
He  was  called  to  see  a  Cow,  ten  years  old,  and  which  had  always  until  then  been  in 
good  health,  and  had  calved  four  times  :  but  the  belly  had  never  been  so  large  as  during 
the  pregnancy  with  the  calf  which  it  was  then  attempting  to  get  rid  of.  It  was  ex- 
tremely feeble,  and  before  anything  could  be  done  towards  assisting  it,  a  stimulant  had 
to  be  administered.  No  portion  of  the  foetus  was  visible,  but  on  Rouchon  introducing  his 
hand  into  the  uterus,  he  found  the  fore  limbs  and  the  head ;  the  creature  was  in  the  dorso- 
lumbar  position,  and  on  the  fingers  being  passed  into  the  mouth,  it  was  discovered  that 
it  was  dead.  The  limbs  and  jaw  were  corded,  and  on  traction  being  patiently  but  forci- 
bly exercised,  the  head  and  fore  limbs  were  extracted,  though  it  was  impossible  to 
remove  more  than  these.  With  very  great  difficulty  the  hand  was  again  passed  into  the 
genital  passages,  and  it  was  found  that  the  abdomen  and  scrotum  of  the  foetus  were  of 
an  enormous  volume.  The  abdomen  was  punctured  with  a  bistoury,  and  Rouchon 
estimated  that  from  seven  to  eight  litres  of  a  yellow,  oily-looking  fluid  escaped  there- 
from. The  extraction  of  the  calf  was  immediately  effected,  and  soon  after  the  Cow 
expelled  nearly  three-fourths  of  a  bucketful  of  the  same  kind  of  liquid. 

2.  Courjon,  according  to  the  same  authority,  saw  a  Cow,  three  years  old,  the  foetus  of 
which,  in  the  same  position,  had  the  head  and  fore  limbs  protruded  ;  in  the  attempts  to 
extract  this  foetus,  its  abdominal  parietes  were  ruptured,  when  it  was  calculated  that 
twenty  litres  of  fluid  escaped.  Soon  after,  this  veterinarian  had  to  puncture  the  abdo- 
men of  another  calf  foetus  with  a  bistoury,  then  to  enlarge  the  incision  with  the  fingers 
and  hand,  in  order  to  permit  the  escape  of  the  fluid  therein,  which  was  supposed  to 
amount  to  twenty-five  litres.     The  foetus  had  also  anasarca  of  the  hind  limbs. 

Schvvarz,  according  to  Franck,  describes  the  case  of  a  calf  affected  with  hydrops 
universalis,  which  an  empiric  had  been  trying  for  twelve  hours  to  extract,  and  the  four 
feet  of  which  had  been  drawn  into  the  vagina.  Schwarz  incised  the  kystoid  swelling 
about  the  neck,  after  which  the  calf  could  be  removed. 

3.  Voigtlander  (Sachs.  Jahresbericht,  1861,  p.  67)  also  mentions  a  similar  case,  in  which 
the  fore  limbs  had  to  be  extracted,  and  the  chest  and  abdomen  opened,  before  birth 
could  be  effected.     The  Cow  was  saved. 

4.  Miiller  {Oesterr.  Vierteljahresschrift,  1868,  p.  36)  likewise  describes  a  dropsical  calf. 


390  FCETAL  DYSTOKIA. 

the  fluid  in  the  kysts  being  clear  and  yellow,  with  whitish  flakes;  they  had  the  form  of 
echinococcus  kysts,  and  were  formed  by  a  thin  serous  membrane.  The  lungs  were  very 
small,  and  the  chest  contained  a  quantity  of  water;  the  heart  was  large,  and  the  right 
chambers  much  widened. 

5.  Gierer  [Ibid.,  187 1)  alludes  to  an  ascitic  calf  which,  when  being  forcibly  extracted, 
ruptured  internally,  and  a  stream  of  fluid  gushed  from  its  mouth  and  nostrils;  The  same 
authority  writes  of  another  calf  in  the  same  condition,  which  ten  men  had  extracted  as 
far  as  the  withers,  but  could  get  it  no  further.  Gierer  contrived  to  make  an  opening  in 
the  abdomen,  when  a  great  quantity  of  fluid  escaped,  and  the  young  creature  was  then 
removed. 

6.  Dinter  [Sachs.  Jahresbericht,  1867,  p.  87)  relates  a  case  in  which  five  men  had  ex- 
tracted the  calf  as  far  as  the  shoulders,  when  it  remained  fast.  It  was  punctured  by  a 
trocar  and  canula,  and  eight  to  ten  quarts  of  blood-tinted  serum  escaped,  When  ex- 
amined after  it  was  removed,  about  half  a  pailful  of  fluid  was  still  in  the  abdomen. 

7.  Binz  [Geburtshiilfe,  etc.,  p.  241)  gives  the  case  of  an  ascitic  calf,  the  head  and  one 
fore  limb  of  which  had  passed  through  the  os  uteri.  The  chest  and  abdomen  were 
opened  through  the  breast,  the  fluid  was  evacuated,  and  delivery  effected. 

An  extremely  rare  cause  of  dystokia  is  due  to  congenital  occlusion  of 
the  urachus,  which  leads  to  great  accumulation  of  urine  in  the  bladder, 
and  consequent  distention  of  the  abdomen.  A  very  good  example  is 
given  in  the  yearly  report  of  the  Veterinary  School  of  Hanover,  for  1872. 

This  condition  will  be  diagnosed  in  the  same  way  as  ascites,  and  the 
same  indications  for  extraction  of  the  foetus  are  to  be  observed. 

Emphysema. 

Emphysema  of  the  foetus  is  sometimes  found  to  be  a  cause  of  dystokia. 
Leconte  mentions  that  he  has  met  with  a  case  in  which  a  living  foetus 
was  partially  emphysematous,  the  head  and  neck,  as  far  as  the  shoulders, 
being  involved. 

This  case  is  exceptional,  however,  as  this  condition  is,  as  a  rule,  ob- 
served only  after  the  foetus  has  perished  in  the  uterus.  It  sometimes 
happens  that  during  parturition  the  water-bag  is  ruptured  before  the 
young  creature  has  made  sufficient  progress,  or  it  may  be  in  a  bad  posi- 
tion. The  uterus  then  closely  contracts  on  it,  over  the  whole  of  its  sur- 
face, and  it  soon  succumbs.  In  the  course  of  two  or  three  days  its 
tissues  have  become  softened  and  decomposed  ;  the  subcutaneous  con- 
nective tissue  becomes  distended  with  gases,  the  result  pf  this  decomposi- 
tion, and  in  a  short  time  the  entire  carcase  of  the  young  creature  is  inflated. 
This  inflation  indirectly  distends  the  uterus,  and  the  foetus  sometimes 
increases  so  immensely  in  volume  as  to  cause  rupture  of  the  walls  of  that 
organ. 

The  hair  on  the  skin  of  the  foetus  is.  loose  and  easily  removed  ;  the  skin 
is  often  dry,  and  the  fluids  small  in  quantity.  Gases  are  not  unfrequently 
disengaged  in  the  foetal  membranes,  and  particularly  in  the  amnion. 
Bossetto  {Gior?iale  di  Veterinaria  Practica.,  1859)  mentions  a  curious  case 
of  this  description,  in  which,  after  rupturing  the  membranes  of  a  foetus 
that  had  been  dead  in  the  uterus  for  some  time,  on  withdrawing  his  hand 
from  the  vagina  there  was  a  rush  of  carburetted  hydrogen  ;  this  became 
ignited  by  the  flame  of  a  candle  held  some  distance  from  the  vulva  of  the 
pregnant  animal.  The  flame,  ten  to  twelve  inches  long,  burned  for  some 
time,  and  the  Cow  did  not  appear  to  suffer. 

Indications. 

The  dryness  of  the  skin  and  the  large  volume  of  the  foetus,  as  well  as 
the  inertia  of  the  uterus,  are  the  obstacles  to  extraction.     Consequently, 


DISEASES  OF  THE  FCETUS.  3^1 

version  and  retropulsion  cannot  be  beneficially  resorted  to  here  ;  but 
deep  incisions  may  be  practised  on  the  surface  of  the  body  of  the  foetus 
as  far  as  the  hand  and  knife  can  reach.  The  maternal  passages,  as  well 
as  the  foetus,  should  then  be  well  lubricated  with  some  fatty  agent,  and  if 
the  carcase  is  in  a  favorable  position  traction  may  be  tried — cords  and 
hooks  being  employed  in  a  manner  hereafter  described.  If  the  position 
is  not  favorable,  then  it  must  be  corrected. 

Should  mechanical  extraction  fail,  then  embryotomy  must  be  practised. 
After  the  foetus  has  been  removed,  thorough  cleansing  of  the  uterus  will 
be  necessary 

POLYSARCIA. 

German  authors  only,  so  far  as  I  can  ascertain,  make  mention  of  this 
condition,  in  which  there  are  abnormal  accumulations  of  adipose  matter 
in  the  subcutaneous  connective  tissue  ;  so  that  at  birth  these  fat  deposits 
often  cause  the  calf  to  weigh  more  than  a  hundredweight.  They  are 
designated  in  Germany  "lard  calves  "  {Speck-kdlber). 


Fig.  84. 
Deformed  Head  and  Neck  of  a  Foal,  due  to  Contraction  and  Pressure  in  the  Uterus. 

Indications. 

The  indications  for  the  extraction  of  these  lardaceous  calves  are,  as 
might  be  presumed,  the  same  as  those  for  over-developed  foetuses  in 
general. 

Contractions. 

This  designation  has  been  given  to  the  permanent  contraction  or 
retraction  of  certain  muscles — and  we  might  add  tendons  and  ligaments 
— which,  in  becoming  hard  and  rigid,  are  at  the  same  time  reduced  in 
length  and  thickness,  so  as  to  form  inextensible  cords  which  deform  the 
part  they  are  attached  to,  and  prevent  its  assuming  its  natural  positions. 

This  state  of  contraction  and  rigidity  only 'takes  place  slowly  and  pro- 
gressively, and  it  chiefly,  though  not  exclusively,  affects  the  muscles  of  the 


392  FOETAL  DYSTOKIA.  ■ 

neck  and  fore  limbs,  giving  these  a  vicious  direction  which  it  is  very 
difficult  to  change,  and  which  at  parturition  may  become  a  rather  trouble- 
some cause  of  dystokia. 

The  cause  of  these  deviations,  which  bring  about  actual  alterations  in 
the  structure  of  the  bones  and  muscles  themselves,  are  very  obscure. 
Bouley  is  of  opinion  that  the  lesion  is  solely  due  to  X^a^ passive  influence 
of  a  false  position,  which  the  foetus  assumes  and  maintains  for  a  long 
time,  and  to  which  the  muscles  and  bones  finally  accommodate  them- 
selves. .  Rainard  thought  the  cause  might  be  of  a  mechanical  nature, 
and  due  to  the  pressure  exercised  on  the  foetus  by  the  colon — particularly 
its  pelvic  portion — when  filled  with  hard  faecal  matters,  the  residue  of 
ligneous  provender.  He  also  considered  it  possible  that  it  might  be  of  a 
convulsive  kind,  owing  to  disease  of  the  nervous  centres. 

When  the  neck  is  affected,  it  is  bent  round  to  the  side,  the  nose  being 
buried  in  the  flank,  or  ^ven  resting  on  the  hind  quarters  of  the  foetus  ; 
and  so  rigidly  is  it  curved,  that  not  only  does  it  resist  all  attempts  to 
straighten  it  in  the  uterus,  but  even  when  extracted  and  the  foetus  is  dead 
the  neck  cannot  be  made  to  assume  a  rectilinear  direction. 

The  period  of  gestation  at  which  this  deviation  occurs  is,  of,  course, 
difficult  to  arrive  at ;  but  Rainard  and  Saint-Cyr  are  of  opinion  that  it 
takes  place  early,  as  the  bones  of  the  head  and  neck  are  more  or  less 
deformed  in  some  cases,  the  head  being  more  especially  distorted  and 
curved  laterally,  and  moulded,  so  to  speak,  to  the  parts  on  which  it 
has  rested  during  intra-uterine  existence. 

This  distortion  appears  to  be  more  frequent  in  monodactyles,  the  neck 
of  which  is  longer  than  that  of  ruminants  or  other  domesticated  animals  ; 
and  according  to  French  writers,  it  appears  to  be  more  common  in  some 
localities  than  others,  and  to  be  frequent  in  certain  years — particularly 
in  those  of  scarcity  or  bad  forage.  Houssard  reported  that  in  Franche- 
Comte  he  had  seen  the  majority  of  brood  Mares  abort  near  the  termina- 
tion of  pregnancy,  or  experience  great  difficulty  in  foaling,  from  this  ab- 
normal distortion  of  the  neck.  Courjon,  another  Veterinary  Surgeon 
practising  at  Meyzieux,  Isere,  has  remarked  on  the  frequency  of  this  ac- 
cident, under  the  influence,  it  was  presumed,  of  the  same  causes.  Schaack 
informed  Saint-Cyr,  that  in  his  long  experience  he  had  met  with  several 
cases  of  this  kind,  one  of  which  was  in  a  Calf  that  nevertheless  lived, 
notwithstanding  the  deformity. 

Contraction  of  the  limbs  also  appears  to  be  more  frequent  in  Foals 
than  Calves,  and  varies  in  degree  :  from  slight  bending  at  the  knees, 
which  generally  more  or  less  disappears  after  birth,  and  as  the  animal 
acquires  strength,  to  extreme  flexion,  so  that  ligaments  must  be  ruptured, 
and  perhaps  bones  broken,  before  the  distortion  can  be  corrected.  The 
accident  is  alluded  to  by  Favre  {Le  Veterinaire  Campagfiard,  p.  290), 
Gaven  {journal  de  Med.  Veterinaire,  1850,  p.  201),  Lemaire,  {Recueil  de 
Mdd.  Veterijtaire,  1858,  p.  444),  Veret  {Ibid.  1837,  p.  289),  and  Cartwright. 

Veret's  case,  alluded  to  by  Saint-Cyr,  is  somewhat  remarkable  and  deserves  notice. 
On  exploring  the  uterus  of  a  Cow  in  obstructed  parturition,  he  recognized  that  the  foe- 
tus was  alive,  and  that  it  was  presenting  with  the  head  and  all  the  feet  together.  The 
left  fore  leg  was  very  thin  and  had  only  one  claw  ;  it  was  bent  at  three  angles  at  25° 
to  30^^,  and  it  was  impossible  to  straighten  it  without  tearing  the  skin,  as  well  the 
flexor  muscles  which,  by  their  retraction,  had  produced  these  angles.  One  of  the  angles 
was  at  the  fetlock,  the  other  at  the  knee,  and  the  third  at  the  elbow.  The  foetus  was  at 
the  same  time  affected  with  ascites.  Delivery  was  very  difficult,  but  it  was  effected  after 
the  two  fore  limbs  had  been  removed  and  the  abdomen  punctured. 


DISEASES  OF  THE  FOETUS. 


393 


The  foetus,  in  addition  to  the  defective  conformation  of  its  left  fore  leg,  had  a  very 
short  and  thick  neck,  and  the  xiphoid  cartilage  vi'as  about  eight  inches  long  and 
curved  upwards.  The  calcis  of  the  right  hock  did  not  project,  and  the  femur  of  the 
same  limb  was  bulging 

Cartwright  gives  two  instances — the  only  ones  in  English  literature — both  of  which 
are  interesting  and  instructive.  In  one  case  ( Veterinarian,  vol.  xx.  p.  385),  the  Calf 
had  been  extracted  by  an  empiric,  who  had  ruptured  the  uterus  of  the  Cow,  so  that  it 
had  to  be  destroyed.  The  hind  parts  of  the  Calf  were  much  contracted  and  diminished 
in  size  ;  the  anus  was  impervious.  The  hind  extremities  were  fractured  in  extraction, 
but  they  must  previously  have  been  lying  under  the  belly  or  against  the  sides,  and  the 
ligaments  of  the  patellcB  af»peared  to  have  become  shortened,  as  "  the  femur  and  tibia 
formed  almost  a  straight  line,  there  not  being  the  least  flexure  at  the  stifle  joints." 
"  The  stifle,  hock,  fetlock,  and  pastern  joints  were  so  firmly  braced  together,  that  they 
were  completely  fixed  and  immovable,  and  would  not  bend  backwards,  sideways,  or  for- 
wards in  the  least.  On  examining  these  joints,  not  the  slightest  union  of  the  cartilages 
or  bones  had  taken  place ;  only  a  shortening  of  the  ligaments  of  the  joints  generally, 
not  permitting  the  usual  flexure  of  the  parts.  From  the  cont-raction  at  the  stifle  joints, 
the  legs  were  almost  straight,  forming  only  a  curve  by  the  metatarsal  and  pastern  bones 
being  drawn  a  little  anteriorly." 

The  other  instance  {Ibid.,  vol.  xvi.,  p.  487)  was  in  a  Cow  six  years  old,  which  could  not 
calve.  The  presentation  of  the  foetus  was  posterior,  and  as  the  hind  legs  could  not  be 
drawn  into  their  proper  position  by  hand,  it  was  attempted  to  do  this  by  force  with 
cords.  But  the  limbs  proved  quite  rigid  ;  one  limb  at  last  broke  off  below  the  hock, 
then  the  other,  and  the  foetus  was  at  length  extracted  by  powerful  pulling.  It  was  then 
noticed  that  "  the  stifle  joint  lay  forward,  high  up  against  the  posterior  ribs,  and  was 
held  firmly  there  by  the  great  contraction  of  the  skin  over  the  parts."  "  The  extensor 
muscles  underneath  were  very  much  shortened.  The  tibia  was  also  bent  unusually 
backwards,  as  the  os  calcis  came  almost  in  contact  with  the  hip  joint.  The  muscles 
here  were  in  the  same  state  of  contraction  and  shortening  as  those  attached  to  the 
patella,  etc.  The  part  of  the  limb  below  the  hock  was  nearly  in  its  natural  position, 
being  only  a  little  more  flexed  upon  the  tibia  than  usual.  The  stifle  and  hock  joints 
were  also  firmly  held  together  in  their  altered  position,  by  the  shortening  of  some  and 
lengthening  of  other  of  the  ligaments  of  the  joints ;  and  when  the  muscles  were  cut 
through,  the  joints  could  not  be  brought  to'their  natural  positions  without  rupturing 
some  of  these  ligaments.  Both  hind  legs  were  in  this  state."  The  Cow  had  to  be  de- 
stroyed next  day,  as  the  neck  of  the  uterus  was  ruptured. 

Indications. 

The  indications  for  delivery  are  the  same  as  those  which  will  be  given 
for  extraction  of  the  foetus  in  malposition  of  the  limbs  and  head. 

Not  unfrequently  recourse  must  be  had  to  embryotomy  ;  and  the  limbs 
more  particularly  require  attention  in  this  operation,  as  by  dividing  the 
muscles,  tendons,  or  ligaments  of  those  which  are  contracted,  they  may 
be  straightened  and  delivery  effected.  A  careful  examination  should  be 
made  of  the  presenting  limbs  in  all  cases  in  which  they  are  found  to  be 
flexed,  in  order  to  discover  whether  the  joints  are  movable  ;  and  great 
care  ought  to  be  exercised  in  using  traction  before  they  are  straightened 
or  removed  by  the  knife  ;  as  rupture  of  the  uterus,  or  severe  laceration 
of  the  other  soft  parts,  may  be  the  result. 

Tumors. 

Tumors  of  various  kinds,  situated  either  externally  or  internally,  may 
prove  an  obstacle  to  birth  ;  though  the  cases  recorded  are  very  few.  Some 
of  the  former  are  kysts  which,  in  some  instances,  may  be  looked  upon  as 
due  to  a  second  undeveloped  ovule  which  has  grafted  itself  on  the  foetus. 
Hygromata  are  not  very  uncommon,  and  some  of  these  are  often  rup- 
tured during  birth. 


I.  Binz  {G eh  arts  half e,  p.  244)  describes  an  immense  kyst  in  the  liver,  which  rendered 
parturition  diflicult ;  and  we  have  already  alluded  to  enormously  enlarged  kidneys  pro- 
ducing ascites. 


394 


FCETAL  DYSTOKIA. 


2.  Liidke  mentions  an  enormous  kyst  on  the  neck  of  a  calf,  as  entirely  opposing 
natural  delivery.  The  kyst  was  situated  in  the  subcutaneous  connective  tissue,  below 
the  ear  on  the  right  side,  and  measured  more  than  a  foot  in  diameter  ;  it  contained  thirty- 
six  pounds  of  fluid,  which  was  yellow-colored,  and  in  which  were  some  flocculi  of  lymph. 
During  labor  it  lay  against  the  fore  limbs,  which  were  advanced  into  the  pelvis,  and  it 
had  pushed  the  head  so  far  back  that  this  could  not  be  found.  The  nature  of  the  tu- 
mor having  been  ascertained,  Liidke  punctured  it ;  this  rendered  delivery  possible,  and 
saved  the  Cow. 

3.  Rossignol  (yournal de  Med.  Veterinaire  de  Lyon,  1864,  p.  400)  gives  a  very  interest- 
ing account  of  a  case  of  this  description.  Making  an  exploration  in  a  case  of  protracted 
labor,  he  found  that  the  foetus,  which  was  dead,  was  in  the  anterior  presentation,  with 
the  head  turned  back  and  out  of  reach.  It  was  decided  to  remove  it  by  embryotomy, 
in  order  to  rescue  the  Cow,  which  was  greatly  exhausted.  The  fore  limbs  were  removed 
o«e  after  the  other,  and  this  allowed  a  cord  with  a  running  noose  to  be  passed  round  the 
neck,  which  was  then  straightened  and  the  head  brought  into  the  vagina,  from  which  the 
foetus  was  extracted  by  moderate  force. 

Birth  was  then  supposed  to  be  finished,  but  to  the  surprise  of  Rossignol  and  his  four 
assistants,  who  pulled  with  all  their  might,  the  calf  could  make  no  further  progress.  The 
case  was  an  embarrassing  one,  and  necessitated  another  examination  ;  this  was  rendered 
easier  from  the  fact  of  the  fore  limbs  having  been  removed.  Passing  the  hand  beneath 
the  thorax  of  the  foetus,  it  soon  came  in  contact  with  a  large,  solid,  round,  and  smooth 
tumor,  but  no  trace  of  ears  or  jaws  could  be  felt.  It  seemed  to  be  firmly  attached  in 
front  of  the  umbilicus,  though  it  was  slightly  movable.  Deciding  that,  whether  it  was 
the  head  of  another  foetus  or  whether  it  was  a  tumor,  the  union  should  be  broken  by 
the  increasing  traction,  a  rope  was  passed  round  the  hind  quarters  of  the  Cow  and  held 
by  assistants  at  its  head,  and  the  pulling  at  the  foetus  recommenced.  This  at  last 
brought  away  the  whole  of  the  body,  but  the  tumor  was  left  behind  in  the  uterus.  All 
these  manipulations  did  not  last  longer  than  half  an  hour. 

The  foetus,  though  large,  was  remarkably  emaciated.  Towards  the  umbilical  region 
there  was  a"  place  as  big  as  the  hand,  which  was  denuded  of  skin  ;  the  latter  had  been 
torn  off,  leaving  the  tunica  abdominalis  exposed ;  this,  around  the  margin  of  the  wound, 
showed  long  fibrous  shreds.  The  umbilical  cord  was  somewhat  long,  but  did  not 
appear  to  have  had  any  connection  with  the  tumor.  Search  was  about  to  be  made  for 
the  latter,  when  the  Cow  lay  down;  the  labor  pains  again  commenced — at  first  feebly, 
but  gradually  increasing — and  at  length,  without  any  assistance,  a  large  white  tumor  was 
expelled,  and  soon  after  the  foetal  envelopes. 

The  tumor  was  spheroidal  in  shape,  white,  hard,  and  nodulated,  and  appeared  to  be 
composed  of  fibro-adipose  tissue.  It  was  covered  by  a  thin,  smooth,  but  resisting 
membrane,  beneath  which  were  blood-vessels.  On  one  side  was  a  net-work  of  veins, 
and  there  were  also  some  fibrous  bands  indicating  where  it  had  been  attached  to  the 
foetus.     It  weighed  a  little  over  eleven  pounds. 

The  Cow  quickly  and  completely  recovered. 

4.  Pflug  {Zeitschrift  fiir  Thiermedicin,  etc.,  vol.  i.,  p.  367)  was  called  to  attend  a  Goat 
in  difficult  labor,  and  on  manual  exploration  discovered  that  the  first  foetus  was  in  a 
normal  position,  but  that  on  each  side  of  the  head,  in  the  parotideal  regions  and  towards 
the  larynx,  were  too  large  swellings  (congenital  scrofula)  which  prevented  the  passage  of 
the  young  creature.  By  manipulation,  pressure  on  the  tumors — which  were  as  large  as 
a  small  fist^ — first  on  one  side,  then  on  the  other,  with  gentle  traction,  the  kid  was 
released.  Two  other  kids  which  were  in  proximity  to  the  first,  were  also  artificially 
delivered. 

5.  Schliepe  (Gurlt  and  Hertwig's  Magazin,  1863)  describes  the  case  of  an  unborn  foal 
which  had,  behind  the  lower  jaw,  towards  the  neck,  a  kind  of  scrofulous  tumor.  On 
examination,  this  was  found  to  be  a  distension  of  the  Eustachian  pouch,  which  con- 
tained six  Berlin  quarts  of  yellow  but  somewhat  coagulated  serum. 

Indications. 

The  indications  will  depend  upon  circumstances.  In  the  examples 
given,  the  course  there  followed  may  be  again  adopted.  Puncturing  the 
tumor  if  it  contains  fluid,  removing  it  if  it  is  accessible  and  solid,  and 
embryotomy  if  neither  of  these  operations  is  likely  to  be  successful,  are 
the  only  measures  which  can  be  recommended. 

DEATH. 

Many  practitioners  are  of  opinion  that  the  death  of  the  foetus  renders 


MONSTROSITIES. 


395 


parturition  difficult.  In  certain  circumstances  it  may  do  so,  but,  as  a 
rule,  provided  it  is  in  a  proper  position  and  properly  developed,  its  death 
has  but  little  inflifence  on  this  act.  We  have  already  alluded  to  the 
death  of  the  foetus  at  page  241. 


•CHAPTER    III. 

Monstrosities. 

The  designation  "Monster,"  "  Monstrosity,"  or  Zz/i-z^j  iV^/wr^  (French, 
Monstre,  Monstniosite ;  German,  Missgeburt ;  Ita.\ia.n,  Afos/ro  ;  Spanish, 
Motistruo)^  is  generally  applied  to  a  creature  which  exhibits  some  vice  in 
conformation, — some  remarkable  anomaly  or  organic  deviation  in  form 
or  structure,  or  both,  in  one  or  more  parts  of  its  body. 

Monstrosities  have  been  conveniently  divided  into  two  kinds :  those 
which  are  anatomically  so,  and  those  which  are  so  by  reason  of  their 
vicious  conformation.  The  first  present  no  modifications  externally,  and 
there  is  no  disturbance  of  function,  but  merely  a  change  in  the  number 
or  position  of  certain  organs — a  change  only  discoverable  hy  post-mortem 
examination.  The  second  includes  those  defects  or  deformities  which 
more  or  less  seriously  impair  the  value  of  the  young  creature,  either  by 
destroying  the  symmetry  of  its  shape,  or  rendering  it  more  or  less  useless 
by  the  absence  or  incompleteness  of  certain  organs. 

The  term  "  monstrosity,"  however,  is  usually  reserved  for  a  creature 
which  presents  the  most  serious  kind  of  organic  alterations,  and  which 
involve  one  or  more  organs — external  or  internal — these  being  modified 
in  form,  structure,  and  relations.  In  this  class  we  may  have  a  deficiency 
in  one  or  more  limbs,  head,  part  of  the  head  or  trunk,  or  fusion  more  or 
less  incomplete  of  two  or  more  individuals,  etc. 

It  must  be  admitted,  however,  that  the  limits  between  these  groups  of 
anomalies  or  organic  deviations  are  not  well  defined,  and  that  they  merge 
into  each  other  imperceptibly  ;  so  that  it  is  not  always  possible  to  say 
where  the  one  class  ends  and  the  other  begins,  and  we  can  only  fix  upon 
the  types  of  each  of  these  artificial  groups. 

In  ancient  times  the  appearance  of  monstrosities  was  ascribed  to  the 
influence  of  enraged  gods,  and  they  were  regarded  with  fear  or  horror  ; 
or  they  were  looked  upon  as  prodigies  or  freaks  of  Nature,  and  described 
as  marvels  or  curiosities. 

Indeed,  it  was  not  until  the  end  of  the  eighteenth  and  commencement 
of  this  century  that  they  began  to  be  studied  in  a  scientific  spirit,  and 
their  anomalies  shown  to  be  only  simple  modifications  or  irregularities  in 
the  development  of  organs.  Haller  and  Meckel  commenced  this  new 
era,  but  it  was  not  until  the  philosophical  study  of  this  subject  had  been 
pursued  by  Etienne  and  Isidore  Geoffroy  Saint-Hilaire,  that  the  science 
of  Teratology  was  founded  on  a  true  basis.  Then  it  was  clearly  demon- 
strated that  monstrosities  themselves  did  not  escape  the  general  laws  of 
organization,  but  own  their  sway  and  prove  their  universality,  and  that 
Nature,  in  its  widest  divergencies,  never  ceases  to  be  faithful  to  the 
decrees  whi::h  the  Creator  imposed  upon  it  at  the  commencement. 

In  1827,  E.  G.  Saint-Hilaire  proposed  a  scientific  classification  of  mon- 
strosities— those  beings  which  had  hitherto  been  looked  upon  as  combina- 


396  FOETAL  DYSTOKIA. 

.  tions  of  different  characters  or  individuals  ;  and  on  this  basis  was  raised 
the  science  of  Teratology  by  his  son  Isidore.  The  labors  of  these  men 
have  been  largely  supplemented  by  the  researches  of  such  authorities  as 
Meckel,  Gurlt,  Otto,  Bischoff,  Leyh,  Martin-Saint-Ange,  Forster,  Dareste, 
Panum,  Lombard ini,  and  others.  The  labors  of  these  investigators  are 
unknown  to  English  veterinary  literature — indeed  the  entire  subject  is 
nowhere  mentioned  f  it  will,  therefore,  be  our  duty  to  notice  it  somewhat 
fully,  not  only  from  its  novelty  in  this'respect,  but  also  from  its  import- 
ance ina  physiological  and  obstetrical  point  of  view. 

Classification. 

Various  classifications  of  monstrosities  have  been  proposed  at  different 
times  by  investigators,  who  generally  based  their  classification  either  on 
the  notions  they  entertained  as  to  the  mode  of  formation  of  these  crea- 
tures, or  on  some  physical  peculiarity  presented  in  their  organization. 
Buffon  divided  them  into  three  classes — i,  monstrosities  by  excess ;  2, 
monstrosities  by  defect ;  3,  monstrosities  by  irregularity  in  structure  or 
situation  of  parts.  To  these  classes  Meckel  added  a  fourth,  which 
included  the  hermaphrodites.  Martin-Saint-Ange  divided  them  into — i, 
monsters  by  excess,  comprising  the  union  of  several  foetuses — double 
monsters,  in  fact ;  2,  monsters  by  excess  of  growth  ;  3,  monsters  by  ab- 
sence of  one  or  more  parts ;  4,  monsters  by  general  defect,  as  dwarfs  ;  5, 
hermaphrodite  monsters. 

The  two  classifications  which  have  generally  been  adopted  by  conti- 
nental veterinarians  are  those  of  Ciurlt  and  Geoffrey  Saint-Hilaire  ;  that 
of  the  former — the  eminent  Berlin  veterinary  professor — being  preferred 
by  the  Germans,  Italians,  Dutch,  and  Danish,  and  that  of  the  latter  by 
the  French. 

Gurlt's  classification  and  nomenclature  are  good  and  explicit,  and  in 
some  respects  to  be  preferred  to  Saint-Hilaire's ;  while  those  of  the  latter 
offer  advantages  which  might  lead  us  to  give  them  the  preference,  apart 
from  the  fact  that  it  is  they  on  which  the  science  was  based. 

Gurlt  t  separates  monstrosities  into  two  classes — Simple  and  Co77ipound. 
The  first  comprises  eight  orders,  twenty-six  genera,  and  seventy-three 
species  ;  the  second  includes  six  orders,  twenty-six  genera,  and  fifty-nine 
species. 

As  some  veterinarians  may  prefer  Gurlt's  classification  to  that  of  Saint- 
Hilaire,  and  particularly  for  its  practical  utility,  we  give  it  here. 

CLASS  I. 
SIMPLE  MONSTROSITIES. 

This  class  is  occupied  with  a  single  individual,  and  refers  to  an 
absence  of  or  addition  to  parts,  exaggeration  of  them,  or  alteration  in 
their  form  or  position.  It  comprises  8  Orders,  26  Genera,  and  73 
SPEcms. 

ORDER  I. — Simple  Monstrosities  through  Absence  of  Parts  : — 

1.  Amorphus. — Absence  of  conformation  ;  i  species  :  A.  globosus. 

2.  Acephalus. — Headless ;  2  species  :  A.  untpes,  A.  bipes. 

*  a  monstrosity  is  generally  only  alluded  to  as  such,  or  as  a  Lusus  Naturce  ;  their  scientific  classification 
has  never  been  attempted  in  this  country. 

t  Pathologische  Anatomic,  Berlin,  1833.  Article:  '■'■  Missbildungen-"  also  '■'■  Ueber  Thierische  Miss- 
geburten"  Berlin,  1877. 


MONSTROSITIES.  397 

3.  Perocephalus. — Head  defective;  7  species  :  P. pseiidocephalus  (ap- 
parently without  a  head),  P.  aprosopus  (head  without  a  face),  P.  micro- 
cephalus  (small  head),  P.  agnathiis  (head  without  a  jaw).  Varieties  :  a^ 
P.  agnatJiwi  hypostojnus  (mouth  a  longitudinal  fissure  beneath  the  ordinary 
situation)  ;  b,  P.  agnathiis  microstomns  (small  mouth)  ;  r,  P.  agnathus 
astomus  (without  a  mouth),  P.  brachyrhy?ichus  (short  face  or  nose),  P. 
anomatus  (without  eyes),  P.  aotus  (without  ears). 

4.  Perosomus. — The  whole  of  the  body  defective  ;  4  species  :  P.  hemi- 
cephalicus  (body  defective  and  head  absent),  P.  horridiis  (horrid  defor- 
mity), P.  ehunbls  (loins  absent),  P.  pseiidoscelus  (body  defective,  with 
posterior  limbs  incomplete). 

5.  Perocormus. — Trunk  defective ;  3  species :  P.  oligospondylus  (de- 
fective vertebrae),  P.  ecaudatus  (without  tail),  P.  anacdoca  (without 
external  generative  organs). 

6.  Peromelus. — Limbs  defective  ;  6  species  :  P.  apus  (without  limbs), 
P.  achirtis  (without  anterior  limbs),  P.  vionochirus  (with  only  one  anterior 
limb),  P.  ascelus  (without  posterior  limbs),  P.  monoscehis  (with  only  one 
posterior  limb),  P.  micromelus  (limbs  shortened)  ;  with  the  varieties,  P. 
micromelus  microchirus  (anterior  limb  short),  P.  microtnelus  microscelus 
(posterior  limb  short). 

ORDER  II. — Simple  Monstrosities  through  Smallness  of  Parts  : — 

7.  Nanosomus. — Limbs  and  trunk  small — dwarf  ;  2  species  :  N.  pyg- 
cemus  (short  and  low,  but  without  disproportion  of  parts),  JV.  caticeps 
(cat-faced  dwarf). 

8.  Nanocephalus. — Small  head  ;  3  species  :  N.  micrommatiis  (eyes 
too  small),  N.  brachyotus  (ears  too  short),  N.  brachygnolus  (lower  jaw  too 
short). 

9.  Nanocormus. — Short  trunk  ;  2  species  :  IV.  rectus  (vertebral  col- 
umn straight,  but  very  short),  N.  curvatus  (vertebral  column  short,  and 
curved  to  one  side). 

10.  Nanomelus. — Limbs  short;  5  species:  N.  brevipes  (all  the  limbs 
short),  N.  brachychirus  (anterior  limbs  too  short),  N.  campylochirus 
(anterior  limbs  short  and  crooked),  N.  chiropterus  (anterior  limbs  short, 
with  cutaneous  folds  resembling  wings),  N.  compyloscelus  (posterior  limbs 
short  and  crooked). 

ORDER  III. — Simple  Monstrosities  through  Abnormal  Division 
OF  the  Body  : — 

11.  Schistocephalus. — Division  of  the  head  ;  5  species :  S.  hemiceph- 
alus  (cleft  in  the  middle)  ;  with  the  varieties  :  a,  S.  hemicephalus partialis, 
or  hydrencephalocele  (partial  hernia  of  the  brain,  with  hydrocephalus)  ;  b, 
S.  hetnicephahis  totalis  (absence  of  all  the  cranium) ;  c,  S.  hemicephalus 
complicatus  (cleft  cranium,  face  defective)  ;  6".  bifidus  (face  divided),  S. 
fissipalatinus  or  rictus  lupinus  (cleft  palate),  S.  fissilabrus  or  labium  lepori- 

num  (cleft  or  harelip),  S.  megolostomus  (wide  mouth). 

12.  ScHiSTOCORMus. — Divided  trunk;  6  species:  S.  fissicollis  (neck 
cleft),  6*.  fissisternalis  (sternum  divided),  S.  schistepigastrico-sternalis  (di- 
vision of  the  sternum  and  anterior  portion  of  the  abdomen),  .S".  exom- 
phalus  (divided  umbilicus),  S.  fissiventralis  (the  whole  of  the  abdomen 
divided),  S.fissispinalis  or  spina  bifida  (division  of  the  spinal  column). 


398  FCETAL  DYSTOKIA. 

13.  ScHiSTOSOMirs. — Division  of  the  head  and  trunk ;  3  species  :  S. 
reflexus  (division  of  the  body  and  inversion  of  the  spinal  column),  S. 
contortus  (division  of  the  body  and  torsion  of  the  vertebral  column),  S. 
microchiriis  (division  of  the  body  and  anterior  limbs  shortened). 

14.  Schistomelus. — Cleft  limbs  j  2  species :  S.  fissimafms  (division 
of  the  anterior  limbs),  S.  fissimgulus  (division  of  the  phalanges). 

ORDER   IV. — Simple   Monstrosities   through   Absence   of  the 
Natural  IDivision  of  Parts  : — 

15.  Atretocephalus. — Absence  of  openings  in  the  head  ;  i  species  : 
A.  ast077ius  (mouth  absent). 

16.  Atretocormus. — Absence  of  the  natural  apertures  in  the  body  ; 
2  species :  A.  aproctus  (anus  absent),  A.  atmrethra  (urethra  absent). 

17.  AscHiSTODACTYLUS. — Phalanges  undivided ;  i  species:  A.  solidun- 
gulus  (absence  of  division  of  the  phalanges  and  claws  in  those  animals 
which  usually  have  them  divided). 

ORDER  V. — Simple    Monstrosities   through    Fusion  or    Coali- 
tion OF  Organs: — 

18.  Cyclops  Monophthalmus. — One  eye  in  the  middle  of  the  face, 
and  a  proboscis  in  addition  ;  3  species  :  C.  megalostomiis  (large  mouth),  of 
which  there  are  two  varieties  :  a^  C.  megalostomus  rhynchcBUus  (large  mouth 
and  proboscis),  b,  C.  megalostomus  archynchiis  (large  mouth,  but  no  probo- 
scis) j  C.  prostomus  (irregular  mouth),  in  which  are  two  varieties :  a,  C. 
prostomus  arhynchus  (irregular  mouth  and  no  nose) ;  b^  C.  prostoimis 
rhynchcenus  (irregular  mouth  and  nose)  ;  C.  astomus  (without  mouth), 
with  two  varieties  :  a,  C.  astomus  arhynchus  (mouth  and  nose  absent)  ;  b, 
C.  astomus  rhynchcznus  (proboscis  present,  but  mouth  absent). 

ORDER  VI. — Simple  Monstrosities  through  Abnormal  Position 
AND  Form  of  Parts  : — 

19.  Campylorrhinus. — Curvature  of  the  nose  ;  i  species  :  C.  lateralis 
(lateral  curvature  of  the  nose). 

20.  Camylorrhacchis. — Curvature  of  the  vertebral  column  ;  2  species  : 
C.  scoliosa  (lateral  curvature  of  the  spine),  C.  contorta  (torsion  of  the 
spine). 

ORDER  VII. — Simple  Monstrosities  through  Excess  in  Forma- 
tion : — 

21.  Megalocephalus. — Head  abnormally  large  ;  2  species  :  M.  hydren- 
cephalus  (with  hydrocephalus),  M.  polycerus  (head  with  large  horns). 

22.  Diphallus. — Double  penis  ;  i  species  :  D.  imperfectus  (double 
penis,  incomplete). 

23.  Megalomelus. — Limbs  with  supernumerary  parts  ;  i  species  :  M. 
perissodactylus  (with  supernumerary  digits). 

ORDER  VIIL — Hermaphrodites: — 

24.  Hermaphroditus. — Double  sex,  with  predominance  of  organs  be- 
longing to  one  sex  ;  2  species :  H.  lateralis  (genital  organs  to  one  side), 
in  which  there  are  two  varieties :  «,  H.  lateralis  masculinus  (with  predom- 
inance of  the  male  organs)  ;  ^,  H.  lateralis  femininus  (with  predominance 


MONSTROSITIES.  3^^ 

of  the  female  organs)  ;  H.  iransversalis  (the  external  generative  organs 
belonging  to  one  sex,  and  the  internal  to  the  opposite  sex),  including  two 
varieties  :  a^  H.  iransversalis  masculimts  (external  genital  organs  male, 
internal  female)  ;  b,  If.  iransversalis  femininus  (external  genital  organs 
feminine,  internal  male — often  imperfect). 

25.  PsEUDO-HERMAPHRODiTUS. — False  hermaphrodites  ;  4  species  :  P. 
megalomasihus  (male  with  large  mammae),  P.  micruphallus  (penis  unusu- 
ally small),  T'.  hypospadiaius  (with  the  urethra  divided  interiorly),  P. 
feminimis  (false  feminine  hermaphrodite). 

26.  Androgynus. — Double  hermaphrodites,  the  male  and  female 
organs  existing  in  a  single  individual,  one  sex  being  incomplete  and  the 
other  predominating  ;  2  species  :  A.  masadimis  (the  external  organs  are 
masculine,  with  a  small  penis,  the  internal  organs  being  male  and  female 
— though  the  one  set  is  more  complete  than  the  other),  A.  feinininus  (the 
external  organs  are  feminine,  with  abnormally  large  clitoris,  the  internal 
being  male  and  female,  with  predominance  of  the  one  over  the  other). 

CLASS  II. 

TREBLE  AND  DOUBLE  MONSTROSITIES. 

In  these  monstrosites  there  is  a  union  of  two  or  three  individuals,  neither 
of  which  is  complete,  but  which  are  united  at  various  points  :  often  wnth 
a  completely  developed  body  is  united  a  portion  of  a  second  individual. 
It  comprises  6  Orders,  26  Genera,  and  59  Species. 

ORDER  I. — Trigeminal  Monstrosities,  in  which  are  united  one  or 
more  parts  or  organs  of  three  individuals  : — 

1.  Cephalotridymus. — Three  heads  united  to  a  single  trunk ;  i 
species  :   C.  unicorporeus  (with  a  single  body). 

2.  Cormotrtdymus. — Posterior  part  of  the  trunk  triplicate,  with  more 
than  four  limbs ;  i  species  :  C.  iricaudaius  (three  croups  with  three  tails, 
but  only  one  anus  and  four  posterior  limbs). 

3.  Melotridymus. — Posterior  part  of  the  body  double,  and  rnore  than 
eight  limbs  ;  i  species  :  M.  decapus  (ten  limbs  of  unequal  length). 

4.  Somatotridymus. — Triple  body ;  i  species  :  ^.  siertialis  (three 
chests  united). 

ORDER  II. — Monster  with  Two  Heads — Cephalodidymi : — 

5.  DiPROSOPus, — Double  face ;  3  species  :  D.  sejuncius  (the  two  faces 
separate),  D.  disians  (the  two  faces  diverging),  including  three  varieties; 
«,  D.  distaiis  disiomus  (a  mouth  in  each  face)  ;  b^  D.  disians  monostomus 
(a  mouth  in  one  face  only)  ;  r,  D.  distonia  hemicephalicus  (without  a 
cranium)  ;  D.  conjimcius  (two  faces  united)  has  two  varieties  :  a,  D.  con- 
junctus  disiomus  (double  mouths)  ;  b,  D.  conjimcius  monostomus  (with  one 
mouth). 

6.  Monocranus. — Single  cranium  ;  4  species  :  M.  mesognaius  (the  lower 
jaw  included  in  or  united  to  the  other  from  the  commencement  of  the 
branches),  M.  dignaius  (lower  jaw  double),  M.  heieroprosopus  (diverse 
faces),  M.  bimandibularis  (upper  jaw  double). 

7.  Heterocephalus. — Double  heads,  one  of  which  is  complete,  the 
other  very  incomplete  ;  2  species :  H.  i?iterposiius  (between  the  two 
branches  of  the  lower  jaw  of  the  complete  head  is  interposed  the  lower 
jaw  of  the  incomplete  one),  H.  opposiius  (the  lower  jaw  of  the  complete 
head  is  depressed  in  front,  and  on  its  upper  surface — anterior  extremity 


400 


FCETAL  DYSTOKIA. 


— it  is  united  to  the  corresponding  part  of  the  second  jaw,  with  which 
it  forms  an  acute  angle). 

ORDER    III. DOUBLED-HEADED    MONSTROSITIES,  WITH    THE    TrUNK 

WHOLLY  OR  PARTIALLY  DOUBLE  : 

8.  DiCEPHALUS. — Two  separate  heads  ;  7  species :  D.  biatlaniiciis 
(double  head  and  two  atlases),  D.  subbicollis  (double  head  with  apparently 
two  necks),  D.  bicollis  (double  head  and  two  necks),  with  two  varieties  : 
D,  bicollis  omocephalus  (both  heads  alike),  Z>,  bicollis  heterocephalus  (one 
head  perfect,  the  other  imperfect)  D.  subbidorsnalis  (double  head,  with 
apparently  a  double  back),  D.  bidorsualis  (double  head  with  double  back), 

D.  bilumbis  (double  head  and  double  loins),  D.  bispinalis  (double  head 
and  vertebral  column)  has  two  varieties :  a,  D.  bispinalis  quadnipes  (with 
four  limbs)  ;  b^  D.  bispinalis  achirus  (without  anterior  limbs). 

9.  DiCRANUS. — Double  cranium  ;  i  species  :  D.  bispinalis  (cranium  and 
vertebral  column  double). 

ORDER  IV. — Monstrosities  with  a  Single  Head,  but  the  Trunk 
OR  Limbs  more  or  less  Completely  Double — Conno-melo- 
didymi: — 

10.  Dipygus. — Double  croups ;  3  species  :  D.  bidorsualis  (double 
croup  and  back),  D.  subbidorsualis  (double  croup,  with  half  the  back  doub- 
led), Z>.  biliitnbis  (croup  and  loins  doubled),  containing  two  varieties:. 
a,  D.  bilumbus  teleocephalus  (with  head  regular)  ;  b^  D.  bilumbis  cacoceph- 
alus  (with  head  irregular). 

11.  Heterodidymus. — Unequally-developed  twins,  the  body  of  one 
being  large  and  regularly  or  irregularly  formed,  the  other  being  small  and 
slenderly  attached  to  some  part  of  its  fellow  ;  3  species  :  H.  octipes  (with 
eight  feet),  containing  two  varieties  :  a,  H.  octipes  emprosthochirophoriis 
(the  anterior  limbs   of  the  parasitic  twin  situated  in  front)  ;  b^  H.  octipes 

pleiirochirophorus  (the  anterior  limbs  of  the  parasitic  twin  situated  at  the 
side)  ;  H.  tetrasulus  (with  four  posterior  extremities),  also  containing  two 
varieties  :  a,  H.  tetrasulus  monopygus  (with  one  croup)  ;  b,  H.  tetrasulus 
dipygus  (with  a  double  croup)  ;  H.  triscelus  (with  three  posterior  limbs). 

ORDER  V. — Monstrosities  with  a  Single  Head  and  Trunk,  and 
more  than  Four  Limbs — Melodidymi : — 

12. — Opisthomelophorus. — An  animal  regularly  formed,  but  which 
bears  on  its  back  or  croup  a  supernumerary  limb  or  limbs  \  3  species  :  O. 
trichirus  (with  an  anterior  limb  on  the  back),  (9,  tetrachirus  (with  two 
anterior  limbs  on  the  back),  O.  tetrascelus  (with  two  posterior  limbs  on 
the  croup). 

13.  Emprosthomelophorus. — With  a  supernumerary  limb  or  limbs  on 
the  neck,  thorax,  or  beneath  the  pelvis ;  5  species  :  E.  octipes  (with  four 
supernumerary  limbs  beneath  the  thorax),  E.  trichirus  (with  an  anterior 
limb  on  the  thorax),  E.  tetrachirus  (with  two  anterior  limbs  on  the  neck), 

E.  triscelus  (with  a  posterior  limb  beneath  the  pelvis),  E.  tetrascelus  (with 
two  posterior  limbs  beneath  the  pelvis). 

14.  Pleuromelphorus. — With  a  supernumerary  limb  or  limbs  situated 
on  the  side  ;  4  species  :  P.  octipes  (with  four  limbs  on  the  side),  P.  tetra- 
chirus (v/ith  two  anterior  limbs  on  the  side),  P.  trichirus  (with  an  anterior 
supernumerary  limb),  P.  triscelus  (with  a  posterior  supernumerary  limb). 


MONSTROSITIES.  401 

ORDER  VI. — Monstrosities   with  the   Head,   Trunk,   and   Limbs 
MORE  OR  LESS  COMPLETELY  DouBLE — Somatodidymi : 

15.  Octopus. — With  eight  limbs;  4  species:  O.  Janus  (two  faces 
placed  opposite  each  other,  and  eight  limbs),  O.  quadriauritus  (eight  limbs 
and  four  ears),  containing  two  varieties  :  a^  O.  quadriauritus  monoprosopus 
(with  a  perfect  face)  ;  b,  O.  quadriauritus  aprosopus  (face  absent)  ;  O. 
biauritus  (eight  limbs  and  two  ears),  O.  syfiapheocephalus  (eight  limbs,  and 
the  heads  joined  externally  only  by  the  skin). 

16.  Tetrachirus. — With  four  anterior  limbs ;  2  species  :  T.  symphyo- 
cephalus  (four  anterior  limbs,  two  lateral  and  two  incomplete,  on  the  back, 
and  heads  joined),  T.  choristocephalus  (four  anterior  limbs,  and  heads 
separate). 

17.  Tetrasculus. — With  four  posterior  limbs  ;  2  species  :  T.symphyo- 
cephalus  (four  posterior  limbs,  and  heads  united),  T.  bifacialis  (four  pos- 
terior limbs,  and  the  two  faces  separate). 

18.  Gastrodidymus. — Twins  united  at  the  abdomen ;  3  species  :  G. 
quadrupes  (twins  united  at  the  abdomen,  and  furnished  with  four  limbs), 
G.  tetrachirus  (with  four  anterior  limbs),  G.  octipes  (with  eight  limbs). 

19.  Gastro-Thoracodidymus. — Twins  united  at  the  thorax  and  ab- 
domen ;  I  species  :    G.  thoracodidymus  octipes  (with  eight  limbs). 

20.  Epigastrodidymus. — Twins  united  at  the  thorax  and  epigastrium  : 
I  species  :   G.  octipes  (with  eight  limbs). 

21.  Thoracodidymus. — Twins  united  at  the  thorax;  i  species:  T. 
octipes  (with  eight  limbs). 

22.  ScHELODiDYMUS. — Twius  United  at  the  posterior  extremities  ;  i 
species :  S.  heptamelus  (with  seven  limbs,  the  posterior  pair  being  united 
into  one,  the  next  pair  at  the  side,  and  the  other  four  in  front). 

23.  IscHiODiDYMUS. — Twins  United  at  the  pelvis  ;  i  species  :  /.  examelus 
(with  six  limbs,  four  anterior  and  two  posterior). 

24.  Omphalo-Chronodidymus. — Twins  united  at  the  umbilicus  and 
the  head  ;  i  species :   O.  disomatus  (the  bodies  separate). 

25.  Pygodidymus. — Twins  united  at  the  croup  ;  i  species  :  P.  aversus 
(bodies  united  at  the  ischii  and  sometimes  at  the  buttock,  and  in  opposite 
directions). 

26.  Cryptodidymus. — Inclusion  of  one  twin  within  the  other ;  2  species : 
C.  abdominalis  {twin  included  in  the  ^hdomtn),  C.  subcutaneus  (\x\covs\- 
plete  foetus  included  beneath  the  skin  of  the  complete  one;. 

Such  is  the  classification  adopted  by  Gurlt,  and  it  will  be  seen  that  it 
is  very  complete,  while  the  nomenclature  scarcely  leaves  any  thing  to  be 
desired.  Nevertheless,  as  Saint-Hilaire's  classification  and  nomenclature 
are  also  employed,  and  are  in  some  respects  advantageous  to  know,  we 
will  now  allude  to  them,  though  not  in  such  detail  as  we  have  done  those 
of  Gurlt,  and  following  the  summary  given  by  Zundel.  Saint-Hilaii^ 
separates  the  Monstrosities  from  the  vices  of  conformation,  which  he  dis- 
tinguishes as  Hemiteries,  or  simple  and  trifling  organic  anomalies,  and 
Ifeterotaxies,  or  mere  changes  in  the  situation  of  organs,  and  nearly 
always  without  alteration  in  relative  position  and  connections.  For  the 
Hermaphrodisms — due  to  the  union  of  the  sexes  or  some  of  their  characters 
in  the  same  individual — he  forms  a  separate  class,  which  he  again  divides 
into  two  subclasses,  according  as  there  is  an  absence  or  excess  in  the 
number   of   parts ;  he    distinguishes   male   hermaphrodism,  female   her- 

26 


402 


FCETAL  DYSTOKIA. 


maphrodism,  and  neutral  hermaphrodism  ;  mixed  ;  complex — masculine 
or  feminine  ;  and  bisexual — perfect  or  imperfect.  The  Monstrosities — 
properly  so  called — exhibiting  anomalies  which  are  more  or  less  serious, 
either  because  of  the  injurious  influence  they  exercise  on  the  functions  of 
the  individual,  or  the  vicious  conformation  they  give  rise  to — are  divided 
into  two  classes  :  Simple  Monstrosities  and  Composite,  Double^  or  Triple 
Monstrosities. 

The  first  class  comprises  three  orders  :  i.  Autositic  Monstrosities  (adroq. 


Fig.  8s. 
Eciromelian  Monstrosity  (Saint-Hilaire)  ;  Nanotnelus  Campylochirus  (Gurlt)  :    Horse. 

self,  G'iToz.^  nourishment) — whose  organs  are  capable  of  maintaining  them 
for  a  variable  period  after  birth.  Only  one  or  more  regions  of  the  body  are 
involved,  the  majority  being  little,  if  at  all,  different  from  the  normal 
standard  ;  the  circulatory  apparatus  is  always  more  or  less  complete, 
particularly  the  heart ;  the  lungs,  nearly  all  the  digestive  viscera,  and  at 
least  a  portion  of  the  head,  are  present ;  and  all  the  anatomical  and 
physiological  characters  are  manifested  externally  by  the  general  con- 
formation, which,  in  the  greater  part  of  the  body,  remains  symmetrical 


Fig. 
Eciromelian  Monstosity  (Saint-Hilaire)  ;  Nanomelus  Campylochirus  (Gurlt)  :   Goat. 

and  almost  normal.  2.  Omphalositic  Monstrosities  {diitpakoq^  umbilicus,  and 
(TtToz,  nourishme?it)—r\hosQ  which  live  imperfectly,  being  maintained  by 
the  nourishment  derived  from  the  mother  through  the  umbilical  cord, 
and  dying  as  soon  as  the  cord  is  ruptured.  These  omphalosites  are 
deficient  in  a  large  number  of  organs,  and  those  which  are  present   are 


MONSTROSITIES. 


403 


generally  very  imperfect  ;  externally  all  the  regions  appear  to  be 
anomalous,  and  the  symmetry  is  imperfect  or  even  effaced.  3.  Parasitic 
Monstrosities — the  most  imperfect  of  all,  and  generally  inert,  irregular 
masses,  composed  of  bones,  adipose  tissue,  etc.,  destitute  of  umbilical 
cord,  and  attached  to  the  generative  apparatus  of  the  mother,  at  whose 
expense  they  maintain  an  obscure  parasitic  existence,  by  means  of  a 
vascular  pedicle. 

The  double  monstrosities  are  divided  into  autositarian  and  double  par- 


Fig.  87, 
Symelian  Monstrosity  (Saint-Hilairk)  ;  Perosomus pseudoscelus  (Gurlt):  Pig. 

asitic.  The  first  are  composed  of  two  individuals  more  or  less  intimately 
united,  and  somewhat  equal  in  development ;  this  inequality  indicating 
that  they  both  have  been  equally  nourished,  and  that  their  functions  have 
been  alike  complete.  The  second  are  composed  of  two  distinct  individ- 
uals, very  unequal  in  development,  the  smallest  being  the  most  imperfect ; 
testifying  that  it,  like  a  parasite,  has  lived  at  the  expense  of  the  other, 
[It  would  appear  that  the  triple  monstrosities  have  not  been  met  with  in 
jufficiently  large  numbers  to  establish  a  trustworthy  classification. 


Celosomian  Monstrosity  (Saint-Hilaire)  ;  Schistocorntus  Jissiventralis  (Gurlt)  :   Calf. 

Each  of  the  orders  of  Saint-Hilaire,  like  those  of  Gurlt,  contains  several 
families,  subdivided  again  into  genera  and  species,  according  to  their 
iffinities,  and  which  include  all  the  monstrosities  he  had  met  with.  With 
regard  to  these  families,  it  may  be  mentioned  that  among  the  single 
lautositic  monstrosities,  there  are  the  ectromelians  {iV-pdu)^  to  make  abort, 
i/oc,  limb)  in  which  we  have  a  more  or  less  complete  deficiency  in  the 
levelopment  of  the  limbs,  either  anteriorly  or  posteriorly,  and  involving 
me  or  more  of  these  (Figs.  85,  86). 


404 


FCETAL  DYSTOKIA. 


The  Symelian  Motisirosities  {ao-j^  with,  >j.ikoq^  limb)  are  those  which  Guilt 
includes  in  his  first  Class  and  Order,  there  being  an  absence  of  parts, 
with  fusion  of  others  (Fig.  87). 

The  Celosomian  Monstrosities  {yjjlr^,  hernia,  aw'ta^  l^ody),  more  frequent 
perhaps  than  any  others,  are  those  which  Gurlt  places  in  his  third  Order 


Ectopia  Cordis  '.    Schistocormus  fissisiernalis 

— Schistocormus,  and  are  chiefly  characterized  by  the  absence,  more  or 
less  complete,  of  the  abdominal  parietes,  and  the  abrupt  curvature  of  the 
sjDine  backwards,  downwards,  or  to  one  side  ;  so  that  the  pelvis  and  pos- 
terior limbs  are  directed  forwards,  to  one  side,  or  over  the  back,  while  the 


Fig.  90. 
Pseiidencephciliaii  Monstrosity  ;  Perocephalus  pseudocephalus,  Gurlt. 

abdominal  cavity  bemg  open,  allows  its  viscera  to  float  about  unprotected. 
There  are  many  degrees  of  this  deformity.  Sometimes  the  abdominal 
cavity  is  open,  the  thorax  being  undeformed  and  closed  in  posteriorly  by 
the  diaphragm,  and  the  ribs  attached  to  the  sternum  (Schistocormus  fssi- 
ventralis,  Gurlt,  Fig.  88).  Sometimes  the  posterior  end  of  the  spine  is 
curved  forward  to  the  middle  of  the  back  {Schistocormus  reflexus^  Gurlt)  ; 
the  ribs  follow  in  the  same  direction,  but  instead   of  bending:  downwards 


MONSTROSITIES.  405 

to  enclose  the  chest,  they  spring  upwards  towards  the  dorsal  spines ;  the 
sternum  is  absent  or  divided  throughout  its  length  {Schistocormus  Jissister- 
nalis — Gurlt,  Fig.  104),  with  evisceration  of  thoracic  organs — most  frequent- 
ly the  heart  {Ectopia  cordis,  Fig.  89)  ;  the  diaphragm  is  not  present,  the 
chest  is  as  widely  open  as  the  abdomen,  and  the  viscera  of  both  cavities 


Fig.  91. 
Cyclopean  Monstrosity; 


are  external  to  the  body  {S.  Schistepigastrico-sternalis),  At  other  times 
the  spine  is  twisted,  and  the  body  and  head  divided  {Schistosomus  con- 
tortus) ;  or  other  deformities  of  a  similar  kind,  and  more  or  less  complex, 
may  be  found.     The  skin  follows  the  displacement  of  the  various  regions 


Fig.  92. 
Cyclopean  Monstrosity  ;   Cyclops  niegalostomus  archynchus  (Gurlt)  :  Ass. 

— the  external  surface  being  generally  in  contact — while  the  lining  mem- 
brane of  the  chest  or  abdomen,  or  both,  becomes  external ;  sometimes  to 
such  an  extent  is  this  inversion  of  the  body  carried,  that  it  is  turned,  as 
it  were,  outside  in :  the  skin  forming  a  kind  of  internal  sac — the  hair  to 
the  interior — and  containing  the  head  and  limbs  of  the  foetus.  With 
such  a  deformity,  of  course  other  serious  malformations  or  displacements 
co-exist :  distorted  pelvis,  wasted  or  undeveloped  limbs,  atresia  of  the 
anus,  more  or  less  complete  absence  of  the  generative  organs,  etc. 


4o6 


FCETAL  DYSTOKIA. 


This  kind  of  monstrosity  will  have  to  be  specially  noticed  hereafter, 
the  eventration  of  the  viscera  of  the  foetus  often  considerably  baffling  the 


Fig-  93- 
Acephalian  Monstrosity;   A.perosomus  Iiemicephalicus  (Gurlt). 

obstetrist  \  while  the  frequent  distortion  of  the  spine  and  limbs  renders 
deliver)^  very  difficult. 

The  Exencephalian  monstrosities,  belonging  to  Gurlt's  third  Order  in 
the  first  Class,  are  those  which  have  the  brain  defective,  deformed,  and 
external  to  the  cranial  cavity — itself  more  or  less  imperfect. 


Fig.  94. 
Schistocephalus  Jissislabruf  of  labmm  leporinuvi  (Hare-up). 


MONSTROSITIES. 


407 


The  Pseudencephalimi  monstrosities  belong  to  the  third  Order  of  Gurlt's 
first  Class,  the  encephalon  being  absent  and  replaced  by  a  variable-sized 
bright  red  tumor,  composed  of  a  multitude  of  small  blood-vessels  \  this 
tumor  rests  on  the  base  of  the  cranium,  the  roof  of  which  is  absent 
(Fig.  90). 

The  Anencephalian  monstrosities — Gurlt's  first  Order,  first  Class — are 
destitute  of  the  encephalon  or  any  thing  to  represent  it,  and  the  roof  of 
the  cranium  is  entirely  absent. 

The  Cyclocephalia?i  monstrosities  (joyj^oz,  circle,  /.zodXr^,  head) — Order 
five,  Class  first  of  Gurlt — are  characterized  by  the  approximation,  or  more 
or  less  complete  fusion  of  the  eyes  into  one  organ,  with  absence,  displace- 
ment, or  deformity  of  the  nose  and  mouth  ;  but  the  ears  are  usually  in 
their  natural  position,  or  perhaps  are  lower  than  usual.  Not  unfrequently 
the  nose  is  absent  and  the  mouth  greatly  enlarged,  while  the  fusion  of  the 
eyes  may  not  be  complete  (Fig.  91,  92). 

The  Acephalian  monstrosities — Gurlt's  first  Class  and  first  Order — are 
more  or  less  destitute  of  head,  and  sometimes  of  neck,  thorax  and  tho- 
racic organs  (Fig.  93). 


Fig-  95. 
Camylorrkacchis  contorta. 

The  Anidian,  or  zoomylian  monstrosities,  we  have  already  described  at 
page  169  :  so  we  need  not  again  refer  to  them. 

The  Schistocephalian  monstrosities  (Gurlt)  have  the  head  or  face  cleft : 
most  frequently  the  face,  the  division  being  sometimes  limited  to  the  nose 
and  upper  lip. 

Those  monstrosities  which  are  characterized  by  the  abnormal  situation 
and  form  of  different  parts — and  which  are  included  in  Class  first,  Order 
six,  of  Gurlt — are  not  exceedingly  rare,  and  in  some  instances  are  proba- 
bly due  to  muscular  contraction,  or  mal-position  for  some  time  in  the 
uterus  (Fig.  95). 

Saint-Hilaire  divides  the  double  monstrosities  into  two  orders  :  Auto- 
sitaric  and  Parasitic;  the  former  being  constituted  by  individuals  more  or 


4o8 


FCETAL  DYSTOKIA. 


less  intimately  united  and  somewhat  equally  developed,  each  concurring 
to  the  mutual  existence  j  while  the  second  is  made  up  of  those,  monstros- 


Fig.  96. 
MoNOMPHALiAN  MONSTROSITY:    Cepka  »-cormodidytnus  (Guklt). 


Fig.  97- 
Skull  of  Syncephalian  Monstrosity. 


MONSTROSITIES. 


409 


ities  which,  though  united,  have  one  being  more  or  less  complete — being 
reduced  in  fact  to  a  limb,  jaw,  or  other  fragment  of  a  body  implantsed  or 
subsisting  on  an  individual  which  is  fully  developed.  iThese  are  included 
in  Gurlt's  second  Class. 

In  the  autositaric  order  we  have  the  Eusomphalian  and  Monophalian 
monstrosities  :  these  have  the  common  character  of  two  heads  and  four 
pairs  of  limbs  ;  the  first  have,  however,  a  distinct  umbilical  cord  to  each 
of  the  united  foetuses  ;  while  in  the  other — the  Monophalian — there  is 
only  a  single  umbilical  cord  and  umbilicus. 

The  Eusomphalian  monstrosity  consists,  then,  of  two  pretty  equally  de- 
veloped foetuses,  each  with  its  own  umbilical  cord,  the  two  being  usually 
joined  together  by  some  soft  part  at  any  region  of  the  body  ;  so  that  they 
may  be  separated  by  a  surgical  operation  without  the  existence  of  either 
being  compromised.  This  is  included  in  the  third  Order  of  Gurlt's  sec- 
ond Class. 

With  the  Monomphalian  monstrosity,  on  the  contrary,  there  being  only 
one  umbilicus  and  one  cord,  the  foetuses  are  joined  at  the  ventral  surface, 
and  have  usually  several  organs  in  common — notably  the  liver,  to  which 
the  umbilical  vein  passes  (Fig.  96). 

The  Sy?tcephalia7i  monstrosities  have  two  bodies  either  completely  sep- 
arated, or  only  divided  above  the  umbilicus,  and  surmounted  by  a  more 
or  less  incomplete  double  head  :  the  two  heads  being  fused,  as  it  were, 
into  one  {Dicephalus  heterocephalus  of  Gurlt — Fig.  97). 

The  Monocephalian  monstrosities,  as  the  name  implies,  differ  from  the 
last  in  having  only  one  head  but  a  double  body,  the  separation  of  the  two 
usually  taking  place  below  the  umbilicus  (Fig.  98). 

The  Sysoinian  monstrosities  (Fig.  99)  have  two 
heads  on  apparently  a  single  body  though  a  closer 
investigation  will  prove  that  the  unicity  is  merely 
superficial,  and  that  at  least  some  parts  are  double. 
Gurlt  describes  a  full-grown  Sysomian  lamb  he  ex- 
amined, and  which  had,  apparently,  a  single  body 
and  only  four  feet,  but  two  necks,  two  heads,  and 
two  tails,  and  the  skin  normally  covered  with  wool. 
The  trunk,  though  somewhat  small,  gave  no  indica- 
tion of  its  duplicity.  It  had,  nevertheless,  two  ver- 
tebral columns,  the  inner  ribs  attached  to  each 
being  shortened  and  fused  together,  while  the  ex- 
ternal ones  were  attached  in  the  usual  way  to  the 
single  sternum.  The  viscera  were  generally  double, 
though  they  were  confounded  at  certain  points.  A 
single  heart  sufficed  for  two  pairs  of  lungs,  one 
pair  of  which,  however,  were  only  rudimentary. 
The  two  livers  were  combined  into  one,  and  in  some 
parts  the  intestines  merged  into  a  single  tube, 
again  to  become  double,  and  finally  to  terminate  in 
one  rectum. 

The   Monosomian  monstrosities   have,  in  reality, 
only  a  single  body,   the   duplicity  generally  com- 
mencing towards  the  neck,  In  the  cervical  region, 
not  unfrequently  at  the  atlas,  and  sometimes  as  far  as  the  facial  region 
(Fig.  100). 

Among  the  double  parasitic   monstrosities,  we  may  mention  Saint-Hi- 


Fig.  98. 

Monocephalian  Mon- 
strosity :  Corttio-Me- 
lodidymi  (Gurlt). 


4IO 


FCETAL  DYSTOKIA. 


laire's  Heterotypians,  in  which  the  smallest  of  the  foetuses  is  attached  to 
the  »nterior  part  of  the  body  of  the  other,  at  or  near  the  umbilicus  ;  the 
Heteraliafis,  in  which  the  parasitic  foetus  is  very  incomplete,  and  perhaps 
reduced  to  a  single  region — as  a  head  without  a  body — attached  some 
distance  from  the  umbilicus  ;  the  Polyg7iathia?is,  in  which  the  parasite  is 
reduced  to  the  mere  fragments  of  a  foetus — the  jaws  and  some  cer*haiic 


Fig.  99. 
Sysomian  Monstrosity:    Dicephalus  bicollis  (Gurlt). 

remains  adhering  to  the  jaws  of  the  other  foetus.  All  these  are  included 
in  Gurlt's  classification,  which  we  would  advise  the  veterinary  obstetrist, 
as  a  rule,  to  employ. 

The  Polymelian  Qj.iXo';,  limb)  monstrosities — Gurlt's  Melodidymi — com- 
prise those  creatures  which  are  so  frequently  exhibited  in  public,  and  in 
which  there  is  only  a  single  body  and  head,  but  supernumerary  limbs. 


Fig.  100. 
MoNosoMiAN  Monstrosity  :    Dicephalus  hi-atlanticus  (Gurlt)  :    Calf. 

These  limbs  may  vary  in  number,  and  be  attached  to  various  parts  of  the 
complete  foetus  ;  there  may  also  be  present,  in  addition  to  the  supernu- 
merary members,  an  unformed  kind  of  tumor  resting  on  the  back  or 
shoulders,  which  in  one  case  has  been  recognized  to  be  composed  of  the 


'  MONSTROSITIES.  4„ 

heart  and  lungs  of  a  second  fcEtus   (Fig.  102).     In  other  instances,  the 
tumor  is  alone  observed,  without  the  additional  limbs.* 

The  Endocymian  monstrosities  are  those  double  foetuses  of  which  one, 
or  part  of  one,  is  included  within  the  other.  They  are  the  Cryptodidymi 
of  Gurlt's  Second  Class. 

Origin  of  Monstrosities,  and  the  Laws  of  Teratology. 

The  causes  which  operate  in  the  production  of  what  we  have  desig- 
nated "  monstrosities,"  appear  to  be  numerous. 

Putting  to  one  side,  as  unworthy  of  notice,  the  superstitious  ideas 
which  long  prevailed  with  regard  to  the  formation  of  these  monstnosities 
— because  they  can  all  be  explained  by  the  laws  teratology — we  come  to 
the  period  when  Regis  started  the  hypothesis  that  the  germs  of  these 
must  have  been  originally  produced  with  those  of  normal  beings,  and  that 


Fig.  10 1. 
PoLYMELiAN  MONSTROSITY:    EtnprosthromelophoTus  (Gurlt):    Calf- 

they  w^ere  developed  in  the  ordinary  course  of  generation.  This  hypoth- 
esis, or  something  like  it,  was  accepted  by  Winslow,  Duvernoy,  Haller, 
and  others,  up  to  the  time  of  Meckel.  Geoffroy  Saint-Hilaire,  however, 
successfully  combated  it,  and  demonstrated  that  these  anomalies  in  or- 
ganization are  not  primary,  but  accidental ;  that  embryos  which,  had  they 
been  placed  in  ordinary  circumstanc'es,  would  have  been  developed  in  a 
normal  manner,  and  which  had,  in  fact,  begun  to  be  so  developed,  only 
became  anomalous  and  monstrous  because  their  development  was  dis- 
turbed. 

Therefore  these  anomalies  did  not  exist  previous  to  impregnation,  but 
were  the  result  of  some  perturbation  occurring  during  the  development 
of  the  embryos,  which  were  at  first  perfectly  normal. 

The   opinion  which  at  present  prevails  with  respect  to  these   malfor- 

*  It  is  not  improbable  that  the  "Nadeah"  bullock  of  India  is  an  animal  with  a  parasitic  monstrosity 
attached  to  it.  A  bull  of  this  kind  has  been  described,  by  an  amateur,  as  having  "  an  excrescence  of  skin, 
covered  with  white  hair,  hanging  from  the  top  of  the  hump,  about  seven  inches  long  and  of  a  soft  nature, 
in  appearance  resembling  a  child's  stocking,  dangling  from  side  to  side  as  the  animal  moved,  butin  noway 
unsightly  or  repulsive  to  look  at." 

Such  animals  are  worshipped,  and  not  put  to  any  work ;  they  are  usually  exhibited,  covered  with  a  kind 
of  earth-colored  cloth  trimmed  with  cowrie-shells,  and  the  owners  derive  a  livelihood  by  exhibiting  them. 
The  "fakeers,"  or  holy  mendicants,  usually  obtain  possession  of  them.  These  double  or  polymelian  mon- 
strosities receive  their  sacred  designation  from  the  god  Mahadeo,  who  is  believed  by  the  Hindoos  to  have 
ridden  upon  a  bull  called  "  Nadeah,"  which  was  capable  of  changing  its  shape,  and  producing  as  many 
legs  or  horns  for  offensive  or  defensive  purposes  as  it  might  find  necessary.  Thus  it  happens  that  any 
animal  with  unnatural  or  extraordinary  marks,  is  supposed  to  have  some  affinity  to  the  great  "  Nadeah  "  of 
Mahadeo,  the  founder  of  Hindoo  teratology. 


1 


412  FOETAL  DYSTOKIA- 

maticMis,  is  to  the  effect  that  the  embryo  or  fcetus  has  been  submitted  to 
some  kind  of  alteration  in  uiero,  and  that  this  has  been  produced  during 
the  interval  between  conception  and  birth.  It  is  a  matter  of  ordinary- 
observation  that  sometimes  a  fall,  blow,  sudden  fright,  or  a'  powerful 
mental  impression  will,  in  woman,  disturlD  the  ordinary  course  of  preg- 
nancy, and  give  rise  to  more  or  less  unusual  symptoms,  and  even  prema- 
ture birth  of  an  imperfect  fcetus.  It  has  been  attempted  to  explain  the 
action  of  these  influences,  by  supposing  that  the  sudden  physical  or  men- 
tal shock  produces  an  abrupt  contraction  of  the  vascular  system  and,  co- 
incidentally,  of  the  uterus  ;  and  that  the  foetal  membranes  are  thus  all 
at  once  constricted,  and  slightly  lacerated.  Consequently,  a  part  of  the 
liquor  amnii  escapes  (as  has  been  frequently  observed),  and  this  is  suc- 
ceeded by  adhesion  of  the  margin  of  the  laceration  in  the  membranes  to 
the  corresponding  part  of  the  body  of  the  embryo  ;  and  thus  are  formed 
those  layers  or  bands  which,  whether  temporary  or  permanent,  disturb 


Fig.  102. 
Double  Parasitic  Monstrosity;  Polytnelian  notomelus ;  Cow. 

more  or  less  the  development  of  the  young  creature,  either  by  prevent- 
ing organs  from  occupying  their  natural  cavities,  hindering  the  union  or 
fusion  of  parts,  or  opposing  or  delaying  the  formation  of  those  which 
should  afterwards  appear.  That  this  opinion  is  not  improbable  may  be 
at  once  conceded,  when  we  remember  that  during  the  early  stages  of 
development  the  ovum  is  little  more  than  a  semi-fluid  mass,  and  that  its 
constituent  parts  are  extremely  impressionable. 

But  the  formation  of  mcxistrosities  is  more  particularly  due  to  what  has 
been  designated  the  theory  of  retardation  or  arrested  development ;  the  de- 
viations from  the  normal  standard  being  the  effect  of  disturbance  and 
arrested  supply  of  nutriment  during  the  period  of  intra-uterine  growth. 
G.  Saint-Hilaire  has  proved  experimentally,  by  means  of  eggs  artificially 
hatched,  that  the  production  of  monstrosities  is  due  to  the  interruption 
or  accidental  suspension  of  development  which  had  commenced  in  a 
regular  manner;  while  Meckel  has  shown  the  striking  analogy  there  ex- 


MONSTROSITIES.  ,  413 

ists  between  many  anomalies  and  various  transitory  conditions  of  em- 
bryonic organization. 

It  has  been  well  remarked  that  the  majority  of  the  malformations  due 
to  defect  in  the  higher  animals,  represent,  in  a  more  or  less  perfect  man- 
ner, the  normal  conformation  of  the  inferior  classes.  For  instance,  the 
imperfection  or  absence  of  limbs  is  the  natural  condition  of  fishes  and 
some  reptiles  ;  the  heart  is  not  present  in  zoophytes  ;  when  it  has  but 
one  cavity  in  the  higher  mammalia,  it  only  resembles  the  single  heart  of 
crustaceae  ;  and  when  the  auricular  septum  of  the  heart  remains  patent, 
it  is  like  the  reptilean  heart.  All  this  is  explained  by  the  fact,  that  the 
embryo  of  the  domesticated  animals,  in  arriving  at  its  ultimate  develop- 
ment, appears  to  pass  through  all  the  degrees  of  organization  which  mark 
the  different  types  in  the  zoological  series.  And  by  means  of  the  knowl- 
edge we  possess  of  the  organization  of  these  types,  we  are  sometimes 
able  to  say  when  a  particular  monstrosity  began  to  deviate  from  the 
normal  condition,  the  nature  of  the  deviation,  and  its  cause. 

An  excess  of  general  development  is  less  frequent  than  the  opposite 
condition  :  partial  excess  of  an  organ  or  region  is  not  unfrequent ;  while 
excess  of  parts  is  far  from  rare,  and  may  be  noted  in  the  vascular  sys- 
tem, in  internal  organs,  and  externally :  more  particularly  is  it  remarked 
in  the  extremities,  when  we  have  in  some  species  "polydactylism,"  and 
in  others  "  hvperdactylism."  It  is  often  obseVved  that  an  excess  in 
development  in  one  part  coincides  with  defective  development  in  an- 
other, as  if  the  balance  in  formative  organization  must  be  maintained 
throughout  the  body. 

With  regard  to  double  monstrosities — the  result  of  two  foetuses  being 
accidentally  joined  together,  and  fused,  as  it  were,  into  each  other — G. 
Saint-Hilaire  proposed  a  special  law  which  he  designated  the  law  of  sim- 
ilar imion  or  of  mutual  affinity.  The  result  of  this  law  is  the  production 
of  symmetrical  development  in  a  double  monster  in  as  perfect  a  manner 
as  in  a  single  and  normal  individual  ;  the  two  creatures  which,  by  their 
union,  form  either  a  partial  or  complete  double  monstrosity,  are  always 
joined  by  the  homologous  faces  of  their  bodies — side  to  side,  front  to 
front,  or  back  to  back.  And  not  only  are  they  united  by  their  homolo- 
gous surfaces  externally,  but  internally  they  are  allied  by  homologous 
organs  :  each  part  or  viscus  of  one  corresponding  to  a  similar  part  or 
viscus  of  the  other  ;  so  that  each  vessel,  nerve,  or  muscle  on  the  plane 
of  union  of  one,  notwithstanding  the  apparent  complexity,  is  joined  to 
the  corresponding  vessel,  nerve,  or  muscle  of  the  other  :  just  as  the  two 
moieties  of  a  single  and  central  organ,  originally  distinct  and  lateral,  be- 
come naturally  fused  together  at  a  certain  period,  and  in  obedience  to 
the  laws  controlling  their  formation  and  development.  A  double  mon- 
ster IS,  therefore,  only  a  being  composed  of  four  more  or  less  complete 
moieties  instead  of  two,  as  in  the  single  individual. 

With  regard  to  more  complex  monstrosities,  we  find  that,  instead  of 
two  moieties,  as  in  the  normal  condition  of  an  individual,  or  the  four 
moieties  as  in  the  double  monstrosity,  we  may  have  six,  eight,  or  even 
more  ;  but  yet  the  law  of  similar  union  prevails,  and  the  moieties  com- 
bine m  twos.  Therefore  it  is  that  a  triple  monstrosity  is  only  a  double 
monstrosity  doubled,  and  a  quadruple  one  a  triple  monstrosity  doubled 
also — all  the  phenomena  of  the  compound  monstrosity  being  accounted 
for  on  the  same  general  principle. 

The  formation  of  double  monstrosities  has  given  rise  to  some  digcus- 


1 


414 


FCETAL   DYSTOKIA. 


sion,  and  at  present  there  are  two  chief  theories  which  are  worthy  of 
notice.  According  to  one  of  these,  there  have  been  originally  two  ova, 
which  may  have  been  derived  from  one  or  from  two  Graafian  vesicles  or 
follicles  rupturing  at  the  same,  or  nearly  the  same  time,  and  passing 
down  the  oviduct  together,  towards  the  cornu,  become  fused  by  pressure 
in  their  passage.  The  other  theory  supposes  the  existence  of  only  one 
ovum,  by  whose  division  or  cleavage  the  double  monstrosity  is  formed. 

The  first  view  is  that  which  has  found  most  favor,  though  quite  re- 
cently it  has  been  considered  as  quite  exploded  by  Dittmer  {Reichert  and 
Dii  Bois-Reymond's  Archiv.,  1875),  who  is  inclined  to  adopt  the  latter 
theory,  and  believes  that  the  double  monster  is  only  an  instance  of  bi- 
lateral symmetry  carried  too  far.  According  to  him,  in  the  primitive 
germ  of  the  normal  embryo  a  longitudinal  groove  is  formed,  which  after- 
wards represents  the  middle  line,  the  two  lateral  parts  developing  sym- 
metrically. But  if  this  groove  is  too  deep  at  one  or  both  ends,  the  two 
halves  will  there  be  separated  ;  and  the  separated  extremities  have  the 
power  of  producing  the  wanting  lateral  half  of  each.  The  separation  of 
the  two  halves  may  occur  at  one  extremity  or  at  both,  and  it  may  extend 
to  any  depth.  According  to  these  differences,  we  should  have  the  vari- 
ous forms  of  double  monster — from  such  creatures  as  the  Siamese  twins 
to  cases  of  a  small  supernumerary  leg.  There  may  even  be  a  further 
stage  of  this  process.  One  of  the  separated  halves  may  present  a  sim- 
ilar exaggeration  of  bilateral  symmetry,  if  it  again  separate  into  two 
halves  like  the  original  germ. 

Thus  may  be  explained  monsters  with  three  heads  or  three  tails. 

Some  objections  might  be  raised  to  this  theor}^  but  this  is  not  the  place 
to  enter  upon  their  discussion.  We  may,  however,  point  out  that  it  will 
scarcely  apply  to  included  monstrosities,  in  which  we  have  one  creature, 
more  or  less  perfectly  developed,  contained  within  another.  We  can 
scarcely  doubt  of  the  existence  of  two  ova,  the  included  one  being  the 
oldest,  and  that  this  inclusion  has  probably  been  effected  at  a  very  early 
period  of  germ  development. 

To  return,  however,  to  the  long-accepted  theory.  If  we  descend  from 
the  complex  phenomena  of  double  monsters  to  single  ones,  and  from 
these  to  simple  anomalies,  we  find  again  that  every  anomalous  union  be- 
tween organs  takes  place  by  homologous  parts.  What  have  been  desig- 
nated "  Symelian  "  monstrosities  are  characterized  by  the  fusion  of  their 
more  or  less  atrophied  abdominal  limbs  ;  in  the  "  Cyclocephalian  "  mon- 
sters the  eyes  are  more  or  less  fused  into  one  organ  of  vision  ;  while  with 
the  "  Otocephalians "  the  ears  themselves  are  joined,  and  often  inti- 
mately confounded.  The  union  of  the  kidneys,  testicles,  cerebral  hemi- 
spheres, and  other  double  organs,  is  often  observed  in  creatures  otherwise 
normal  in  conformation  ;  and  all  these  anomalies  occur  under  the  reign 
of  the  same  law — that  of  "  similar  union  " — which  for  organs,  as  for  en- 
tire individuals,  operates  on  homologous  parts. 

With  regard  to  the  remote  or  proximate  causes  which  lead  to  the  pro- 
duction of  monstrosities,  it  is  very  probable  that  the  most  prominent  are 
irregularity  or  inequality  in  the  nutrition  of  the  foetus,  physical  injury, 
undue  pressure,  alterations  in  the  membranes,  or  diseased  conditions  of 
the  young  creature.  G.  Saint-Hilaire  and  Valentine,  by  disturbing  the 
development  of  the  embryo  of  the  fowl  during  the  early  stage  of  incuba- 
tion of  eggs — through  shaking,  jarring,  and  pressing  them,  perforating  the 
shell,  or  covering  it  with  w^x — could  almost  create  monstrosities  at  will. 


MONSTROSITIES.  41 5 

And,  as  Zundel  remarks,  an  accident  during  gestation — a  blow,  a  fall,  a 
displacement  of  the  uterus — will  produce  the  same  results  in  animals. 
And  Lafosse  observes  that  it  is  perhaps  because  of  the  pressure  to  which 
the  foetus  of  ruminants  is  exposed,  owing  to  the  accumulation  and  fer- 
mentation of  food  in  the  rumen,  that  must  be  attributed  the  greater  fre- 
quency of  anomalies  in  the  species  of  this  order  than  in  the  other  domes- 
ticated animals.  The  quantity  and  quality  of  the  food,  and  the  work  to 
which  the  mother  is  subjected,  have  an  undoubted  influence  on  the  nutri- 
tion of  the  embryo. 

A  circumstance  which  appears  to  have  some  influence  in  the  produc- 
tion of  anomalies  in  animals,  is  the  great  disparity  in  size  between  the 
male  and  female.  Lafosse  endeavors  to  prove  this  by  showing  that  the 
frequency  of  certain  vices  of  conformation — such  as  hypospadias,  umbili- 
cal hernia,  want  of  proportion  between  the  jaws,  etc. — is  most  notable  in 
the  mule. 

We  are  also  convinced  that  excessive  consanguinity  (breeding  "  in  and 
in  ")  likewise  leads  to  the  frequent  production  of  monstrosities  ;  we  have 
witnessed  some  startling  instances  in  the  Cow  and  Pig.  Weakness  of  the 
procreative  powers  may  also  tend  to  the  development  of  monsters. 

A  too  small  uterus  may  likewise  act  mechanically  in  distorting  the 
fcetus  j  while  the  health  or  disease  of  the  organ,  or  of  the  foetal  mem- 
branes, must  exert  a  powerful  influence  on  its  development  and  conforma- 
tion. It  is  not  improbable  that  the  Celosomian  monstrosity  {Schistosomus 
reflexus),  observed  only  in  the  bovine  species,  is  due  to  the  form  of,  or 
pressure  in,  the  uterus  ;  and  to  the  same  cause  may  also  be  ascribed  the 
greater  frequency  of  double  and  triple  monstrosities  in  this  species  than 
in  any  other. 

The  amputation  of  limbs,  or  portions  of  them,  may  be  due  to  the  action 
of  the  umbilical  cord,  which,  in  the  Mare  at  least,  is  perhaps  sufficiently 
long  for  this  purpose. 

Hereditary  influence  is  here  undeniable.  In  the  human  species  it  has 
often  been  remarked,  and  scarcely  less  frequently  in  animals.  Hornless 
cattle,  double-headed  puppies,  tailless  cats,  and  other  anomalies,  are 
commonly  reproduced.  Franck*  mentions  the  case  of  a  Mare  which  con- 
stantly had  foals  whose  lower  jaw  was  so  short  that  they  could  not  suck  ; 
consequently  they  died.  Gurlt  alludes  to  a  Bitch  \Wiich  brought  forth 
four  litters  of  puppies  ;  the  first  litter  consisted  of  six,  two  of  which  were 
minus  their  fore  feet  and  were  hare-lipped  ;  there  were  five  in  the  second 
litter,  four  of  which  were  monstrosities ;  in  the  third  litter  there  was  the 
same  number,  and  the  fifth  puppy,  which  was  otherwise  normal,  had  a 
hump  in  the  middle  of  its  back  ;  four  puppies  were  produced  in  the  fourth 
litter,  three  of  which  were  anomalous. 

A  psychical  or  mental  influence  has  often  been  invoked  to  account  for 
certain  monstrosities,  and  the  vulgar  opinion  since  Old  Testament  times 
is  certainly  entirely  in  favor  of  its  existence  j  but,  on  the  other  hand,  it 
has  often  been  denied.  While  there  can  be  no  doubt  that  the  popular 
mind  has  greatly  exaggerated  this  influence,  yet  it  would  appear  from  the 
interesting  observations  collected  by  Trehonnais,  as  well  as  the  curious 
instances  recorded  by  Buhler,  Weber,  Herbst,  Bagge,  Rueff,  and  others — 
and  which  we  regret  we  have  not  space  to  quote — that  it  does  operate  to 
some  extent  in  animals  ;  fear  especially,  as  has  been  already  said,  will 
react  on  the  embryo  or  foetus. 

*  Handbuch  der  thierarztlichen  Geburtshiilfe,  p.  434. 


1 


41 6  ^         FCETAL  DYSTOKIA. 

Disease  of  the  foetus  itself,  or  maladies  transmitted  from  the  mother, 
may  play  an  active  part  in  the  production  of  anomalies  and  monstrosities. 

Frequency  of  Monstrosities. 

Monstrosities  are  far  from  being  rare  in  the  domesticated  animals,  but 
they  do  not  occur  with  the  same  frequency  in  all  the  species.  Gurlt* 
tabulates  740,  which  shows  the  proportion  furnished  by  the  different  ani- 
mals.    This  is  as  follows  : — 

Ass 3 

Mule 3 

Goat 24 

Mare 56 

Cat 71 

Bitch 78 

Sow 87 

Ewe 179 

Cow 239 

Baumeister  and  Rueff  mention  that  in  the  King  of  Wurtemberg's  pri- 
vate stud,  of  2340  foals  produced,  there  were  only  nine  monstrosities,  or 
one  abnormal  to  260  normal  foals.  In  the  Hohenheim  dairies,  among 
the  Cows  the  monstrosities  were  only  one-half  per  cent,  (i  per  200)  ; 
swine  came  next  in  frequency,  then  goats  and  sheep.  Among  the  latter 
there  was  only  one  monster  in  768  lambs. 

Saint-Cyr  collected  49  instances  (not  including  hydrocephalic  mon- 
sters), which  were  apportioned  in  the  following  manner  : — 

Cow 27 

Sheep  and  Goat       -         -         -         -  13 

Sow -  4 

Cat           ------  4 

Bitch       ------  o 

Mare -  i 

Though  monstrosities  are  not  rare  m  animals,  yet  all  do  not  give  rise  to 
difficult  parturition  ;  for  in  some  cases  the  deformity.does  not  interfere 
at  all  with  birth  ;  in  others  in  which  the  deformity  is  of  such  a  nature  as 
would  impede  delivery,  birth  often  occurs  prematurely  when  the  foetus  or 
foetuses  are  small  and  soft ;  while  even  when  fully  developed,  double  and 
triple  monstrosities  have  been  occasionally  born  without  assistance. 

Nevertheless,  there  is  ample  proof  that  triple,  double,  and  even  single 
monstrosities,  often  require  to  be  removed  artificially,  and  may  be  pro- 
ductive of  serious  consequences  to  the  mother.  These  we  will  now  allude 
to. 

Distorted  Monstrosities. 

The  distorted  monstrosities  which  Gurlt  \i?is  dQs\gx\2itQd  Camyiorrhacchis 
contorta,  and  which  are  characterized  by  abnormal  situation  and  form  of 
different  parts  (Fig.  95),  may  occasionally,  from  their  crooked  shape, 
prove  a  source  of  difficulty  during  birth.     The  distortion   may  be  due 

*  Pathol.  Anatomic,  vol.  ii.,  p.  5. 


MONSTROSITIES.  4 1 7 

either  to  muscular  contraction  in  the  foetus,  or  to  extraneous  uterine 
pressure,  and  if  we  glance  at  the  figure  which  illustrates  one  variety  of 
this  malformation  at  page  407,  we  will  readily  perceive  that  the  obstetrist 
may  indeed  have  a  serious  task  before  him  if  he  is  required  to  remove 
such  a  misshapen  foetus.  The  remarks  we  have  made  with  regard  to 
dystokia  from  muscular  contraction  are  applicable  to  this  form  of  mon- 
strosity ;  and  in  the  majority  of  instances,  it  will  be  found  that  embry- 
otomy, or  even  the  Cassarean  section,  must  be  resorted  to.  The  following 
are  illustrative  cases. 

Wilson  (  Veterinarian,  vol.  xl.,  p.  770)  attended  an  aged  Cow  which  had  been  in  labor 
for  more  than  twenty  hours.  The  abdominal  viscera  of  the  foetus  were  hanging  from 
the  Cow's  vagina,  and  as  much  of  the  pudendum  as  could  be  seen  was  livid  and  flaccid. 
Introducing  his  arm,  he  discovered  what  afterwards  proved  to  be  an  irregularly-round 
bony  mass,  too  large  apparently  for  birth.  The  presenting  substance  was  a  portion  of  a 
malformed  foetus.  Nothing  resembling  a  calf  could  be  discovered,  though  what  seemed 
to  be  a  kyst  was  found  ;  this  was  punctured,  but  with  no  evident  result.  Embryotomy 
was  out  of  the  question,  as  it  was  not  known  how  to  proceed ;  so  it  was  decided  to  draw 
the  mass  into  the  genital  passage,  in  order  to  extract  it.  Tracing  the  connections  of  the 
fostal  viscera,  what 'was  supposed  to  be  the  oesophagus  was  found  in  the  middle  of  the 
hard  mass.  Four  or  five  inches  within  this  orifice,  a  strong  iron  hook,  to  which  a  cord 
was  fastened,  was  inserted. 

Smearing  the  foetus  well  with  soft  soap,  and  giving  the  cord  to  an  assistant,  with  in- 
structions to  pull  steadily  and  gently,  after  some  manipulation  the  mass  was  carried  into 
the  OS  uteri,  and  by  continuing  the  efforts  delivery  was  effected.  On  examination,  the 
bony  mass  felt  within  the  uterus  was  found  to  be  composed  of  all  the  bones  of  the  trunk, 
except  the  cervical  vertebras,  "  jumbled  and  thrown  together."  "  Projecting  from  one 
side  of  this  were  the  fore  legs,  and  in  the  middle  of  these  the  head  and  neck,  all  fully 
formed  and  well  haired."  The  part  mistaken  for  a  kyst  and  punctured,  was  discovered 
to  be  a  large  piece  of  perfect  skin  growing  from  the  bony  lump,  and  falling  round  the 
whole  mass.     The  Cow  recovered  in  a  short  time. 

The  same  writer  {Ibid.,  vol.  xli.,  p.  606)  attended  another  aged  Cow  which  had  been  irt 
labor  for  a  day.  Two  or  three  j^ersons  had  felt  for  the  calf,  but  could  not  understand 
its  presentation,  which  was  very  peculiar.  The  head  and  fore  legs  were  in  the  natural 
position,  but  the  two  hind  feet  were  also  in  the  passage — one  resting  on  the  spine  and 
the  other  against  the  right  shoulder  of  the  calf,  each  leg  with  its  posterior  part  superior. 
Wilson,  at  first  believing  two  calves  to  be  present,  endeavored  to  return  the  hind  legs 
into  the  uterus,  but  they  were  immovable,  and  the  presentation  could  not  be  changed. 
Embryotomy  was,  therefore,  resorted  to,  and  each  hind  leg  was  detached  at  the  stifle 
joint  ;  after  which  the  Cow  calved  without  much  difficulty.  An  examination  of  the  foetus 
showed  that  the  position  of  the  hind  legs  depended  upon  a  twist  in'the  loins.  The  Cow 
perfectly  recovered. 

Cyclopean  Monstrosity. 

A  Cyclopean  Monstrosity  would  not,  so  far  as  the  visual  deformity  is 
concerned,  give  any  trouble  to  the  obstetrist  ;  but  in  conjuction  with  this 
condition  we  not  unfrequently  find  other  anomalies  existing,  as  in  the 
following  instance  : — 

Wilson  { Veterinarian,  vol.  xli.,  p.  607)  mentions  the  case  of  a  Cow  which  was  nearly 
fifty-five  weeks  pregnant  when  parturition  commenced.  The  presentation  of  the  foetus 
was  natural,  but  the  limbs  were  excessive  in  size.  Eventration  had  to  be  effected  before 
delivery  was  completed,  the  calf  having  been  in  the  genital  passage  for  more  than  two 
hours,  notwithstanding  the  efforts  of  three  or  four  men,  who  pulled  at  it  from  time  to 
time.  The  calf  was  not  larger  than  the  female  calf  usually  is,  but  the  nasal  bones  were 
entirely  absent,  as  well  as  the  nasal  openings — the  skin  in  this  situation  being  elongated 
as  a  simple  but  well-haired  flap.  On  the  under  part  of  this  flap,  which  was  about  three 
inches  long,  the  lower  jaw,  mouth,  and  tongue  appeared  to  be  properly  formed.  "  The 
foetus  was  a  cyclops,  as  only  one  eye  existed,  and  this  in  the  centre  of  the  forehead.  The 
eye  was  very  imperfect,  and  the  eyelids  were  much  contracted  and  ran  parallel  to  the 
longitudinal  suture.  The  external  ears  seemed  to  be  perfect  in  form,  but  the  meatus 
auditorius  was  closed  in  both  of  them." 

27 


4i8 


FGETAL  DYSTOKIA. 


This,  it  will  be  seen,  was  a  variety  o£  Gurlt's  cy clops.     Youatt  gives  a  good  descrip- 
tion of  the  head  of  a  cyclops  foal  in  the  V^eterinarian  (vol.  vii.,  p.  434). 

Pseud  ENCEPHALi AN  Monstrosity. 


The  head  of  the  foetus  may  prove  a  cause  of  protracted  or  difficult  par- 
turition, as  we  have  seen  when  treating  of  hydrocephalus  as  a  source  of 
dystokia,  as  well  as  in  other  kinds  of  anomalies,  when  it  is  either  greatly 
deformed  or  double.  We  are  cognizant  of  only  one  instance  in  which 
a  pseudencephalian  monstrosity  {Ferocephalus pseudocephalus,  Gurlt)  gave 
rise  to  difficulty  in  birth. 

Maw  (  Veterinarian,  vol.  xxxiii.,  p.  450)  attended  a  Cow  in  calf  for  the  first  time,  and 
which  had  been  violently  in  labor  for  six  hours.  A  shepherd  had  been  attempting  de- 
livery, and  found  the  fore  legs  of  the  fcetus  presenting,  the  head  being  turned  back ;  the 
latter  was  adjusted,  but  yet,  notwithstanding  considerable  force,  the  calf  could  not  be 
removed.  By  skilful  manipulation  Maw  succeeded  in  extracting  it,  when  it  was  discovered 
to  have  "  a  protuberance  on  its  head  about  the  size  of  a  child's  head,  with  hair  on  it, 
and  the  tongue  protruded  from  the  mouth  like  a  man's  hand,  withthe  thumb  and  fore 
fingers.  On  all  the  four  feet  were  four  digits,  and  the  hind  quarters  and  tail  were  like 
those  of  a  dog  ;  the  legs  were  about  six  inches  long,  and  there  was  no  roof  to  the  mouth 
— this  aperture  freely  opening  into  the  nostrils.  The  Cow  was  much  exhausted,  but  ulti- 
mately recovered. 


Fig.  103.  / 

SvsoMiAN  Monstrosity:   Dicephalus  bicollis  (Gurlt). 

Double-headed  (Monosomian  and  Sysomian)  Monstrosities. 

The  occurrence  of  double-headed  monstrosities  is  more  common,  per- 
haps, than  any  other  anomaly  ;  they  are  observed  more  particularly  in  rumi- 
nants, though  instances  are  recorded  of  their  appearing  in  the  Pig,  and 
even  in  the  Gat  species. 

We  have  collected  reports  of  some  three  dozen  cases,  the  large  majority  of 
which  refer  to  this  anomaly  in  the  Calf,  and  not  one  to  the  equine  or  asinine 


MONSTROSITIES.  419 

species.  Only  two  of  these  cases  appear  in  English  literature.  We 
have  already  shown,  in  the  classification  of  monstrosities,  the  kind  and 
degree  of  division  there  exists  between  the  heads,  and  we  have  only  now 
to  deal  with  this  anomaly  from  an  obstetrical  point  of  view. 

It  may  be  observed  that  many  of  these  creatures  have  been  born  alive, 
and  have  continued  to  live  for  some  time.  Canu  mentions  a  double- 
headed  Calf  which  survived  its  birth  fifty  days,  and  Bert  gives  a  good 
description  of  another  which  he  examined  when  it  was  fifteen  months 
old  ;  but  in  the  latter  instance  the  anomaly  was  limited  to  the  lower  part 
of  the  head,  the  jaws  only  giving  evidence  of  duplicity. 

The  existence  of  this  anomaly  renders  birth  more  or  less  difficult,  or 
even  impossible,  according  to  the  size  of  the  heads,  their  point  of  junc- 
tion— whether  at  the  face  or  cranium,  or  towards  the  neck,  and  also  ac- 
cording as  the  presentation  of  the  foetus  is  anterior  or  posterior.  In  very 
many  of  the  cases  recorded,  the  mother  died  or  had  to  be  killed,  while  in 
others  birth  occurred  without  assistance  and  with  but  little  difiiculty  : 
rather  a  matter  for  wonder,  considering  the  width  of  two  foetal  heads 
joined  towards  tne  upper  part  of  the  neck.  In  this  respect  the  Monoso- 
mian  must  prove  more  troublesome  sometimes  than  the  Sysomian  mon- 
ster.    In  the  majority  of  cases  the  presentation  is  anterior. 

An  examination  will  reveal  the  existence  of  this  condition,  when  the 
obstetrist  will  adopt  the  measures  necessary  for  extraction.  In  very 
many  of  the  cases  embryotomy  will  have  to  be  resorted  to,  or  even  the 
Csesarean  section.  Decapitation  of  one  or  both  heads  may  sometimes 
suffice.  In  other  cases,  judicious  manipulation  and  well-timed  traction 
will  effect  delivery.  When  the  heads  are  united  at  the  cranium  (as  in 
Figs.  97  and  100),  and  it  is  impossible  to  decapitate,  the  obstetrical  saw, 
chisel,  or  bone  forceps  may  be  usefully  employed  to  disunite  them  at 
their  junction. 

With  double  necks,  amputation  of  one  head  and  neck  should  be  ef- 
fected as  low  down  as  possible, 

1.  Wilson  ( Veterinarian,  vol.  xlii.,  p.  407)  describes  a  Monosomian  monster  ;  the  heads 
were  of  equal  size  and  fully  developed.  With  the  exception  of  the  atlas  and  dentata, 
the  bones  were  natural  in  shape.  The  dentata  did  not  differ  much  from  the  normal 
form  ;  but  the  ring  or  body  of  the  atlas  was  curved  from  below  upw^ards,  at  its  anterior 
and  middle  part,  and  had  attached  to  the  extremity  of  this  curved  portion  an  extra  piece, 
which  was  carried  with  a  sweep  upwards  and  backwards  to  join  the  body  of  the  bone 
superiorly.  This  interposed  portion  of  bone  contributed,  on  either  side,  to  the  formation 
of  the  concavities  for  the  attachment  of  the  two  occipital  bones.  The  spinal  cord  was 
not  bifid,  as  only  a  common  but  enlarged  cavity  existed  in  the  atlas.  The  presentation 
of  the  fcEtus  was  posterior,  and  delivery  could  not  be  effected  until  the  greater  part  of 
the  foetus  was  removed  by  dissection. 

This  was  the  fourth  case  of  double  head  this  veterinarian  had  met  with  in  twenty-five 
years'  practice.  The  first  (a  calf)  was  delivered  alive,  but  only  lived  about  half-an-hour ; 
the  next  two  were  born  dead. 

2.  Shipley  [Veterinary  Journal,  March,  1877)  gives  details  of  the  case  shown  in  figure 
100.  The  mother  was  a  medium-sized  Cow,  which  had  been  in  labor  for  about  twenty- 
four  hours,  during  which  an  empiric  had  exerted  all  his  skill  for  several  hours  to  effect 
delivery.  Shipley  found  the  genital  canal  dry  and  swollen  from  the  severe  treatment. 
With  difiiculty  the  fore-legs  of  the  foetus  were  reached,  and  then  a  malformed  or  double 
head.  The  lower  jaw  of  each  head  was  smashed,  and  the  incisors  pulled  out  or  hanging 
from  the  gum.  This  damage  had  been  done  during  the  attempts  at  extraction ;  unsuc- 
cessful efforts  had  also  been  made  to  amputate  the  head. 

With  much  trouble  and  labor,  the  fore  limbs  were  pushed  forward  as  far  as  possible 
into  the  uterus,  and  a  strong  cord  passed  over  the  back  of  the  heads  behind  the  ears  ; 
then,  with  the  aid  of  some  men  who  pulled  at  this  cord,  and  in  manipulating  the  two 
noses  of  the  foetus — first  to  one  side,  then  the  other,  gradually  drawing  each  forward — 


1 


42 o  .  FCETAL  DYSTOKIA. 

the  heads  were  extracted,  and  cut  off  at  their  junction  with  the  atlas.  The  neck  was  now 
pushed  back,  the  fore  limbs  lifted  up,  and  with  a  little  assistance  the  body  of  a  well-de- 
veloped calf  was  extracted.  The  creature  was  alive  at  an  earlier  period,  and  Shipley 
had  no  doubt  that  it  could  have  been  delivered  more  easily  than  by  cording  the  lower 
jaws  and  using  a  halter  over  the  head.  The  spinal  cord  was  single ;  the  cerebrum  on 
each  side  was  fairly  developed;  the  cerebellum  was  only  "semi-double;"  the  two 
tongues  were  nearly  perfect. 

3.  Canu  {Mem.  de  la  Soc.  du  Calvados,  etc.,  p.  362)  mentions  that  a  double-headed  calf 
was  found  behind  a  Cow  one  morning,  and  it  was  not  known  how  delivery  had  been  ef- 
fected.    It  was  alive,  and  sucked  by  either  mouth. 

4.  Rainard  {Op,  Cit.,  vol.  i.,  p.  486)  gives  a  very  interesting  account  of  a  double-headed 
kitten,  which  made  a  posterior  presentation  in  the  lumbo-sacral  position.  The  body 
having  been  extracted,  the  greatest  difficulty  was  experienced  in  removing  the  head, 
M'hich  the  finger  introduced  into  the  uterus  discovered  to  be  double.  It  was  finally  re- 
moved by  traction — first  on  one  side  of  the  body,  then  on  the  other — the  young  creature 
dying  during  the  manipulation. 

5.  Forster  (Franck,  Op.  Cit.,  p.  441)  delivered  a  Cow  of  a  double-headed  calf,  which 
was  affected  with  prolapsus  cerebri ;  no  cutting  was  required — only  manual  assistance. 
The  calf  lived  for  about  sixty  hours  ;  when  it  sucked  by  one  mouth  the  milk  escaped 
from  the  other  mouth.  The  junction  of  the  heads  took"  place  at  the  temporal  bones, 
immediately  behind  the  orbit  (Fig.  97).     The  Cow  was  a  frequent  bearer  of  twins. 

Franck  gives  a  number  of  examples  of  this  form  of  monstrosity,  from 
German  veterinary  literature. 

Celosomian  Monstrosities. 

Those  creatures  which  are  more  or  less  destitute  of  abdominal  and 
thoracic  parietes,  and  otherwise  deformed  in  various  degrees,  would  ap- 
pear to  be  somewhat  frequently  met  with  by  the  veterinary  obstetrist. 
The  above  designation  for  them  will  be  recognized  as  that  bestowed  by 
G.  Saint-Hilaire,  the  name  proposed  by  Gurlt  being  Schistosomas  7'eflexus 
or  contortiis  (Fig.  88).  They  also  are  found  more  often  in  the  Cow  than 
in  other  animals,  the  Sheep  being  next  in  the  order  of  frequency.  Of 
forty-nine  monstrosities  referred  to  by  Saint-Cyr,  twelve  belonged  to  this 
order,  and  of  these  eleven  were  calves,  and  only  one  lamb.  Our  own 
figures  place  the  proportion  of  calves  much  higher. 

Perhaps  this  relative  frequency,  as  Saint-Cyr  remarks,  is  at  least  partly 
due  to  the  fact  that  the  singularity  of  thfe  malformation  is  so  striking  that 
observers  are  more  ready  to  publish  cases  of  this  kind  ;  while  parturition 
being  always  more  or  less  laborious,  empirics  who  may  chance  to  be  called 
in  cannot  understand  the  anomaly,  and  the  veterinary  surgeon  has  at  last 
to  be  sent  for. 

Diagnosis. 

The  diagnosis  of  this  malformation  is  not  difficult  to  the  practised 
obstetrist.  If  the  fcetal  intestines  are  apparent  at  the  genital  orifice  of 
the  mother,  their  small  size  indicates  at  once  that  they  are  those  of  the 
foetus,  while  an  exploration  of  the  vagina  and  uterus  will  discover  the 
distorted  body,  with  the  viscera  unprotected  and  floating  freely  about. 
When  nothing  is  visible  externally,  of  course  the  diagnosis  is  more  diffi- 
cult ;  and  this  difficulty  is  increased  with  certain  presentations  and  posi- 
tions of  the  foetus.  When,  for  instance,  this  is  anterior,  and  the  spine  is 
greatly  distorted,  the  hand  will  first  meet  the  head,  and  around  it  all  the 
feet  ;  and  it  will  be  in  vain  for  the  obstetrist  to  attempt  to  separate  these, 
and  to  push  back  the  posterior  limbs  in  order  to  put  the  foetus  in  a  good 
position,  as  the  rigidity  of  the  crooked  spine  prevents  this  being  accom- 
plished.    In  other  cases  the  presentation  may  be  abdominal  or  posterior, 


MONSTROSITIES. 


421 


and  then  the  hand  encounters  a  confused,  soft,  floating  mass  of  viscera, 
the  nature  of  which  is  not  easily  ascertained.  However,  the/^<?/  of  the 
intestines  should  lead  to  a  suspicion  of  the  case,  while  the  twisted  spine, 
deformed  pelvis,  and  general  distortion,  ought  to  lead  to  a  diagnosis.  In 
some  cases  the  exposed  heart  can  be  seized  by  the  hand,  and  if  the  foetus 
is  alive  the  contractions  of  this  organ  will  be  distinctly  perceptible. 

Prognosis. 

The  prognosis  in  these  cases  of  dystokia  will  greatly  depend  upon  the 
distortion  and  size  of  the  foetus,  as  well  as  upon  its  position.  In  thirty- 
nine  observations  collected  by  Franck,  twenty-eight — or  seventy-two  per 
cent. — of  these  monstrosities  were  born  without  injury  to  the  mother,  and 
a  number  of  them  without  assistance  ;  the  remaining  eleven  Cows  had  to 
be  slaughtered.  In  thirty-two  instances,  twenty-eight — or  ninety-three  per 
cent. — of  the  foetuses  presented  by  the  abdomen  ;  only  four  cases — thir- 
teen per  cent. — presented  anteriorly,  with  the  head  and  all  the  feet  towards 


Fig-  104. 

Celosomian  Monstosity:    Lamb. 

I,  Hind  Foot ;  2,  Fore  Feet ;  3,  Tail ;  4,  Tongue ;  5,  Elbow  of  Left  Fore  Limb  ;  6,  Stifle  ;  7, 
Ribs  everted  ;  8,  Viscera. 

the  genital  canal.  The  latter  were  the  most  serious,  as  in  three  of  them 
the  Cows  died.  Of  the  twenty-eight  abdominal  or  visceral  presentations, 
twenty-three  births  took  place  without  permanent  injury  to  the  mothers, 
the  other  five  being  killed.  One  was  delivered  by  the  CjEsarean  section. 
In  some  of  the  cases  in  which  birth  occurred  without  assistance,  the 
young  creature  was  born  alive. 

Extraction. 

As  we  have  seen,  the  prognosis  in  the  large  majority  of  cases  is  favor- 
able, and  particularly  when  the  presentation  is  abdominal.  Here  careful 
manipulation  will  effect  delivery,  and  often  the  only  mutilation  necessary 
is  the  removal  of  the  fcetal  viscera.  These  being  got  rid  of,  hand  or  cord 
traction  made  on  the  most  convenient  parts,  or  the  insertion  of  a  hook 
behind  the  spine  into  the  pelvis,  or  any  other  likely  and  accessible  part, 
with  gradual  pulling,  delivery  will  be  effected  ;  if  not,  the  vertebrae  should 
be  divided. 

But  when  the  head  and  all  the  feet  present,  then  the  case  is  much  more 
serious.  If  the  foetus  is  only  moderately  developed,  even  in  this  position 
it  has  been  removed  by  traction.  But  in  nearly  all  these  cases  embry- 
otomy must  be  adopted. '    Some  practitioners  have  succeeded  in  extracting 


1 


42  2 


FCETAL  DYSTOKIA. 


the  calf  by  cording  the  head  and  fore  limbs,  and  pulling  at  these,  while 
the  hind  limbs  were  being  pushed  back  into  the  uterus,  and  so  dislocating 
the  spine  and  straightening  the  body.  If  the  spine  does  not  give  way,  it 
may  be  cut  or  sawn  through. 

In  removing  the  body  of  the  foetus  by  instalments,  the  limbs  are  ampu- 
tated one  after  the  other,  according  to  the  rules  to  be  prescribed  for  this 
operation  ;  and  it  may  be  necessary  to  excise  two,  three,  or  four  of  the 
legs,  and  even  the  head  of  the  foetus,  before  delivery  can  jpe  completed. 

As  we  have  shown,  the  number  of  cases  recorded  of  this  kind  of  mon- 
strosity is  relatively  somewhat  large  ;  but  we  will  only  select  a  small 
number  in  illustration  of  the  varieties,  difficulties,  and  results  met  with  in 
practice. 

1.  Bull  [Veterinarian,  vol.  ix.,  p.  158)  mentions  a  Ewe  which  had  gone  its  full  time, 
and  with  difficulty  produced  a  lamb.  This  creature  presented  a  sudden  incurvation 
about  tlie  centre  of  the  spine,  with  a  similar  inversion  of  the  ribs ;  so  that  the  hind  legs 
lay  upon  the  neck  and  upper  part  of  the  shoulders,  while  the  fore  legs  took  a  direction 
upwards,  embracing  the  hind  quarters,  and  forming  a  kind  of  collar,  by  which  they  and 
the  head  were  encircled.  The  head  was  deeply  bent  under  the  breast,  and  the  chest 
and  abdomen  were  not  enclosed  ;  consequently,  all  the  internal  organs  lay  loose  or 
floating  in  the  uterus  while  the  young  creature  was  there  (Fig.  104).  Every  part  appeared 
to  have  attained  its  full  development. 

2.  Tennant  {Ibid.,  vol.  vii.,  p.  439)  describes  the  case  of  a  Cow  which  had  calved.  It 
had  usually  produced  twins,  and  it  was  suspected  another  remained  in  the  uterus.  On 
introducing  the  hand,  it  met  with  a  substance  which  felt  like  the  liver,  and  afterwards 
proved  to  be  so ;  the  parietes  of  the  abdomen  were  absent,  the  common  integuments 
were  reflected  upwards  upon  the  sides,  and  the  whole  of  the  viscera  left  exposed.  The 
left  hind  leg  was  bent  first  forward  and  then  backward  over  the  ilium  towards  the  tail, 
somewhat  enveloped  in  the  integument  of  the  belly.  There  was  no  diaphragm,  but  the 
thoracic  viscera  were  entire.  After  extraction,  the  hind  leg  just  mentioned  was  found 
to  resemble  the  fore  leg. 

3.  Marshall  {Ibid.,  vol.  xl.,  p.  650)  attended  a  small  heifer,  three  and  a  half  years  old, 
which  had  gone  its  full  period  of  gestation,  and  which  three  shepherds  had  been  attempt- 
ing to  deliver  of  its  calf  for  twelve  hours.  Examination /^r  z/a^'-/««w  discovered  one 
fore  and  two  hind-feet,  as  well  as  the  head,  presenting ;  the  latter  being  inverted,  and 
one  knee  and  hock  much  distorted ;  the  tail  could  also  be  felt.  Every  attempt  to  rectify 
the  position  or  extract  the  foetus  by  pulling  failed,  and  the  Cow  was  destroyed.  A 
superficial  examination  of  the  foetus  showed  that  the  whole  of  the  viscera  of  the  abdo- 
men, chest,  and  pelvis  were  on  the  outside  of  the  body,  but  nearly  in  their  normal  posi- 
tion and  perfect.  The  intestines  contained  meconium  ;  the  mammary  glands  and  four 
teats  were  on  the  thighs ;  the  spine  was  bent  backwards  about  the  middle  of  the  dorsal 
vertebra,  with  the  spinous  processes  resting  on  the  sacrum  ;  the  sternum  and  abdornen 
being  split  upon  exposing  the  viscera.  One  fore-leg  was  turned  back  at  the  shoulder, 
resting  upon  the  ribs  near  where  they  join  the  vertebrae,  and  hooked  at  the  pastern  over 
the  spine ;  the  other  fore-leg  was  placed  in  a  contrary  direction,  the  two  hind-legs  and 
head  accompanying  it.  These  were  the  parts  which  presented  in  the  uterus.  The 
foetus  was  alive  a  short  time  before  the  Cow  was  destroyed. 

Recourse  could  not  be  had  to  embryotomy:  "there  was  no  room  to  use  the  knife,  as 
the  greatest  bulk  of  the  foetus  was  at  the  part  to  be  operated  on,  and  the  upper  joints  of 
the  limbs  were  immovable." 

4.  Toll  {Ibid.,  p.  719)  alludes  to  five  cases,  in  two  of  which  the  Cows  were  killed  by 
the  owners ;  in  the  other  three  delivery  was  effected  by  removing  the  abdominal  and 
thoracic  viscera  of  the  foetus,  dividing  the  lumbar  vertebrae  by  means  of  a  strong  knife, 
and  extracting  the  hind  quarters  by  a  hook  and  cord.     The  Cows  did  well. 

5.  Gibbs  and  Helmore  {Ibid.,  vol.  xli.,  p.  517)  each  met  with  a  case.  The  former  was 
successful  in  extricating  the  monstrosity ;  but  the  latter  could  not  deliver,  and  the  Cow 
had  to  be  killed. 

6.  Watson  {Ibid.,  vol.  xliv.,  p.  531)  attended  a  (?ow  in  parturition  which  two  men  had 
been  trying  to  deliver  for  some  hours.  The  animal  was  standing,  and  two  of  the  feet 
of  the  foetus  were  protruding  from  the  vagina.  An  exploration  proved  that  the  calf  was 
malformed,  the  heart  and  intestines  being  exposed,  three  feet  presenting,  and  a  large 
sac  on  the  cranium.  The  head  and  tail  were  in  the  genital  passage,  while  the  fourth 
limb — a  fore  one — was  felt  doubled  up  and  enclosed  in  a  sort  of  bag.     The  cranial  sac 


MONSTROSITIES.  423 

was  punctured  ;  the  confined  limb  released,  by  incising  the  bag  containing  it ;  then,  after 
attaching  cords  to  two  of  the  legs  and  trying  in  vain  to  bring  the  foetus  into  a  favorable 
position,  it  was  found  necessary  to  amputate  two  of  the  extremities  in  utero.  This  was 
done  by  cutting  the  skin  round  the  pastern,  slitting  it  up  to  the  shoulder  in  the  one  case 
and  hip  in  the  other,  then  skinning  and  dissecting  with  the  scalpel.  These  limbs  being 
removed,  cords  were  fastened  to  the  others  and  to  the  lower  jaw.  Considerable  traction 
•  was  then  applied,  and  the  remaining  portion  of  the  foetus  was  extracted. 

The  Cow  made  a  good  recovery.  The  lower  part  of  the  body  of  the  foetus  was  open 
from  the  neck  to  the  anus,  the  spine  curved  backwards  in  a  circle  towards  the  head,  so 
that  the  lower  surface  of  the  vertebrae  became  uppermost ;  the  limbs  and  viscera  were 
correspondingly  displaced,  and  the  skin  had  no  attachments  to  the  other  tissues  ;  there 
was  no  pelvic  cavit}-,  but  simply  a  broad  pubic  bone  growing  out  from  the  vertebrae  with 
which  the  hind  limbs  articulated  ;  and  the  whole  vertebral  column  was  completely 
anchylosed. 

7.  Rossignol  [Jottrnal  de  Med.  Veterinaire  de  Lyons,  1S66,  p.  263)  was  requested  to  assist 
a  Cow  which  was  in  labor.  The  owner  informed  him  that,  instead  of  bringing  forth  a 
calf,  nothing  was  to  be  seen  but  bowels,  and  Rossignol  therefore  suspected  that  a  seri- 
ous injury  had  been  done  to  the  Cow,  through  rupturing  the  metro-vagirtal  parietes.  It 
was  not  so,  however.  The  Cow  was  lying  on  its  left  side,  and  made  no  expulsive  efforts ; 
but  a  large  mass,  composed  of  coils  of  intestine,  distended  by  gas,  lay  outside  the  vulva. 
The  color  of  these  was  rather  bluish,  and  from  their  small  diameter  it  was  obvious  that 
they  belonged  to  the  foetus.  On  passing  the  hand  into  the  vulva,  it  readily  entered  a 
large  cavity,  recognized  to  be  a  part  of  the  foetus  ;  the  kidneys,  liver,  and  rudiments  of 
the  stomach  of  the  young  creature  could  be  touched.  The  abdominal  parietes,  as  well 
as  the  skin,  were  evidently  absent.  As  the  tail  and  the  points  of  the  hocks  could  be 
made  out,  it  was  obvious  that  the  presentation  was  a  posterior  one,  and  that  extraction 
would  be  easy.  Each  hind  limb  was  accordingly  pushed  forward  by  the  cannon  bone 
until  the  hoofs  could  be  touched  ;  these  were  then  lifted  up  and  brought  towards  the 
vulva.  This  manoeuvre  was  facilitated  bv  the  position  of  the  foetus — which  was  lumbo- 
pubic.  Delivery  was  accomplished  in  less  than  half  an  hour.  The  foetus  was  completely 
destitute  of  skin  from  the  last  three  sternal  ribs  to  the  pelvis ;  it  adhered  to,  but  did 
not  extend  beyond,  the  loins  ;  it  covered  the  ribs,  but  not  their  cartilages ;  the  ribs 
curved  outwards,  the  sternal  ones  had  no  cartilages,  and  the  lungs  and  heart  were 
visible. 

The  Cow  lay  as  if  paralyzed  for  eight  days,  and  was  able  to  get  up  on  the  fourth  day 
after  delivery ;  the  following  year  it  gave  birth  to  a  well-formed  calf. 

8.  Daube  {journal  de  Veterinaires  du  Midi,  1869,  p.  497)  visited  a  Cow  which  had  gone 
seventeen  days  beyond  its  time,  and  had  worked  until  the  previous  evening.  It  was 
exhibiting  symptoms  of  colic  ;  a  vaginal  exploration  did  not  discover  any  foetal  move- 
ments. A  large  quantity  of  liquor  amnii  had  escaped,  and  the  udder  had  become  sud- 
denly swollen.  As  the  labor  pains  were  only  very  slight,  nothing  was  attempted  until  the 
next  day.  Early  in  the  morning,  however,  the  owner  came  to  report  that  the  Cow  was 
nearly  dead,  and  though  straining  violently,  there  were  no  signs  of  the  calf.  Daube 
found  the  Cow  lying,  and  apparently  very  prostrate ;  so  he  immediately  proceeded  to 
deliver  it.  When  his  hand  reached  the  uterus  it  met  an  unformed  mass,  the  position  of 
which  he  could  not  ascertain  ;  he  felt  it  in  all  directions,  but  there  was  nothing  definite 
— nothing  but  convexities.  It  was  impossible  to  seize  a  limb :  the  hand  always  glided 
between  the  different  envelopes  of  the  foetus  without  meeting  any  thing  recognizable. 
However,  in  thrusting  it  into  the  abdominal  cavity  the  head  of  the  creature  was  felt, 
and  this  led  to  the  suspicion  that  it  was  a  posterior  presentation.  Passing  the  hand 
over  the  back  a  hard  convex  mass  was  perceived  ;  this  was  the  vertebral  column,  on  each 
side  of  which  the  ribs  were  found  constantly  under  the  hand.  This  extreme  difficulty 
in  diagnosing  the  case,  or  distinguishing  the  position  of  the  calf  and  seizing  the  limbs, 
caused  Daube  to  believe  that  his  hand  was  engaged  between  the  inner  surface  of  the 
uterus  and  the  external  surface  of  the  placenta ;  and  as  he  had  been  already  engaged  for 
two  hours  in  trying  to  make  out  the  nature  of  the  mass,  he  came  to  the  conclusion  that  the 
foetus  had  become  twisted  on  itself  and  entangled  in  the  placenta.  Impressed  with  this 
notion,  he  thought  it  necessary  to  tear  through  what  he  considered  were  the  fecial 
envelopes  (the  "waters"  having  escaped  since  the  previous  evening),  imagining  that  by 
this  procedure  he  might  be  able  to  distinguish  and  seize  the  limbs,  as  well  as  the  body  of 
the  foetus.  This  laceration  having  been  effected,  the  hand  was  withdrawn,  when,  to  his 
great  astonishment,  the  intestines  of  the  creature  were  recognized;  soon  the  liver, 
spleen,  lungs,  etc.,  were  successively  extracted.  But  he  could  not  comprehend  how 
he  had  torn  the  skin  of  the  creature  in  order  to  allow  of  this  escape  ;  however,  in  the 
midst  of  his  manipulations  he  at  last  discovered  the  articulation  of  a  limb,  and  which  he 
took  to  be  that  of  the  stifle.  After  five  hours'  labor,  it  was  deemed  impossible  to  extract 
the  foetus  entire  ;  so  embryotomy  was  decided  upon. 


1 


424 


FCETAL  DYSTOKIA. 


The  limb  was  disarticulated  by  the  bistoury,  and  found  to  be  as  surmised  ;  its  extrac- 
tion, nevertheless,  was  hindered  by  the  ilium,  which  was  placed  in  a  vertical  direction 
at  the  pelvic  inlet  ;  so  he  was  obliged  to  amputate  it  at  the  stifle.  The  foetus  was  pushed 
forward,  and  attaching  a  cord  to  the  ilium,  this  was  brought  into  a  horizontal  position 
and  extracted.  Still  the  hind  limb  could  not  be  removed,  until  by  chance  the  upper 
extremity  of  the  tibia  was  secured  by  a  cord,  traction  was  applied,  and  the  leg  came  away, 
though  destitute  of  skin,  which  had  become  everted  from  it,  and  had  to  be  cut  through 
at  the  foot  before  the  member  could  be  completely  detached.  It  being  impossible  to 
find  the  other  limb,  a  cord  was  tied  to  the  piece  of  skin  which  had  just  been  divided, 
and  a  hook  having  been  fixed  into  the  most  accessible  part  of  the  foetus,  four  men  and 
Daube  himself  pulled  at  the  cords,  when  the  foetus  was  finally  extracted.  At  first  sight 
it  looked  as  if  the  foetus  was  still  in  the  placenta,  but  a  little  investigation  proved  it  to 
be  otherwise.  The  ribs  appeared,  in  the  first  place,  to  form  tv/o  wings  to  the  vertebral 
column;  then  the  skin  of  the  foetus  itself  formed  a  closed  sac  enveloping  it,  and  which 
proved  so  resisting.  The  limbs  were  greatly  misplaced  and  distorted.  The  right 
fore-leg,  for  instance,  was  detached  from  the  scapula  and  suspended  merely  to  the 
skin,  being  apparently  destitute  of  muscle  ;  it  bent  around  behind  the  head  like  a  collar  ; 
the  left  fore  leg  lay  along  the  left  jaw  in  passing  above  the  preceding,  when  it  deviated 
to  the  right,  curved  round  the  nostrils,  and  towards  the  left  eye,  where  it  was  indented 
by  the  other  limb,  the  inferior  extremity  of  which  was  placed  against  the  right  jaw. 
The  left  hind  limb  was  directed  forwards  along  the  vertebrae;  the  tail  was  also  reversed 
and  passed  forward  ;  while  no  trace  of  the  anus  could  be  discovered. 

The  most  remarkable  feature  of  the  case,  in  Daube's  estimation,  was  the  disposition 
of  the  skin,  which  was  inverted — turned  outside-in — and  formed  a  closed  sac  for  the  calf 
itself,  being-  perfectly  contiguous  throughout,  the  internal  part  having  become  external, 
and  the  hair  everywhere  in  contact  with  the  young  creature's  body.  The  pectoral, 
abdominal,  and  pelvic  organs  must,  therefore,  have  floated  in  the  placental  fluid. 

9.  Bosch  [Miinchener  Jahresbericht,  1873-4)  describes  an  instance  in  which  the  intes- 
tines were  enclosed  in  a  skin  capsule  some  distance  from  their  proper  situation,  the 
abdominal  cavity  containing  a  yellowish  mSss  of  exudate  {sulzige  exsicdatmasse'),  as  did 
also  the  foetal  membranes. 

10.  Anacker  [Der  Thierarzt,  1870,  p.  85)  alludes  to  a  monstrosity  of  this  kind,  the  ab- 
domen of  which  presented ;  the  liver,  kidneys,  etc.,  were  removed,  but  the  Cow  had  to 
be  killed. 

Franck  gives  a  number  of  instances  similar  to  the  above.  .  ; 

Double  and  Triple  Monstrosities. 

We  have  already  alluded  to  monstrosities  which  have  the  head  double  ; 
we  now  come  to  the  consideration  of  those  which  have  the  body  more  or 
less  double,  or  even  triple,  and  which  have  been  designated  by  G.  Saint- 
Hilaire  as  Eusomphalian,  Monomphalia?!^  and  Monocephalian,  according  to 
the  degree  of  separation  of  the  bodies,  and  whether  two  are  united  to  a 
single  head — the  double-headed  creatures  being  designated  Syncephalian. 

From  an  obstetrical  point  of  view,  there  is  little  need  to  distinguish 
between  the  Eusomphalian  and  Monomphalian  Monstrosities  ;  for,  as 
already  explained,  they  consist  of  two  distinct  foetuses  joined  together  at 
some  part  of  their  body,  the  character  distinguishing  them  being  the  pres- 
ence of  a  double  or  single  umbilical  cord  (see  Figs,  96,  98,  99,  100). 

The  occurrence  of  such  monstrosities  is  generally,  though  not  always, 
serious,  so  far  as  birth  is  concerned  ;  they  are  met  with  in  all  the  domes- 
ticated animals,  but  perhaps  most  frequently  in  the  bovine  and  ovine 
species.  Several  instances  are  mentioned  in  which  birth  has  taken  place 
without  difficulty,  and  the  young  creatures  have  lived.  Holzner  of  Erding, 
quoted  by  Franck,  states  that  a  double  lamb,  with  eight  feet,  double  abdo- 
men, and  single  breast,  neck,  and  head,  w^as  born  without  assistance.  But 
in  other  cases,  unless  relief  is  afforded,  the  gravest  results  are  certain  to 
ensue. 

Saint-Cyr  alludes  to  three  instances  in  which  embryotomy  had  to  be 
practised,  and  in  two  of  these  the  mother  succumbed  \  the  third,  however, 
— a  Mare — recovered. 


i 


MONSTROSITIES.  425 

Diagnosis. 

The  diagnosis  of  these  monstrosities  is  often  very  difficult,  as  they  may 
be  mistaken  for  ordinary  twins.  Franck  has  drawn  attention  to  the  circum- 
stance that  there  is  very  frequently  a  difference  in  the  presentation  of  the 
■  merely  double-headed  foetus  and  the  double  fcetus,  particularly  the  double 
croup ;  the  first  being  mostly  in  the  anterior  presentation,  the  latter  in  the 
posterior. 

In  the  case  of  the  double  fcetus,  its  presence  may  be  suspected  when 
one  cannot  be  moved  without  also  moving  the  other  ;  when  one  is  brought 
into  a  good  position  with  regard  to  passing  through  the  pelvic  inlet,  and 
it  cannot  be  advanced  beyond  a  certain  point,  though  the  passage  ap- 
pears to  be  sufficiently  wide  to  permit  easy  delivery,  because  the  other 
lies  across  the  inlet ;  when  the  hand  is  passed  between  the  two  foetuses 
and  is  stopped  at  the  point  where  the  skin  is  carried  between  them  at 
their  junction  ;  and  when  they  are  united  by  homologous  parts,  as  already 
explained.  With  regard  to  the  latter,  as  Saint-Cyr  points  out,  we  may 
be  positive.  If,  for  instance,  two  foetuses  lie  together  at  the  inlet  in  the 
same  presentation — anterior  or  posterior — there  is  nothing  to  be  inferred 
from  this  as  to  their  being  monstrosities  or  merely  twins,  as  the  presen- 
tation may  be  the  same  for  these  latter  ;  but  if  one  is  in  the  anterior,  the 
other  in  the  posterior  presentation,  then  we  may  be  certain  that  they  are 
7iot  united.     Heterologous  parts  do  not  unite. 

The  diagnosis  in  the  case  of  Monocephalian  monstrosities  is  compara- 
tively easy  when  the  head  presents.  But  much  care  and  attention  are 
necessary  in  forming  a  diagnosis  in  such  cases,  and  the  examination  of 
the  bodies  should  lead,  if  possible,  to  an  exact  notion  of  their  condition. 

Extraction. 

In  some  cases,  though  they  are  very  rare,  extraction  may  be  possible 
by  manipulation  and  judicious  traction  ;  but,  as  a  rule,  embryotomy,  or 
even  the  Cesarean  section,  has  to  be  practised.  If  it  were  possible  to 
separate  the  two  individuals  by  excising  the  parts  which  unite  them,  then 
birth  would  probably  be  as  easy  as  with  twins  ;  but  it  can  rarely  be  prac- 
ticable, for  the  simple  reason  that  the  point  of  union  is  generally  beyond 
reach  :  it  is  too  extensive  to  be  cut  through,  or  the  junction  is  of  an  os- 
seous character.  Nevertheless,  cases  may  occur  in  which  the  knife  and 
the  obstetrical  saw  or  bone  forceps  may  be  most  effectively  employed  in 
accomplishing  disunion. 

When  the  monstrosity  is  in  the  anterior  presentation,  should  it  prove 
to  be  double-headed,  then  it  will  be  found  advisable  to  remove  one  of 
the  heads  as  low  down  the  neck  as  possible  ;  after  this  is  done,  removal 
of  two  or  more  of  the  anterior  limbs,  by  subcutaneous  section,  will  often 
diminish  the  diameter  of  the  body  to  such  an  extent  that  traction  on  the 
head  and  remaining  skin  of  the  limbs  will  sometimes  effect  delivery.  If 
not,  then  eventration  of  the  thorax  and  abdomen  will  be  necessary. 
When  the  two  croups  cannot  be  made  to  pass  through  the  pelvis  togeth- 
er, it  will  be  imperative  to  divide  each  across,  as  far  back  as  possible, 
extract  the  anterior  halves,  push  the  posterior  into  the  uterus,  turn  them, 
and  deliver  them  as  in  the  posterior  presentation.  Sometimes  excision 
of  one  or  more  of  the  hind  limbs,  in  order  to  diminish  the  volume  of  the 
double  croup,  will  be  necessary  before  the  operation   can   be   completed. 


1 


426  FCETAL  DYSTOKIA. 

With  Monocephalic  monstrosities,  of  course  the  head  and  neck  are  not 
interfered  with,  only  the  body  and  limbs  requiring  attention. 

When  the  presentation  is  posterior,  the  procedure  must  be  carried  out 
in  a  similar  manner ;  but  in  all  cases  the  task  is  a  long  and  fatiguing 
one,  and  the  tax  upon  the  endurance  and  sensibilities  of  the  mother  is 
heavy  indeed. 

The  examples  of  such  monstrosities  occasioning  dystokia  are  not  nu- 
merous ;  in  English  veterinary  literature  we  can  only  discover  two. 

I.  Carlisle  {Veterinarian,  vol.  xiii.,  p.  405)  was  called  to  assist  in  delivering  a  Cow,  the 
peculiar  formation  and  monstroiisness  of  the  calf  preventing  birth.  The  foetus  was  pre- 
senting two  feet  and  a  tail,  but  its  position  could  not  be  made  out,  three  hind  legs  and 
two  tails  being  discovered ;  two  of  the  legs  were  in  the  vjigina,  with  one  tail  ;  the  other 
leg  was  articulated  with  the  superior  part  of  the  pelvis,  and  lay  over  the  back.  The 
body  seemed  to  be  large,  and  changing  its  position  or  extracting  it  was  deemed  impossible. 
The  Caesarean  section  was  proposed,  but  the  Cow  was  too  weak  to  undergo  such  a  formid- 
able operation  ;  so  embryotomy  was  decided  upon.  "  I  introduced  an  instrument  re- 
sembling a  short  strong  bistoury,  guarded  by  my  finger  and  thumb,  with  its  handle  rest- 
ing on  the  palm  of  my  hand.  I  commenced  my  dissection  at  the  rectum,  cutting  down- 
wards, severing  the  symphysis  pubis,  and  dilating  the  opening  as  much  as  possible.  I 
succeeded  in  removing  the  abdominal  viscera,  and  part  of  the  contents  of  the  thorax.  I 
next  crushed  in  the  ribs  ;  by  so  doing  I  was  able  to  remove  the  double  pelvis  and  the  hind 
legs.  We  now  gained  a  favorable  position,  and  from  our  conjoint  efforts  we  brought  to 
light  one  of  the  most  singular  formations  ever  witnessed.  The  animal  had  two  heads, 
seven  legs,  and  nine  feet ;  two  spines  and  two  tails — one  emerging  from  the  termination 
of  each  spine ;  also  a  double  number  of  ribs.  The  ribs  were  given  off  from  the  superior 
and  inferior  spine,  and  met  at  the  middle  of  the  sides,  forming  only  one  cavity.  There 
was  a  trachea  and  oesophagus  to  each  head,  and  these  united  near  to  their  termination  in 
the  lungs  and  stomach.  The  hind  leg,  which  articulated  with  the  superior  parts  of  the 
ossa  innominata,  was  double  from  the  hock,  and  at  its  termination  were  three  distinct 
feet,  perfectly  developed.  The  organs  within  the  thorax  and  abdomen  were  single,  ex- 
cept that  at  the  termination  of  the  colon  the  intestine  was  bifid,  forming  two  rectums, 
which  terminated  under  each  tail.  When  the  creature  was  placed  in  a  standing  position, 
the  two  fore  legs  which  grew  from  the  inferior  spine  pointed  upwards  over  the  shoulders 
of  the  outer  fore  legs.  In  all,  as  I  have  stated,  there  were  four  fore  legs,  three  hind 
ones,  and  nine  feet.  The  umbilical  cord  entered  the  abdomen  on  the  side,  at  the  union 
of  tlie  ribs."  This,  it  will  be  perceived,  was  a  inoitoi7iphalian  monstrosity — Gurlt's 
Cephalo-cormodidiytnus. 

2.  Cartwright  {Ibid.,  vol.  ix.,  p.  619)  describes  a  monocephalous  monstrosity,  which  was 
extracted  by  the  natural  force  of  fifteen  men  and  the  empiric  who  superintended  them. 
Four  hours  were  occupied  in  the  extraction.  The  presentation  was  anterior,  and  the 
calf  was  born  naturally  as  far  as  the  middle  of  the  body.  The  uterus  of  the  Cow  be- 
came prolapsed  soon  after,  and  a  farrier  attempting  to  return  it,  injured  it  so  much  that 
the  animal  had  to  be  killed. 

3.  Jannee,  a  Belgian  Veterinary  Surgeon  {Journal  de  Med.  Veteri7taire  de  Lyon,  1851, 
p.  311),  extracted  a  double  monster  from  a  Mare ;  the  latter  survived. 

4.  Olivier  {Ibid.,  1847,  p.  422)  describes  the  birth  of  a  monocephalous  foetus,  which 
presented  posteriorly,  back  upwards.  Two  hind  feet  had  passed  through  the  vulva  ; 
these  were  pulled  at,  and  this,  with  the  efforts  of  the  mother,  brought  two  other  hind 
feet  into  view.     As  nothing  more  could  be  done  by  traction,  embryotomy  was  practised. 

■  5.  Saint-Cyr  {Op.  cit.,  p.  432)  received  the  body  of  a  monocephalous  lamb  which  had 
been  taken  from  a  Ewe  three  years  old,  and  which  had,  without  much  difficulty,  pro- 
duced three  well-formed  lambs,  then  this  monstrosity.  The  expulsion  of  the  latter  was 
not  very  troublesome  ;  the  presentation  was  anterior,  position  vertebro-sacral.  As  it 
was  a  little  slow  in  being  born,  slight  traction  brought  it  away.  It  was  alive  before  par- 
turition was  completed,  but  was  dead  when  born. 

6.  Franck  {Op.  cit.,  p.  438)  alludes  to  a  Cow  which  "liad  an  extremely  pendulous  abdo- 
men, and  could  not  calve.  An  examination  discovered  four  hind  feet  in  the  genital 
passage ;  so  it  was  surmised  that  the  deep  abdomen  could  not  be  altogether  the  cause, 
and  various  attempts  were  made  at  delivery  ;  but  these  only  resulted  in  producing  tume- 
faction of  the  parturient  canal,  and  a  closer  examination  was  consequently  rendered 
impracticable.  Franck  thought  the  case  was  one  of  twins,  and  tried  to  extract  one  of 
them  by  a  pair  of  the  presenting  feet.  But  as  this  was  impossible,  and  every  other  at- 
tempt failed,  the  Cow  was  killed,  without  embryotomy  having  been  resorted  to.     The 


D  YSTOKIA  FROM  MUL  TIP  A  RITY. 


427 


monstrosity  was  monocephalous — eight  limbs,  double  croup,  and  the  body  single  for- 
wards. 

7.  Horst  (Kahlert's  Geburtshillfe,  p.  186)  removed  a  monomphalian  monstrosity  from 
a  Cow  by  embryotomy. 

8.  Funk  (Franck,  Op.  cit.,  p.  439)  attended  a  Cow  in  which  the  four  hind  feet  of  the 
foetus  presented  ;  it  was  believed  to  be  a  twin  birth.  After  attempting  to  deliver  on 
this  supposition,  it  appears  to  have  been  discovered  that  the  dystokia  was  due  to  mon- 
strosity. The  Cow  was  finally  killed,  and  there  was  found  in  the  uterus  a  very  large 
foetus,  which  had  a  single  head,  chest,  abdomen,  and  two  fore  extremities  ;  but  it  had 
three  spines  and  pelves,  and  to  each  a  pair  of  hind  limbs — six  posterior  limbs  in  all. 

9.  Adam  {Ibid.,  p.  439)  describes  a  double  lamb  which  a  sheep  brought  forth  dead.  It 
was  eusomphalian. 

10.  Tetzler  [Ibid.,  p.  439)  describes  a  triple  monstrosity  he  removed  from  a  Cow, 
which  recovered  from  the  severe  manipulation.  The  monster  was  single  anteriorly,  but 
it  had  two  well-developed  spines,  and  four  hind  limbs,  a  third  rudimentary  spine,  with  a 
pair  of  undeveloped  limbs. 


CHAPTER  IV. 

Dystokia  from  Multiparity. 

At  page  151  allusion  was  made  to  the  relative  position  of  the  young 
in  multiple  pregnancy,  and  at  page  244  we  described  the  manner  in  which 
twin  births  take  place.  We  need  not  again  refer  to  these,  but  we  must 
notice  those  cases — rare  it  is  true — in  which  difficulties  are  encountered 
from  pathological  conditions  in  twin  parturition.  As  has  been  shown, 
in  ordinary  cases  one  foetus  occupies  the  body  of  the  uterus,  the  other  one 
of  the  cornua,  or  both  may  be  in  the  cornua  ;  and  both  may  present  either 
anteriorly  (Fig.  37),  posteriorly,  or  one  in  the  first  and  the  other  in  the 
second  presentation  (Fig.  53),  One  alone  must  pass  through  the  genital 
canal,  then  the  other,  as  there  is  not  space  for  both  at  once  ;  and  birth 
is  usually  quite  as  easy  as  if  there  was  only  one  foetus.  Indeed,  it  is 
sometimes  easier,  from  the  fact  that  parturition  either  occurs  before  the 
full  period  of  gestation  has  expired,  and  the  progeny  are  therefore  not  so 
largely  developed  ;  or,  if  the  usual  term  has  beei^  reached,  it  nearly 
always  happens  that  the  twins  are  smaller  than  in  uniparous  births. 
When  the  most  advanced  foetus  is  expelled,  a  variable  period  elapses  be- 
fore the  birth  of  the  second  takes  place.  During  this  interval,  the  uterus 
is  accommodating  itself  to  its  altered  conditions,  and  preparing  for  the 
expulsion  of  the  remaining  foetus,  while  the  parent  remains  restless,  pays 
but  little,  if  any,  attention  to  the  young  creature  already  born,  and  man- 
ifests a  particular  anxiety,  which  is  an  almost  certain  indication  that  par- 
turition is  not  completed  ;  when  the  uterus  has  got  rid  of  its  occupants, 
the  mother  then  turns  its  attention  to  the  offspring. 

This  is  the  ordinary  course  of  affairs  ;  but  it  is  not  always  so  fortunate. 
In  some  instances,  after  the  expulsion  of  the  first  foetus,  the  uterus  is 
seized  with  a  kind  of  inertia,  and  labor  may  be  suspended  for  hours,  even 
for  days,  and   sometimes  more  than  a  week.*     During  this  suspension, 

*  This  uterine  inertia,  scarcely  noticed  by  veterinary  writers  as  occurring  in  mutiparous  animals,  we  have 
often  observed.  Even  while  we  write  theSe  pages  a  case  presents  itself.  A  medium-sized  bull-terrier 
Bitch,  belonging  to  a  brother  officer,  required  my  assistance  last  year,  through  being  unable  to  pup.  The 
animal  had  been  in  labor  for  some  time,  and  the  head  of  a  puppy  was  in  the  vagina.  This  was  easily  re- 
moved by  an  instrument  hereafter  to  be  described,  as  was  another  which  we  contrived  to  seize  immediately 
afterwards.  These  were  all  that  the  uterus  contained,  and  they  certainly  were  not  too  large  for  the 
genital  passage  ;  the  uterus  could  not  expel  them. 


428 


FCETAL  DYSTOKIA, 


the  parent  at  times  gives  indications  of  uneasiness  by  pawing,  looking  at 
the  sides  now  and  again,  straining  at  intervals  perhaps,  and  not  unfre- 
quently  exhibiting  svmptoms  of  colic,  while  the  milk  retains  all  the  char- 
acters of  colostrum  until  the  other  foetus  is  born. 

Retention  of  the  second  foetus  after  a  certain. time  is  fatal  to  its  exist- 
ence ;  even  in  animals  with  a  multiple  placenta — such  as  the  Cow,  whose 
foetus  retains  its  vitality  much  longer  than  that  of  those  whose  placenta 
is  single,  like  the  Mare — the  retained  fcetus  has  never,  according  to  Saint- 
Cyr,  been  known  to  exist  forty-eight  hours  after  the  birth  of  the  first. 

This  suspension  of  labor  in  twin  birth,  and  which  is  not  at  all  unfre- 
quent,  is  ordinarily  due  to  malposition  of  the  second  fcetus ;  and  this 
cause  of  dystokia  is  one  which  nearly  always  demands  the  attention  of 
the  veterinary  obstetrist. 


Fig.  105. 
Twin  Fcetuses,  in  different  presentations,  passing  into  the  Genital  Canal. 

This  malposition    of  the    single  foetus  will  be   noticed  presently ;  we 
have  now  to   consider  difficult  birth  due  to  multiparity.     Dystokia  from 

About  a  month  ago,  this  officer,  who  had  in  the  mean  time  removed  to  Portsmouth,  wrote  to  inform  me 
that  the  Bitch  was  again  pregnant,  and  owing  to  my  having  made  him  acquainted  with  its  uterine  pecu- 
liarity, he  was  anxious  to  know  wliat  he  should  do  when  its  time  was  due  for  pupping.  Recommending 
certain  hygienic  precautions,  I  advised  that  nothing  special  should  be  attempted  unless  birth  was  delayed, 
as  on  the  previous  occasion ;  then  a  dose  of  tincture  of  ergot  of  rj'e  was  to  be  administered,  followed  by 
another  if  necessary.  The  other  day  I  had  a  letter  stating  that  on  the  Thursday  night  the  Bitch  had  four 
small  pups,  but  there  was  no  sign  of  milk.  A  dose  of  castor  oil  was  given,  as  symptoms  of  constipation  were 
exhibited  (due,  in  all  probability,  to  foetal  retention) ;  the  following  day  the  animal  was  in  pain,  "and  as 
she  was  strong  and  well  in  herself,  I  did  not  like  to  give  the  ergot  of  rye  yet.  However,  on  Saturday 
morning  she  became  very  ill,  and  was  scarcely  able  to  stand  up,  and  yet  there  was  no  milk.  So  about  ten 
o'clock  I  gave  her  a  drachm  of  tincture  of  ergot  of  rye  (our  prescription),  and  about  j  p.m.  she  passed  a 
dead  pup,  followed  shortly  h-j  five  live  ones.  She  is  now  (Tuesday)  all  right,  but  all  the  live  puppies  died, 
save  two." 

This  case  is  interesting,  as  showing  the  tendency  in  some  animals  to  uterine  inertia  ;  as  testifying  to  the 
great  value  of  ergot  of  rye— at  least,  with  the  camivora— its  ecbolic  action  on  animals  being  denied  by 
many  veterinarians  ;  as  proving  that  the  death  of  one  foetus  in  titero  does  not  always  imperil  the  existence 
of  the  others  ;  and  as  demonstrating  that,  contrary  to  what  occurs  in  the  Mare  and  Cow,  foetuses  will  exist 
in  the  uterus  of  the  Bitch  for  forty-eight  hours  after  the  expulsion  of  others  without  succumbing,  even  when 
one  of  their  number  is  dead. 


DYSTOKIA  FROM  MULTIPARITY.  429 

this  cause  always  happens  when  the  two  foetuses  are  about  the  same 
distance  from  the  os  uteri,  and  both  present  together  at  the  pelvic  inlet; 
the  uterine  contractions  carry  them  simultaneously  into  the  opening,  but 
of  course  they  cannot  possibly  pass  through  the  canal  at  the  same  time  ; 
hence  the  difficulty  in  birth — a  difficulty  which  varies  according  to  the 
relative  situation  of  the  two  foetuses  towards  each  other. 

The  foetuses  may  be  so  situated  that  when  the  hand  is  introduced  into 
the  vagina  or  os.  it  will  either  encounter  the  head  of  one  foetus  with  the 
fore  limbs  of  the  Qther ;  four  anterior  or  posterior  limbs  ;  two  hind  and 
two  fore  limbs  (Fig.  105)  ;  two,  four,  or  six  feet  ;  a  head  and  a  tail,  etc. 

The  cause  of  this  malposition  is  in  all  probability  due  to  the  relative 
smallness  of  the  twins,  and  the  changes  which  occur  in  their  situation 
during  birth ;  and  it  will  be  apparent  that  the  obstetrist  must,  in  some 
cases  at  least,  find  it  difficult  to  distinguish  between  such  presentations 
of  twins  and  some  of  the  monstrosities  or  deformities  we  have  described. 

Diagnosis. 

In  such  cases  the  obstetrist  has  to  ascertain,  as  Saint-Cyr  points  out : 
I.  Whether  individual  twins  are  present;  2.  To  distinguish,  among 
the  parts  which  present,  those  which  belong  to  each  foetus.  This  can 
only  be  done  by  a  most  careful  manipulation,  and  even  then  at  times  the 
obstetrist  will  find  himself  embarrassed.  For  instance,  when  the  fore 
feet  of  one  foetus  presents  along  with  the  head  of  the  other,  the  operator 
may  be  led  to  believe  that  there  is  only  one  animal  to  extract ;  and  as 
the  position  is  seemingly  favorable,  and  the  difficulty  only  due  to  exces- 
sive size  of  the  foetus,  powerful  traction  is  resorted  to  for  its  removal. 
This,  however,  fails  to  effect  its  object ;  and  when  another  exploration  is 
made,  it  is  discovered  that  the  attempt  has  so  fixed  the  foetal  parts  in 
the  pelvis,  that  the  most  energetic  and  skilful  manipulation  will  scarcely 
move  them  in  order  to  alter  their  position. 

In  other  instances,  we  fine  the  limbs  of  the  foetuses  so  interlocked  that 
they  are  with  the  greatest  difficulty  disengaged. 

Extraction. 

It  is  evident  that,  if  delivery  is  to  be  effected,  one  foetus  must  be 
extracted  at  a  time.  They  must,  therefore,  be  disengaged,  and  one 
pushed  forward  into  the  uterus,  while  the  other  is  carried  towards  the 
vulva.  When  the  latter  has  been  born,  then  the  second,  if  in  a  wrong 
position,  must  be  adjusted  and  removed. 

This  is  easily  written  ;  those  who  have  had  to  carr}^  it  out  in  practice 
jare  alone  competent  to  say  how  difficult  it  is  to  execute  in  the  majority 
of  cases.  It  must  be  remembered  that,  as  in  nearly  every  other  case,  the 
veterinary  obstetrist  is  only  called  in  when  the  foetuses  have  been  for 
some  time  wedged  in  the  pelvic  enterance  by  the  uterine  contractions, 
and  most  likely  also  by  the  injudicious  manipulations  of  amateurs  or 
empirics.  If  he  had  the  advantage  of  attending  the  animal  before  mat- 
ters had  proceeded  so  far,  and  the  foetuses  were  still  in  the  abdomen, 
then  the  difficulties  would  be  greatly  diminished. 

Recognizing  the  presence  of  twins,  he  would  select  that  which  is  in  the 
most  favorable  position,  cord  the  head  and  fore  limbs,  or  the  hind  limbs 
if  they  presented,  place  them  in  a  good  direction  for  extraction,  and  by 
the  aid  of  assistants  draw  it  towards  the  outlet,  while  the  other  foetus  is 
pushed  deeper  into  the  uterus.     When  the  first  foetus  is  well  into  the 


1 


430  FCETAL  DYSTOKIA. 

passage,  and  the  other  behind  and  clear  of  it,  the  operation  may  be  said 
to  be  completed.  It  may,  be  noted,  however,  that  owing  to  the  obstacle 
offered  by  the  first  foetus,  the  one  remaining  in  the  uterus  is  very  often  in 
a  WTong  position,  and  the  uterus  contracting  upon  it  after  removal  of  the 
other,  may  fix  it  in  that  position,  and  thus  necessitate  adjustment  and 
other  assistance  being  rendered. 

Perhaps  the  following  examples  will  better  illustrate  the  difficulties 
met  with,  and  the  mode  of  overcoming  them,  than  any  thing  more  w-e 
could  add  : 

1.  Cartwright  received  from  Mr.  Cox,  of  Ashbourne,  the  following  description  of  a 
case  : — The  Cow  having  made  no  progress  in  parturition,  he  examined  it,  and  found  the 
tail  and  breech  of  one  foetus  and  all  the  feet  of  the  other  presented.  He  corded  the 
hind  feet  of  the  latter,  and  pulled  at  them,  at  the  same  time  pushing  the  head  and  fore 
legs  back ;  but  from  one  of  the  hind  legs  not  properly  advancing,  he  made  a  further 
examination,  when  he  discovered  that  it  had  passed  between  the  hind  legs  of  the 
other  calf,  constituting  what  country  people  term  "  leg-hanked.  "  The  extremity  of 
the  hind  leg  which  did  not  sufficiently  advance  was  then  unfastened,  and  by  pulling  at 
the  other  leg  it  caused  the  one  still  corded  to  come  from  between  the  hind  legs  of  the 
other  calf ;  after  which  it  was  again  corded  and  brought  up,  and  the  calf  was  readily 
extracted. 

2.  The  same  authority  {Veterhmrian,  vol.  xxi.,  p.  496)  mentions  the  case  of  an  aged 
Ewe  which  was  then  yeaning.  The  head  of  a  lamb  was  seen  beyond  the  vulva,  but  it 
could  not  pass  any  further.  On  introducing  the  fingers  into  the  passage,  the  head  of 
another  lamb  was  felt  within  the  pelvis.  The  Ewe  being  aged  and  roomy,  the  hand 
could  be  passed  into  the  vagina  by  the  side  of  the  protruded  lamb's  neck,  when  the 
head  of  the  other  lamb  was  encountered,  and  pushed  back  into  the  uterus.  Having 
done  this,  one  of  the  fore-legs  was  drawn  out  ;  this  limb  and  the  body  were  then  pulled 
at,  when  the  lamb  was  easily  extracted,  although  the  other  leg  lay  behind.  Only  the 
head  of  the  other  lamb  presented  ;  but  one  of  the  fore-legs  was  eventually  secured,  and 
this  lamb  was  removed  in  the  same  manner  as  the  last.  The  first  lamb  was  a  very 
large  one  ;  the  other  was  smaller.     The  Ewe  and  lambs  did  well. 

Cartwright  remarks  :  "  It  is  astonishing  how  lambs  will  rally  and  recover,  though  ap- 
parently almost  dead." 

3.  Laycock  {  Veterinariatt,  vol.  xxx.,  p.  505)  was  called  to  a  Heifer  in  labor,  and  in 
which,  he  was  informed,  "  all  four  feet  of  the  calf  wanted  to  come  together  " — no  sus- 
picion existing  that  there  was  more  than  oiie  calf  in  the  uterus.  On  examination,  it  was 
discovered  that  twins  were  present,  and  that  their  legs  were  so  entangled  with  each 
other,  through  the  attempts  of  amateurs,  that  it  was  almost  impossible  at  first  to  ascer- 
tain in  what  position  either  calf  presented.  Subsequent  exploration  proved  that  the 
parties  who  had  been  trying  to  deliver  the  Cow  had  drawn  the  legs  of  one  calf  along 
with  the  head  of  the  other,  and  so  far  out  that  neither  head  nor  limbs  could  be  returned 
into  the  uterus.  Finding  that  both  foetuses  were  dead,  one  of  the  protruding  limbs  was 
amputated,  but  no  further  progress  could  be  made  in  delivery ;  then  the  other  limb  of 
the  same  foetus  was  excised,  and  the  body  could  then  be  removed.  The  Cow  was  too 
much  exhausted  to  undergo  manipulation  for  the  extraction  of  the  other  foetus ;  so  stim- 
ulants and  gruel  were  administered,  and  it  was  left  to  rally  until  the  next  morning.  A 
farrier,  however,  soon  after  interfered  ;  he  had  the  animal's  hind  quarters  elevated  by 
means  of  pullevs,  and  took  away  the  calf  ;  the  Cow  quickly  perished.  • 

4.  Austin  [Ibid.,  vol.  xxxiv.,  p.  16)  mentions  a  Cow  in  New  Zealand,  which  had  been 
in  the  field  a  day  and  night  with  the  head  and  fore  legs,  apparently,  of  a  calf  protruding 
from  the  vagina.  The  calf  was  dead.  "  After  making  the  Cow  fast,  I  found  that  the 
head  belonged  to  one  calf  and  the  fore  legs  to  another,  and  it  was  a  work  of  some  little 
time  to  put  back  both  the  calves,  and  get  them  out  separately — the  fore  legs  of  the  first 
calf  and  the  head  of  the  second  being  doubled  back." 

Both  calves  were  dead ;  the  Cow  ultimately  did  well. 

5.  Canu  [Reaieil  de  Med.  Veterinaire,  1837^  p.  442)  gives  the  following  good  case  of  a 
fine  Cow,  five  years  old: — Being  sent  for  to  see  this  animal,  Canu  found  in  the  vagina  a 
head  and  six  limbs  so  interlaced  that  it  was  difficult  to  distinguish  the  anterior  from  the 
posterior.  The  head  was  only  half  through,  and  the  fore  limbs  of  the  most  favorably 
situated  foetus  were  no  further  advanced  than  those  of  the  other  ;  the  straining  of  the 
mother  acted  on  both  the  foetuses  alike,  and  as  the  second  one  occupied  one-third  of  the 
pelvic  cavity,  no  progress  whatever  was  made.  In  order  to  avoid  a  mistake,  cords  of 
different  colors  were  attached  to  each  foetus.     Attempts  were  then  made  to  push  for- 


DYSTOKIA  FROM  MULTIPARITY. 


431 


ward,  with  the  right  hand,  the  foetus  which  presented  the  four  limbs,  while  traction  was 
exercised  on  the  other. 

This,  however,  was  unavailing,  for  when  the  front  part  of  the  first  foetus  was  pushed 
the  hind  quarters  presented,  and  vice  versd ;  so  Canu  was  obliged  to  introduce  both 
hands  into  the  vagina.  The  arms  being  sustained  by  an  assistant,  the  anterior  limbs 
were  seized  by  one  hand,  the  posterior  in  the  other,  and  then  he  pushed  with  all  his 
strength ;  while  two  assistants,  pulling  at  the  moment  when  the  Cow  made  a  great 
effort,  advanced  the  first  foetus,  the  chest  of  which  caused  Canu  to  withdraw  his  arms, 
when  the  entire  foetus  soon  came  away.  With  regard  to  the  second  foetus,  two  cords 
were  fixed  on  the  posterior  limbs ;  the  tail  was  well  placed,  and  the  fore-arms  being 
grasped  above  the  knees,  they  were  pushed  into  the  uterus.  The  assistants  then  pulled, 
the  croup  passed  into  the  genital  passage,  and  birth  was  promptly  terminated. 

6.  Liautard  {Joicrnal  de  Med.  Veterinaire  de  Lyon,  1846,  p.  575)  states  that  a  Mare 
belonging  to  the  Military  Train  had  been  accidentally  impregnated  by  an  Arab  horse 
while  in  bivouac.  Experiencing  difficulty  in  foaling,  he  was  called  upon  to  attend  upon 
this  Mare.  On  his  arrival,  he  found  it  to  be  in  an  anxious  state,  looking  alternately  to 
the  right  and  left  side,  and  attempting  to  get  rid,  by  rubbing,  of  a  foetus  half  extruded 
from  the  vulva,  but  whose  posterior  extremities  evidently  prevented  further  progress  ; 
the  poor  animal  endeavored  to  seize  the  foal  by  its  teeth,  strained  in  an  irregular  man- 
ner, and  was  much  agitated ;  then  it  gathered  itself  on  its  hind  quarters,  lay  down  on 
the  litter  with  a  plaintive  moan,  sprang  up  again  immediately,  neighed,  and  impatiently 
kicked  the  ground. 

The  foetus  was  in  a  good  position ;  its  envelopes  were  ruptured  and  the  "  waters  " 
had  escaped ;  the  fore  limbs  rested  on  the  Mare's  thighs,  while  the  head,  hanging  be- 
tween them,  showed  some  contusions  ;  the  foal  still  lived. 

Two  men  placed  at  the  head  of  the  Mare  grasped  her  securely,  and  a  third  held  up  a 
fore  foot ;  while  an  intelligent  assistant,  standing  beside  Liautard,  seconded  his  efforts. 
The  energetic  straining  of  the  Mare  effectually  prevented  any  retrograde  movement  of 
the  foal,  which  was  otherwise  too  far  expelled  to  be  pushed  forward.  After  a  number 
of  fruitless  efforts,  the  open  hand,  introduced  on  the  left  side  of  the  foal,  finally  reached 
the  OS  uteri,  when  it  was  found  that  the  creature  was  not  malformed,  and  the  hind  limbs 
had  a  good  direction  ,  there  was  nothing  anomalous  in  the  cervix;  but  a  hard  movable 
body,  which  the  hand  could  scarcely  disturb,  because  of  the  difiiculty  of  introducing  it 
farther,  was  engaged  in  the  inlet,  into  which  it  entered  more  deeply  as  soon  as  the  pres- 
sure was  removed.  From  an  attentive  examination,  Liautard  acquired  the  conviction 
that  this  body  was  a  second  foetus,  which  must  be  moved  out  of  the  way  if  the  Mare  was 
to  be  relieved  from  the  painful  state  it  was  in,  and  delivery  effected.  With  this  view,  it 
was  pushed  into  the  uterus  as  far  as  possible,  the  arm  was  quickly  drawn  from  the  va- 
gina, and  the  assistant  at  that  instant  pulling  the  partially  extruded  foal  promptly  and 
energetically,  while  the  Mare  made  a  strong  expulsive  effort,  the  half-born  creature  was 
extracted. 

Soon  after,  another  foetus — dead,  and  in  its  envelopes — was  ejected  almost  without 
an  effort.  This  one  appeared  to  have  died  about  the  fifth  month  of  gestation,  and  its 
small  size  explained  how  it  could  _  partially  enter  the  pelvis,  even  though  the  passage 
was  already  occupied  by  the  first. '  With  regard  to  the  latter,  it  died  fourteen  days  after 
birth,  from  the  effects  of  an  inguinal  hernia  produced  during  parturition — doubtless  by 
the  compression  the  abdominal  region  experienced  while  passing  through  the  narrowed 
genital  canal. 

7.  Van  Hertsen  {Annales  de  Med.  Veterinaire  de  Brzixelles,  1864,  p.  281)  communi- 
cates the  case  of  a  fine  Dutch  Cow,  for  the  fourth  time  pregnant,  and  in  labor  for  an 
hour.  The  two  front  limbs  and  the  head  of  a  calf  appeared  at  the  vulva,  and  notwith- 
standing the  energetic  pulling  of  six  men,  by  means  of  cords  tied  to  the  limbs  and  the 
lower  jaw,  it  was  impossible  to  extract  it.  Introducing  his  oiled  hand  into  the  vagina. 
Van  Hertsen  discovered  that  the  head  and  two  limbs  of  the  foetus  apparent  at  the  vulva 
were  so  tightly  fixed  in  that  canal  that  he  could  not  turn  them ;  indeed,  he  could  scarcely 
pass  two  fingers  as  far  as  the  middle  of  the  passage.  It  therefore  became  necessary  to 
push  the  calf  into  the  uterus,  in  order  to  discover  the  obstacle  to  birth ;  but  it  was  im- 
possible to  do  so — //  was  like  pushing  against  a  wall.  To  make  further  traction  on  the 
head  and  limbs  appeared  to  be  useless  ;  these  appeared  to  belong  to  a  calf  of  ordinary 
size,  and  the  obstacle  to  its  expulsion  must  depend  on  some  other  cause.  Embryotomy 
appeared  to  be  indispensable,  and  was  at  once  resorted  to.  The  lower  jaw,  already  dis- 
articulated, was  removed  ;  then,  though  with  much  difficulty,  the  head  was  excised  ;  but 
the  limbs  were  not  cut  off,  as  it  was  thought  they  might  prove  useful  to  attach  cords  to 
afterwards.  It  was  again  attempted  to  push  the  body  into  the  uterus  ;  the  Cow  was 
lying,  and  Van  Hertsen,  lying  down  also  behind  it,  and  placing  his  feet  against  a  barrel, 
seized  with  his  right  hand  the  first  cervical  vertebrae  of  the  foetus,  and  in  the  left  hand 


432  FCETAL  DYSTOKIA. 

the  two  fore  limbs,  and  pushed  with  all  his  force.  All  at  once  the  part  held  in  the  right 
hand  went  forward  into  the  uterus,  but  the  limbs  did  not  stir.  Being  then  able  to  intro- 
duce his  hand  easily  into  the  uterine  cavity,  he  ascertained  that  it  contained  two  calves, 
placed  one  above  the  other.  The  limbs  in  the  vagina  belonged  to  the  lower  one,  the 
Ivsad  of  which  was  bent  back  beneath  the  sternum  and  between  the  limbs,  so  that  the 
neck  lay  against  the  Cow's  pubis.  The  upper  calf  lay  like  one  Horse  upon  another, 
and  it  was  the  head  of  this  one  which  had  passed  into  the  vagina. 

It  was  then  easy  to  extract  the  calves  in  succession,  only  one  assistant  being  neces- 
sary. The  lower  calf  was  not  yet  dead,  though  it  died  soon  after  extraction.  Eight 
days  subsequent  to  this  operation  the  Cow  was  perfectly  well. 

GROUP  II. 

DYSTOKIA  FROM   MALPRESENTATION   OR   MALPOSITION 
OF  THE  FCETUS. 

Though  the  impediments  to  labor  in  the  human  female  are  not  unfre- 
quently  due  to  the  foetus  being  in  such  a  position  that  it  cannot  pass 
through  the  pelvic  canal,  yet  it  is  very  questionable  whether,  in  animals, 
this  cause  of  dystokia  is  not  much  more  common,  much  more  compli- 
cated, and  very  much  more  difficult  to  be  rectified.  In  woman  the  im- 
pediment in  this  case  chiefly  occurs  when  the  axis  of  the  foetus  does  not 
coincide  with  that  of  the  uterus — when,  for  instance,  the  head  or  the 
breech  cannot  pass  through  the  pelvic  inlet,  and  the  presentation  is  more 
or  less  oblique  or  transverse.  It  is  exceedingly  rare  indeed  that  the  neck 
or  limbs  offer  an  obstacle  to  birth. 

With  the  calf  and  foal  the  case  is  very  different.  These  creatures  have 
the  neck  and  limbs  long  and  very  flexible,  and  even  the  body  itself  is 
comparatively  long  and  readily  curved  in  any  direction.  The  conse- 
quence is  that  the  limbs  or  neck  may  be  bent  under,  to  one  side,  or  above 
the  trunk  ;  while  the  latter  may  be  flexed  in  such  a  manner  as  to  become 
quite  distorted. 

For  these  reasons,  we  have  a  great  number  of  more  or  less  complicated 
malpresentations  and  positions,  which  give  rise  to  varying  degrees  of  dys- 
tokia, some  of  them  of  a  very  formidable  kind. 

It  will  therefore  be  readily  understood  that,  even  when  the  axis  of  the 
young  creature's  body  coincides  with  that  of  the  uterus  and  pelvic  canal, 
and  the  latter  is  normal  in  dimensions,  birth  may  not  be  possible  without 
assistance ;  and  this  establishes  a  wide  difference  between  the  obstetrics 
of  the  human,  and  the  equine  and  bovine  species.  Added  to  this,  the 
veterinary  surgeon  has  the  difficulties  before  mentioned  to  contend  with: 
powerful  and  often  irritable  animals ;  a  long  genital  canal  and  deep 
uterus  ;  uterine  contractions  so  energetic  that  they  fatigue  and  paralyze 
the  hand  and  arm  ;  the  disadvantages  of  position  in  the  parturient  animal ; 
the  late  period  at  which  professional  assistance  is  sought  for  ;  and  the 
damage  that  may  have  been  inflicted  by  amateurs  and  empirics. 

Considering  the  frequency  of  these  causes  of  dystokia,  and  their  often- 
times serious  character,  they  deserve  the  most  careful  study  in  order  that 
they  may  be  successfully  overcome.  This  study  also  embraces  the 
measures  to  be  adopted  in  overcoming  them  ;  and  as  certain  of  these 
have  to  be  resorted  to  in  nearly  every  case  of  this  kind,  we  will  now  refer 
to  them.  These  general  measures  are  based  on  the  indication  afforded 
by  the  knowledge  that,  as  labor  is  rendered  difficult  or  impossible  from  a 
vicious  position  of  the  young  creature,  so  this  position  must  be  changed 


DYSTOKIA  FROM  MALPRESENTATION  OF  FOETUS.      433 

to  one  more  favorable,  in  order  that  natural  or  spontaneous  birth  may 
be  effected,  or  artificial  extraction  rendered  possible.  This  change  of 
position  can  only  be  effected,  as  a  rule,  by  moving  the  foetus  itself,  and 
so  altering  its  relations  to  the  neighboring  parts  of  the  mother  :  the 
movements  being  designated  7fiutations  by  obstetrists. 

The  procedure  varies  with  circumstances  :  sometimes,  for  instance,  the 
object  rnay  be  achieved  by  merely  altering  the  position  of  the  parturient 
animal;  at  other  times  by  sustaining  its  abdomen  and  manipulating  exter- 
nally ;  but  in  the  great  majority  of  cases,  it  is  necessary  to  introduce  the 
hand  into  the  genital  canal,  and  operate  directly  on  the  body  of  the  foetus. 
The  principal  of  these  mutation  movements  are  three  in  number:  Retro- 
pulsion.  Rotation,  and  Version. 

In  order,  however,  that  these  movements  may  be  effected,  certain  con- 
ditions are  necessary.  In  the  first  place,  it  is  absolutely  essential  that  the 
OS  uteri  be  sufficiently  dilated,  or  relaxed  and  extensible,  for  the  hand  to 
reach  the  interior  of  the  uterus  ;  next,  the  body  of  the  foetus  must  be 
movable  in  the  uterus — a  circumstance  not  always  noted,  as  the  organ 
is  often  closely  contracted  on  its  contents,  should  the  liquor  amnii  have 
escaped  some  time,  or-  the  foetus  itself  may  be  fixed  in  the  pelvic  canal. 
And,  finally,  the  foetal  envelopes  must  be  ruptured,  as  it  is  impossible  to 
manipulate  the  young  creature  effectively  while  it  is  entirely  invested  in 
them. 

Before  any  alteration  in  the  position  of  the  foetus  can  be  accomplished, 
these  conditions  must  be  assured. 

Retropulsion, — When  the  foetus,  in  a  vicious  position,  has  entered  the 
pelvic  cavity  and  become  fixed  there,  or  even  when  in  the  uterus  and 
approaching  the  inlet,  before  the  position  can  be  corrected  it  is  nearly 
always  necessary  to  push  it  forward  into  the  uterus  ;  as  there  only,  from 
the  greater  space  this  organ  affords,  and  the  elasticity  of  its  walls,  can 
the  impediment  be  overcome  and  adjustment  effected. 

"  Retropulsion  "  is  often  necessary  during  protracted  labor,  even  when 
the  foetus  is  in  a  good  position,  to  enable  the  obstetrist  to  attach  cords  to 
the  limbs  or  some  part  of  the  head  or  body. 

The  retropulsion  is  sometimes  easy,  at  other  times  it  is  most  difficult 
and  laborious,  and  in  certain  cases  it  may  even  be  altogether  impossible. 

The  most  favorable  attitude  for  performing  this  operation,  in  the  larger 
animals  at  least,  is  undoubtedly  the  standing  one  ;  but  the  body  should 
not  be  perfectly  horizontal,  as  a  great, advantage  will  be  derived  from 
raising  the  hind  quarters  to  a  considerable  degree,  as  we  thereby  throw 
the  uterus  and  its  contents  forward,  and  away  from  the  pelvic  inlet.  This 
elevation  may  be  effected  by  straw  or  litter  placed  under  the  animal's 
hind  feet.  In  order  to  obtain  this  inclination  promptly,  Schaack  recom- 
mends that  the  Cow  be  made  to  kneel  on  its  knees  ;  two  assistants  keep- 
ing the  fore  limbs  flexed,  while  other  two  maintain  the  hind  quarters  in 
an  upright  position. 

When  the  animal  is  recumbent  and  cannot  be  induced  to  rise,  there  is 
but  little,  if  any  thing,  to  be  gained  by  raising  and  supporting  it  by  means 
of  slings  or  other  appliances  ;  as  the  pressure  which  these  produce  on  the 
abdomen  opposes  the  manoeuvres  we  have  mentioned.  Not  unfrequently 
the  sight  of  a  strange  dog  will  cause  the  animal  to  get  up. 

When,  however,  the  Mare  or  Cow  is  exhausted,  and  it  would  be  injudi- 
cious or  impossible  to  make  it  stand,  then  manipulation  must  be  attempted 

28 


434 


FCETAL  DYSTOKIA. 


in  the  recumbent  posture.  When  this  is  decided  upon,  in  the  great  ma- 
jority of  cases  it  will  be  found  that  a  considerable  advantage  will  be  ob- 
tained by  placing  the  animal  on  its  back,  propping  it  up  in  this  ]Dosition 
with  trusses  of  straw  placed  on  each  side,  and  raising  the  croup  by  intro- 
ducing another  truss  beneath  the  hind  quarters. 

.  With  regard  to  the  smaller  animals,  such  as  the  Bitch,  they  can  be 
placed  on  their  back  on  a  table,  and  an  assistant  may  raise  the  pelvis  as 
high  as  may  be  deemed  necessary.  Retropulsion  of  the  foetus  may  be 
effected  with  the  hand  in  the  large  animals,  the  operator  supporting  him- 
self firmly  on  his  legs  ;  the  arm  must  be  strong,  and  very  often  it  has  to  be 
engaged  in  the  genital  canal  as  high  as  the  shoulder.  It  may  sometimes 
happen  that  both  hands  have  to  be  employed  as  repellers,  and  the  body 
of  the  operator  pushed  forward  by  assistants. 

Seeing  the  difficulties  attending  this  operation,  and  finding  that  the 
hand  and  arm  are  not  always  sufficient,  Continental  veterinarians  have 
for  a  long  time  resorted  to  a  "crutch"  or  "repeller"  (French, /c*<?/r??/j-- 
soir ,   German,  Geburtskriicke)  in  conjunction  with  the  hand. 

This  instrument  is  of  iron,  and  is  between  two  and  three  feet  in 
length  ;  it  has  a  handle  at  one  end,  and  a  concave  transverse  piece,  like 
the  head  of  a  crutch,  at  the  other.  This  piece  may  be  either  solid  or 
jointed  (Figs.  io6,  107,  108,  109).  Provided  the  latter  is  sufficiently 
strong  at  the  joints,  it  possesses  advantages  over  the  solid  instrument : 
the  principal  of  which  is  its  easier  introduction  into  the  vagina  and  uterus. 
The  crutch  end  being  carefully  carried  by  one  hand  through  the  genital 
canal,  towards  the  foetus,  is  applied  to  the  most  convenient  part  of  the 
latter  ;  while  the  handle  is  seized  in  the  other  hand,  and  the  propulsion 
may  then  be  effected  either  by  this  hand,  the  breast  of  the  operator,  or 
by  an  assistant. 

Many  authorities  speak  very  highly  of  this  instrument,  from  the  fact 
that  it  permits  the  displacement  of  the  foetus  much  further  forward  than 
the  hand  alone  can  effect,  and  thus  allows  a  wider  space  between  the 
pelvic  inlet  and  the  body  of  the  young  creature  ;  consequently,  adjust- 
ment of  the  latter  can  be  more  easily  and  promptly  accomplished. 

An  assistant  can  maintain  the  body  of  the  foetus  some  distance  from 
the  pelvis  by  this  instrument,  while  the  hand  of  the  operator  is  making 
the  necessary  rectifications  ;  the  latter  is  therefore  much  relieved,  and  to 
some  extent  he  is  also  exempted  from  the  difficulty  and  fatigue  caused  by 
the  uterine  contractions. 

The  ordinary  repeller  has  some  disadvantages,  the  greatest  of  which, 
perhaps,  is  its  being  inapplicable  to  certain  regions  of  the  foetus  which 
may  chance  to  be  in  an  oblique  line  to  its  direction — such  as  the  head, 
limbs,  etc.  To  remedy  this  defect,  I  have  added  a  short,  pointed  spike, 
which  can  be  screwed  into  the  middle  of  the  crutch,  opposite  the  handle, 
when  necessary  (Fig.  106);  and  this  effectually  prevents  its  slipping; 
the  part  in  contact  with  the  foetus,  when  provided  with  this  tooth  or 
spike,  resembles  a  trident.  While  the  instrument  is  being  employed — 
all  propulsion  should  only  be  made  during  the  intervals  between  the 
pains — one  hand  of  the  operator  should  guide  and  maintain  it  against  the 
foetus,  to  prevent  injury  to  the  maternal  organs. 

Some  authorities,  however,  object  to  the  employment  of  the  repeller — 
or  rather  assert  that  they  have  never  required  its  services.  Brunet  and 
Schaack  observe  that  when  their  own  strength  is  not  sufficient,  they  are 
aided  by  an  assistant.     Brunet  has  the  hand  and  arm  of  the  latter  acting 


DYSTOKIA   FROM  MALPRESENTATION  OF  FCETUS.     435 

on  the  fcetus  at  the  same  time  as  his  own — both  arms  being  in  the  genital 
canal ;  while  Schaack  gets  his  assistant  to  seize  his  right  arm  with  one  of 
his  hands,  resting  the  other  on  his  left  shoulder,  and  pushing  him  for- 
ward— Schaack's  right  arm  and  hand  in  this  way  playing  the  part  of  the 
crutch. 


Solid  Repeller,  with 
A  Movable  Spike. 


Fig.  107. 

Si.MPLE- Jointed 
Repeller. 


Fig.  io8. 

Jointed  Repeller: 
Open. 


Fig.  109. 

Jointed  Repeller: 
Closed. 


In  order  to  propel  the  head,  Binz  invented  an  instrument  like  a  gob- 
let, furnished  with  a  long  handle  ;  the  hollow  portion  fitted  on  the  muzzle 
of  the  foetus,  and  the  head  could  then  be  pushed  forward.     Solid  rods  to 


1 


436 


FCETAL  DYSTOKIA. 


be  fixed  to  the  limbs  of  the  foetus,  in  order  to  push  them  out  of  the  way, 
have  been  proposed,  but  their  utility  is  questionable. 
■  It  must  not  be  forgotten  that,  after  all,  the  hand  is  the  safest  and  most 
perfect  of  instruments,  and  should  always  be  preferred — at  least  at  first — 
to  such  appliances  as  we  have  described.  Saint-Cyr  truly  remarks  that 
the  hand  feels  the  parts  on  which  it  is  placed ;  it  adapts  itself  more  ex- 
actly to  the  surfaces  with  which  it  comes  in  contact ;  it  perceives  the 
resistance  they  offer,  and  warns  the  operator  as  to  the  amount  of  force 
necessary  to  effect  a  certain  object ;  whereas  the  presence  of  a  hard  and 
rigid  instrument  increases  the  uterine  contractions  ;  and  however  well 
adapted  it  may  be,  it  may  suddenly  glide  off  rounded  and  slippery  sur- 
faces, and  cause  serious  injury. 

Nevertheless,  there  may  be,  and  often  are,  occasions  when  the  hand 
cannot  accomplish  what  is  necessary  in  the  way  of  retropulsion,  and  it  is 
these  in  which  the  repeller  may  be  most  useful,  and  it  will  be  found  quite 
safe  when  employed  by  a  careful  and  experienced  operator. 

We  have  already  remarked  that  this  operation  is  frequently  very  diffi- 
cult and  laborious,  especially  when  the  animal  has  l)een  in  labor  for  some 
time.  When  the  "  waters  "  have  escaped,  the  uterus  is  closely  and  spas- 
modically applied  to  the  body  of  the  fcetus,  a  portion  of  which  may  be  so 
firmly  wedged  in  the  pelvis  that  to  move  it  appears  to  be  a  hopeless  task ; 
and  the  genital  canal  is  itself  hot  and  dry.  The  first  indication  in  such 
cases  is  to  lubricate  this  canal,  as  well  as  the  interior  of  the  uterus,  in 
order  to  overcome  the  intimate  adhesion  between  that  organ  and  the 
foetus.  Mucilaginous  or  oily  fluids  may  be  employed  for  this  purpose, 
and  they  should  be  injected  unsparingly  into  the  genital  canal,  the  hind 
quarters  of  the  animal  being  at  the  same  time  raised  as  high  as  possible, 
in  order  to  facilitate  the  entrance  of  the  lubricant.  After  a  few  injections, 
the  uterus  in  some  cases  becomes  relaxed,  and  the  foetus  may  then  be 
pushed  away  from  the  pelvis. 

This  spasmodic  contraction  of  the  uterus,  especially  during  the  labor 
pains,  is  a  great  obstacle  to  every  kind  of  manipulation  in  the  interior  of 
the  organ.  In  order  to  diminish  the  violence  of  the  pains,  it  is  often 
attempted  to  attract  the  animal's  attention  by  pinching  its  body  ;  pressing 
on  its  loins  with  a  stick  ;  putting  a  twitch  on  the  Mare's  nose  or  ear  ; 
partially  closing  the  nostrils  to  check  inspiration  ;  tying  a  rope  tightly 
round  the  body ;  placing  a  strange  dog  before  it,  etc.  The  inclined  posi- 
tion of  the  body  may  allay  them. 

When  any  or  all  of  these  means  fail,  it  may  be  necessary  to  give  the 
animal  a  narcotic  in  the  form  of  opium  or  chloral  hydrate,  either  in 
draught  or  enema  (we  prefer  the  latter),  and  to  continue  the  emollient 
injections. 

Retropulsion,  as  we  have  said,  should  only  be  effected  in  the  intervals 
between  the  "pains  ;"  though  during  these  the  expulsive  efforts  should 
be  resisted,  so  that  what  has  been  accomplished  may  not  be  lost.  The 
propulsion  should  be  done  by  jerks,  which  are  far  more  effective  than  a 
continuous  push  ;  they  are  not  productive  of  any  inconvenience. 

Rotation. — "  Rotation  "  of  the  foetus  consists  in  turning  it  more  or 
less  round  its  longitudinal  axis,  with  the  view  of  changing  the  relation 
between  the  presenting  parts  and  the  maternal  pelvis,  or,  as  Saint-Cyr 
has  it,  modifying  tho;  position  without  interfering  with  t\\Q.  presentation. 

After  pushing  away  the  body  of  the  foetus — but  not  its  limbs,  if  they  are 


DYSTOKIA  FROM  MALPRESENTATION  OF  FCETUS. 


437 


well  placed — from  the  pelvic  inlet,  the  hand  and  fore-arm  are  introduced 
in  supinaticm  and  well  forward  between  the  body  of  the  young  creature 
and  the  floor  of  the  uterus  ;  then  resting  the  arm  on  the  pubis,  it  is  em- 
ployed as  a  lever  in  raising  and  turning  the  part  of  the  foetus  in  hand  to 
the  right  or  left,  as  may  be.  If  the  young  creature  is  nlive,  this  manoeu- 
vre is  much  more  easily  executed  than  when  it  is  dead,  as  it  seconds  the 
effert.  BoutroUe  advises  that  the  abdomen  of  the  mother  be  raised  by 
means  of  a  girth  or  folded  blanket,  while  rotation  is  being  effected  ;  and 
other  authorities  have  recommended  the  employment  of  a  lever  between 
the  foetus  and  the  uterus  to  effect  this  turning.  Rainard  recommends, 
when  the  limbs  are  in  the  pelvis,  to  tie  them  together,  draw  them  beyond 
the  vulva,  put  a  piece  of  stick  or  any  oth^r  convenient  article  between 
them,  and  to  use  this  as  a  kind  of  lever  to  turn  the  body  of  the  foetus 
round  to  the  necessary  extent ;  or,  which  is  preferable,  as  in  the  latter 
operation  the  limbs  of  the  young  animal  may  be  seriously  injured,  to  give 
the  limbs  to  an  assistant  who,  acting  under  instructions  from  the  opera- 
tor, turns  them  one  over  the  other  in  a  kind  of  twisting  and  swinging 
manner,  in  the  direction  indicated  by  the  operator,  whose  efforts  are  in 
this  way  greatly  assisted. 

The  operation  of  rotation  is  completed  when  the  greatest  diameter  of 
the  foetus  is  coincident  with  the  sacro-pubic  diameter  of  the  pelvic  inlet 
— a  right  or  left  vertebro-ilial  position,  for  example,  being  transformed 
into  a  vertebro-sacral  position. 

Saint-Cyr  points  out  that  this  modification  need  not  always  be  so  com- 
plete, and  that  it  frequently  suffices  to  convert  a  lateral  position  into  an 
oblique  one,  by  making  the  dorso-sternal  diameter  of  the  foetus  correspond 
to  the  oblique  diameter  of  the  inlet — measuring  this  from  the  supra- 
cotyloid  crest  of  one  side  to  the  sacro-iliac  articulation  of  the  other.  The 
same  observation  is  applicable  to  posterior  presentations. 

Version. — "  Version,"  or  *'  turning,"  in  veterinary  obstetrics  signifies 
effecting  a  change  of  presentatio7i,  or,  in  other  Avords,  bringing  towards  the 
inlet  a  part  of  the  foetus  other  than  that  which  presented  spontaneously, 
and  thus  correcting  a  faulty  presentation. 

A  longitudinal  presentation  is  that  in  which  spontaneous  birth  can  be 
alone  effected  ;  a  transverse  presentation  renders  birth  impossible,  and 
these,  consequently,  give  rise  to  dystokia.  Version  is  therefore  indicated 
in  all  transverse  presentations,  no  matter  what  region  of  the  body  may 
first  offer  at  the  pelvic  inlet  j  it  may  even  be  required  in  certain  forms  of 
anterior  or  posterior  presentation  ;  and  in  all  cases  it  is  necessary  to 
repel  the  presenting  part,  so  as  to  bring  one  or  other  of  the  ends  of  the 
oval  mass  formed  by  the  body  of  the  foetus  to  the  pelvic  inlet. 

Hence  we  have  two  kinds  of  version  :  one  which  has  for  its  object  the 
movement  of  the  head  of  the  foetus  towards  the  pelvic  inlet — anterior  or 
cephalic  version ;  and  the  other  the  posterior  part  of  the  body  to  the 
same  opening — posterior  or  pelvic  version,  corresponding  to  the  podalic 
version  in  human  obstetrics.  Each  of  these  versions  has  its  advantages 
and  disadvantages,  according  to  circumstances  ;  though  the  majority  of 
authorities  ^xoi^x pelvic  version,  for  the  simple  reason  that  with  this  there 
are  only  two  appendages  to  care  for — the  hind  limbs,  to  which  it  is  com- 
paratively easy  to  give  a  good  direction  ;  while  in  cephalic  version  there 
are  not  only  the  fore  limbs  to  attend  to,  but  also  the  head  and  neck,  the 
unfavorable  direction  of  which  may  give  rise  to  much  trouble  in  delivery. 


438  FOETAL  DYSTOKIA. 

Version  can  only  be  effected  in  the  uterine  cavity,  when  the  uterus  is 
entirely  in  the  abdomen  ;  so  if  any  portion  of  the  foetus  has  entered  the 
inlet,  retropulsion  must  be  resorted  to.  Then  the  operation  can  be  com- 
menced. It  is  divided  by  Saint  Cyr  into  two  principal  movements  : 
Repulsion  and  Evolution. 

In  these  manoeuvres,  the  veterinary  obstetrist,  as  in  so  many  other  in- 
stances, has  not  the  advantages  which  the  accoucheur  of  woman  possesses 
with  regard  to  manipulation,  and  especially  that  which  can  be  practised 
outside  the  abdominal  walls  in  conjunction  with  the  version  movements 
in  the  uterus. 

Repulsion. — The  hand — usually  the  right — being  introduced  into  the 
uterus,  reaches  the  presenting^  part  of  the  foetus,  and  by  a  succession  of 
forcible  pushes,  moves  it  away  from  the  inlet — in  fact  propels  it ;  though 
this  retropropulsion  should  not  be  made  directly  forward,  but  obliquely,  so 
as  to  press  the  region  we  desire  to  get  rid  of  upward,  downward,  or  to 
either  side,  according  to  circumstances.  In  this  way,  the  opposite  parts 
-glide  over  the  uterine  walls — previously  lubricated  :  they  move  round 
towards  the  hand,  and  are  more  easily  reached. 

Evolution. — When  the  parts  which  are  sought  for  reach  the  hand,  they 
are  firmly  seized  by  the  operator  and  drawn  towards  him.  The  uterine 
contractions  assist  in  this  operation,  the  version  movement  is  continued, 
the  foetus  becomes  lengthened,  as  it  were,  and  unfolded,  and  when  its 
larger  diameter  is  brought  into  the  axis  of  the  pelvis  the  manoeuvre  is 
completed. 

Version  is  not  always  successful  when  first  attempted  ;  indeed,  it  has 
often  to  be  relinquished  and  again  tried,  until  successful — notwithstand- 
ing the  fatigue  and  demands  on  patience  these  repeated  efforts  entail. 

Complete  version  is  required  in  the  transverse  position  of  the  foetus, 
and  is  generally  difficult ;  it,  and  indeed  all  degrees  of  turning,  and  all 
vicious  positions  of  the  foetus,  demand  that  the  first  thing  to  be  done  is  to 
secure  the  most  useful  parts  which  present,  as  the  limbs  or  head,  by  cords 
or  other  appliances,  so  as  to  be  able  to  find  and  utilize  them  again  if  cir- 
cumstances require  that  they  should  be  used  to  assist  in  delivery.  Very 
frequently  traction  on  one  or  more  of  these  cords,  and  the  manipulations 
of  a  hand  in  the  uterus,  will  greatly  facilitate  turning. 

As  in  so  many  other  obstetrical  operations,  undue  haste  and  violence 
are  to  be  guarded  against  in  these  mutations,  and  gentleness,  patience, 
and  perseverance  observed.  We  not  unfrequently  find  that,  when  the 
presentation  is  anterior  or  posterior,  and  the  limbs  are  in  a  favorable 
direction,  though  the  body  of  the  foetus  may  be  somewhat  inclined  to  the 
right  or  left,  the  uterine  contractions  are  sufficient  to  effect  adjustment, 
gradual  and  well-directed  traction  being  alone  required  from  the  operator. 

Independently  of  the  general  mutatio7is  which  have  for  their  object  the 
movement  of  the  whole  mass  di  the  foetus  in  the  uterus,  it  is  sometimes 
only  required  to  resort  X.o  partial  mutations — as  in  the  adjustment  of  one 
or  more  of  the  limbs,  head,  neck,  etc.,  these  consisting  of  exte?ision — as 
when  the  arm  is  extended  on  the  shoulder,  the  fore-arm  on  the. arm,  the 
head  on  the  neck,  the  latter  on  the  trunk,  etc.,  Tiudjlexion,  in  bending  the 
various  articulations — as  those  of  the  limbs,  in  order  to  place  them  or  the 
body  in  a  better  direction ;  and  rotation.  In  all  these  manoeuvres,  a 
rudimentary  knowledge  of  mechanics  will  be  of  great  advantage,  and 
particularly  that  pertaining  to  levers,  which  is  particularly  applicable 
to  manipulations  of  the  limbs,  that  so  frequently  prove  of  the  greatest 
service  in  obstetrical  operations. 


DYSTOKIA  FROM  JTALPRESENTATION  OF  FGETUS. 


439 


It  only  too  often  happens  that  the  anii  of  the  obstetrist  is  found  to  be 
sadly  too  short  in  version  and  other  manoeuvres,  and  these  are  conse- 
quently rendered  more  difficult  of  accomplishment.  With  regard  to  this 
it  is  well  to  point  out,  what  is  not  always  known,  that  the  obstetrist  should 
always  employ  the  arm  corresponding  to  the  side  of  the  foetus  on  which 
the  limb,  or  part  sought  for,  or  to  be  manipulated,  is  placed.  For  in- 
stance, if  the  foetus  is  in  the  anterior  presentation  and  vertebrc-iacral  posi- 
tion, with  the  head  bent  round  towards  the  left  flank,  or  the  left  fore  limb 
(right  hind  limb  in  a  posterior  presentation)  doubled  under  the  body,  he 
will  use  his  right  arm  ;  but  the  left  will  be  employed  in  the  opposite 
conditions.  By  doing  so,  the  operator  gains  in  length  of  arm,  particularly 
towards  the  shoulder,  and  can  consequently  reach  deeper  into  the 
uterus. 

Flexion  and  extension  of  a  limb  are  often  made  simultaneously,  and  it 
semetimes  happens  that  in  extending  such  a  part  as  the  head  to  straighten 
it,  it  effects  its  own  rotation.  Extension  alone  serves  to  bring  the  limbs 
from  under  the  chest  or  abdomen  ;  flexion  is  rarely  resorted  to,  and  chiefly 
when  it  is  desired  to  return  an  extended  limb  ag;iin  into  the  uterus.  In 
these  operations  on  the  limbs,  when  the  weight  of  the  foetus  is  an  obstacle, 
the  body  of  the  creature  is  inclined  to  the  side  opposite  to  that  of  the 
limb  to  be  manipulated  ;  thus,  if  the  right  limb  is  flexed  under  the  body, 
and  we  desire  to  extend  it,  the  foetus  is  inclined  from  right  to  left,  so  that 
the  right  side  being  raised,  the  limb  can  be  taken  from  under  it.  The 
body  is  turned  in  the  way  we  have  indicated  for  rotation. 

We  have  casually  alluded  to  the  attitude  of  the  larger  animals  during 
version,  retropulsion,  and  rotation,  and  pointed  out  the  advantage  to  be 
derived  from  elevating  the  hind  quarters,  either  by  placing  litter  under 
the  hind  feet,  or  causing  the  animal,  if  a  Cow,  to  kneel  on  the -knees. 
And  we  have  also  remarked  that  it  is  not  always  possible  to  obtain  the  de- 
sired attitude,  but  that  these  manoeuvres  must  sometimes  be  performed 
when  the  animal  is  recumbent. 

It  may  even  happen  that  it  will  be  advantageous  to  cause  the  animal  to 
lie.  Leconte  strongly  recommends  placing  the  animal  on  its  sternum,  and 
flexing  the  fore  and  hind  limbs  under  the  body  ;  in  this  attitude  the 
uterine  cavity  can  be  more  easily  explored,  and  the  necessary  alterations 
made  in  the  position  of  the  foetus  :  the  operator  lying  extended  behind 
the  animal.  Some  obstetrists  place  the  animal  on  the  right  or  left  side, 
the  operator  lying  on  either  of  his  sides,  according  to  the  arm  he  intends 
to  use. 

Throwing  down  an  animal  for  this  purpose  is  always,  however,  to  be 
avoided  if  possible  ;  and  if  it  is  already  down,  it  should  either  be  placed 
on  its  sternum  or  compelled  to  get  up.  When  the  the  uterus  is  lying  very 
low  in  the  abdomen,  should  the  latter  be  extremely  pendulous,  or  when 
the  foetus — as  in  the  Cow — is  fixed  beneath  the  brim  of  the  pelvis,  it  may 
be  found  very  advantageous  to  place  the  parturient  creature  on  its  back. 

As  for  the  operator,  he  must  conform  his  attitude  to  that  of  his  patient. 
We  have  already  written  on  this  point  when  treating  of  parturition,  and 
we  have  nothing  to  add.  If  the  animal  is  standing  and  the  hind  quar- 
ters are  raised,  and  particularly  if  the  obstetrist  is  not  tall — and  more 
especially  if  the  patient  is  a  Mare,  we  may  follow  the  plan  adopted 
with  much  success  by  Dickens  {Veterinarian,  vol.  xxxiv.,  p.  260).  This 
consists  in  placing  the  animal,  if  the  case  is  likely  to  be  protracted, 
H  under  an  open  shed,  tving  the  head  to  the  manger  or  rack,  and  supporting 


440 


FCETAL  DYSTOKIA. 


the  body  by  two  sacks  passed  under  the  belly  and  attached  to  ropes 
which  pass  over  a  beam  above.  A  partition  on  the  right  side,  to  prevent 
swerving,  is  preferred,  the  assistant  being  placed  on  the  left  side.  Im- 
mediately behind  the  animal  is  put  a  strong,  four-legged  wooden  cow- 
crib,  which  serves  many  purposes.  Firstly,  it  prevents  the  Mare  backing  ; 
secondly,  the  operator  standing  in  it  is  perfectly  safe  from  injury  during 
his  manipulations,  while  it  gives  him  a  great  advantage  in  the  elevation  it 
aifords — especially  with  tall  animals  ;  thirdly,  it  forms  a  convenient 
stage  whereon  to  place  cords,  instruments,  medicinal  agents,  etc. 


CHAPTER  I. 
Dystokia  Depending  on  the  Anterior  Presentation. 

We  have,  at  page  227,  explained  that  there  are  three  principal  presenta- 
tions :  anterior^  posterior,  and  transverse — the  latter  being  either  dorso- 
lumbar  or  sterno-abdomi?tal ;  and  that  in  each  of  these  presentations  the 
foetus  might  offer  in  different  positions,  many  of  which  would  be  more  or 
less  vicious  and  complicated,  whether  as  regards  the  whole  mass  of  the 
body,  or  only  parts  thereof — as  the  limbs,  head  and  neck,  etc.  We  will 
now  consider  these  false  presentations  and  positions,  in  the  order  indicated 
at  page  T^dZ,  which  is  that  followed  by  Saint-Cyr  :  though  it  differs  a 
little  from  that  adopted  by  Franck  and  other  Continental  veterinary 
obstetrists. 

We  may  remark  that  Rainard,  looking  at  the  subject  from  an  obstetrical 
point  of  view,  considered  the  head  and  limbs  of  the  foetus  as  appendages 
which,  from  their  wrong  direction,  may  more  or  less'hinder  its  expulsion. 
Thus  the  head,  one  or  both  of  the  fore  limbs,  or  even  the  posterior  limbs 
in  the  anterior  position,  may  cause  the  most  varied  complications  :  one 
or  more  of  which  may  be  found  in  the  same  animal,  and  even  complica- 
ting each  other.  Thus,  with  a  vicious  position  of  the  head  we  may  have 
a  wrong  direction  of  the  fore,  and  perhaps  also  of  the  hind  limbs.  But 
as  the  double  or  triple  complications  are  difficult  to  describe,  and  as  the 
practical  value  of  the  descriptions  might  consequently  suffer,  it  is  deemed 
the  best  course  to  study  each  complication  separately  :  the  complex  cases 
arising  from  their  combination  being  then  easily  understood,  and  the 
indication  for  overcoming  them  being  also  simplified. 

These  complications  are  very  often  found  in  the  Mare  and  Cow,  less 
frequently  in  the  Sheep  and  Goat,  and  rarely  in  the  Bitch,  Sow,  or  Cat. 
We  have  no  means  of  arriving  at  a  knowledge  of  their  relative  frequency 
in  any  species.* 

■*  Zippelius,  quoted  by  Franck,  in   112  cases  of  dystokia,  found  them  to  be  due  to  the  several  causes  in 
the  following  proportions : 

Abortions        --....-------31 

Occlusion  of  the  os  uteri    -----------30 

Torsion  of  the  uterus      --.- .-lo 

Lateral  inclination  of  the  head  and  neck  of  the  foetus       -----     16 

Lateral  inclination  of  the  head  and  misdirection  of  the  fore  limbs       -        -  4 

Head  and  neck  under  the  fore  limbs         -        --        -        -        -        -        -3 

Head  bent  up  on  the  back      ----------  2         ■ 

Torsion  of  the  uterus  with  posterior  presentation     ------       i 

Posterior  presentation  with  misdirection  of  the  hind  feet      -        -        -        -  2 

Limb  over  neck  .-..-.__----i 

Lunr.bo-pubic  position    -----------  3 

Posterior  and  transverse  presentation       --------i 

Rhachitism  affecting  the  pelvis  of  Cow  and  Calf  -        -        -        -        -  .       i 

Hydrops  amnii   --------        -        ..--i 

Mummification  of  the  foetus  ----------         x 

\ 


DYSTOKIA  DEPENDING  ON  ANTERIOR  PRESENTATION    441 

SECTION    I. DYSTOKIA    DUE    TO    THE    FORE    LIMBS. 

In  the  anterior  presentation,  and  what  we  have  designated  the  "  normal 
position,"  the  two  fore  Hmbs  of  the  foetus  are  extended  in  front  towards 
the  pelvic  inlet,  the  head  being  also  extended  and  resting  either  upon  or 
between  the  legs,  the  distal  extremity  of  which  extends  beyond  its  nose — 
the  whole  forming  a  wedge-shaped  mass.  Consequently,  the  fore  feet 
should  be  the  first  parts  to  pass  through  the  genital  canal ;  and  if  only 
one  appears  with  the  head,  or  if  the  latter  alone  offers,  then  one  or  both 
of  the  anterior  limbs  are  in  a  wrong  direction,  and  birth  may  be  hindered 
if  they  are  not  adjusted.  The  directions  they  may  assume  are  generally 
four  :  I.  They  may  be  incompletely  extended  in  the  pelvis ;  2.  They  may  be 
crossed  over  the  neck  ;  3.  They  may  be  bent  at  the  knees ;  4.  They  may  be 
extended  completely  under  thefcetus.  Each  of  these  misdirections  may  be 
met  with  in  the  four  principal  positions  of  the  anterior  presentation,  and, 
as  has  been  mentioned,  one  or  both  limbs  may  be  involved ;  if  the  latter, 
then  the  direction  may  be  the  same  or  different. 

The  cause  of  misdirection  of  the  limbs  is  not  well  ascertained.  In 
many  cases  it  may  be  due  to  insufficient  dilatation  of  the  os  uteri,  which 
hinders  their  advancing  with  the  head  :  the  joints  of  the  limbs  readily 
flexing  when  the  feet  come  in  contact  with  the  cervix,  while  the  uterine, 
contractions  propel  the  more  rigid  head  and  neck  into  the  vagina.  The 
misdirection  may  also  primarily  occur  during  intra-uterine  existence,  and 
before  parturition  sets  in,  and  particularly  if  the  fcetus  dies  before  birth, 
when  its  position  is  not  the  same  as  at  that  period.  There  can  be  no 
doubt,  however,  that  the  accident  generafly  happens  during  parturition. 

I.  Anterior  Limbs  incompletely  Extended  in  the  Pelvis. 

As  might  be  inferred,  this  misdirection  of  the  limbs  differs  but  little 
from  that  which  they  assume  in  normal  parturition,  they  being  only  par- 
tially retained,  and  the  head  more  or  less  in  advance  of  them.  It  is 
usually  due  to  the  shoulders  not  being  closely  applied  to  the  chest  of  the 
foetus,  and  the  elbows,  consequently  thrown  wide  apart,  coming  in  con- 
tact with  the  brim  of  the  pelvis,  thus  proving  an  obstacle  to  the  progress 
of  the  young  creature.  It  appears  to  occur  generally  in  the  vertebro- 
sacral position,  and  most  frequently  in  the  Cow.  It  may  also  be  owing 
to  the  flexion  of  the  fetlocks,  when  the  feet  meet  with  any  trifling  ob- 
stacle. 

Indications. 

The  indication  in  such  a  simple  case  as  this  is  obvious — straighten  the 
fore  limbs,  and  bring  them  to  their  proper  height  in  the  pelvis.  Very 
often  this  cannot  be  done  by  mere  traction,  which,  in  extending  the  arms 
of  the  foetus,  brings  the  elbows  still  further  away  from  the  body.  In  such 
circumstances  retropulsion  must  be  resorted  to,  the  body  being  pushed  a 
little  beyond  the  pelvic  inlet ;  then  traction  being  employed,  the  limbs 
are  readily  extended  to  their  natural  position,  and  delivery  may  be  ac- 
complished with  further  assistance. 

2.  Fore  Limbs  Crossed  over  the  Neck. 

Saint-Cyr, asserts  that  this  complication  '-^  not  very  uncommon  in  the 
Mare,  less  frequent  in  the  Cow  ;  and  he,  with  many  other  veterinary  ob- 


442 


FCETAL  DYSTOKIA. 


stetrists,  has  witnessed  several  instances.  One  or  both  h'mbs  may  be 
carried  over  the  neck,  and  the  complication  is  only  observed  when  the 
foetus  is  in  the  vertebro-sacral  position. 

It  is  undoubtedly,  in  many  instances,  an  obstacle  to  parturition,  as  the 
shoulders  are  no  longer  lodged  in  the  hollow  space  at  each  side  of  the 
neck,  but  are  fixed  at  the  side  of  the  chest,  the  transverse  diameter  of 
which  they  increase.  The  obstacle  is  still  greater  if  one  or  both  of  the 
limbs  should  chance  to  cross  towards  the  summit  of  the  head.  At  all 
times  the  complication  is  more  serious  if  the  labor  pains  are  violent  and 
irregular — as  they  generally  are  in  the  Mare  when  there  is  any  impediment 
to  birth  :  then  there  only  too  frequently  results  laceration  of  the  roof  of 
the  vagina,  perforation  of  the  rectum,  rupture  of  the  perineum,  etc.  Jn 
the  most  favorable  cases,  labor  is  protracted  and  more  severe,  and  con- 
tusions of  the  genital  canal  are  almost  unavoidable.  In  some  cases  birth 
may  and  does  tak,e  place  without  assistance.  Rainard  alludes  to  the  case 
of  an  Ass  in  which  spontaneous  delivery  occurred,  notwithstanding  the 
existence  of  this  complication. 


Anterior  Presentation  :    Fore  Limb  Crossed  Over  the  Neck. 


The  misdirection  is  recognized  by  the  limb  or  limbs  appearing  to  be 
shorter  and  higher  than  usual  ;  if  only  one  limb  is  displaced,  then  two 
limbs  will  be  found  on  one  side  of  the  head,  one  being  much  shorter  aiid 
higher  than  the  other. 

Indications. 

When  only  one  limb  is  crossed,  reduction  is  not  difficult,  and  may  be 
effected  in  the  pelvis.  The  leg  is  seized  a  little  above  the  fetlock,  raised, 
drawn  to  its  proper  side,  and  extended  in  the  genital  canal.  Delivery 
may  then  take  place  without  help,  or  gentle  traction  on  the  head  and  limbs 
may  be  necessary.  f 

When  both  fore-limbs  are  crossed,  and  the  foetus  is  not  too  far  advanced 


b 


DYSTOKIA  DEPEND lAG  ON  ANTERIOR  PRESENTATION,    443 

in  the  pelvis,  cords  should  be  fixed  to  the  pasterns,  and  the  trunk  pushed 
into  the  uterus  ;  assistants  then  pull  moderately  at  the  cords,  and  in  such 
a  manner  as  to  bring  each  limb  to  its  own  side,  if  the  hand  of  the  operator 
cannot  effect  this  in  the  uterine  cavity.  In  this  way  a  kind  of  rotation 
of  the  limbs  is  effected,  and  they  are  brought  each  to  its  proper  side,  and 
a  little  beneath  the  head. 

When  the  fcetus  is  firmly  fixed  in  the  pelvis,  and  retropulsion  is  impos- 
sible, the  limbs  must  be  amputated,  one  after  the  other.  Such  an  opera' 
tion  must,  however,  be  very  exceptionally  required  in  this  complication. 

3.  Fore-limbs  Flexed  at  the  Knees. 

The  fore-limbs  flexed  at  the  knees,  and  fixed  under  the  neck  and  chest, 
are  a  very  frequent  and  often  troublesome  complication.  It  is  generally 
found  in  the  Mare  and  Cow  ;  when  it  occurs  in  the  Sheep  and  Goat  it  is 
rarely  of  any  importance,  as  delivery  can  usually  take  place  without 
assistance  ;  in  the  young  of  Carnivora,  the  metacarpal  bones  are  too 
short  to  offer  any  obstacle  when  the  knee  is  flexed. 

This  misdirection  of  the  fore-limbs  may  occur  in  all  the  positions  of 
the  anterior  presentation,  but  chiefly  in  the  vertebro-sacral  position — the 
most  frequent.  One  or  both  limbs  may  be  flexed,  and  the  complication 
is  not  unusually  accompanied  by  a  misdirection  of  the  head  ;  hence,  there 
are  several  varieties  of  the  complication,  the  most  important  being  those 
due  to  the  general  position  of  the  foetus.  We  will  follow  Saint-Cyr  in 
studying  it  in  three  positions — the  vertekro-sacral,  vertebro-pubic,  and  vcrte- 
bro-ilial. 

I.  Vertebro-Sacral  Position  of  the  Fcetus. — If,  at  the  moment 
when  the  limbs  of  the  fcetus  enter  the  pelvic  inlet,  they  are  not  quite 
extended,  and  the  feet  are  slightly  below  the  level  of  the  anterior  border 
of  the  pubis,  the  uterine  contractions  push  them  against  that  bone,  and 
there  they  remain  ;  at  the  same  time  the  head  enters  the  inlet,  and  as  it 
proceeds  the  limbs  become  flexed,  the  knees  are  bent  and  advance  with 
the  head,  but  the  metacarpals  and  phalanges  are  directed  backwards 
beneath  the  fore-arms,  and  the  limbs  thus  doubled  are  applied  against  the 
neck.  We  have,  therefore,  the  head,  fore-arms,  and  metacarpals  in  one 
mass  entering  or  being  propelled  into  the  limited  space  afforded  by  the 
inextensible  pelvic  circle,  and,  according  to  circumstances,  the  hand  of 
the  obstetrist  will  meet  with  these  parts  in  varying  relative  positions,  de- 
pending on  the  stage  of  labor.  When  parturition  has  only  recently  com- 
menced, the  head  has  entered,  or  is  about  to  enter,  the  inlet,  and  the 
limbs  placed  beneath  it  are  still  somewhat  free  in  the  uterine  cavity, 
while  the  fcetus  itself  is  not  immovably  fixed  if  the  waters  have  not  long 
escaped.  But  when  labor  has  been  progressing  for  some  time,  the  head 
is  well  advanced  in  the  passage — sometimes  as  far  as  the  vulva  ;  but  far 
behind  it  are  the  limbs  imbedded  on  each  side  of  the  neck — the  knees 
towards  the  head,  the  feet  at  the  elbows. 

With  the  smaller  ruminants,  as  already  remarked,  birth  may  take  place 
spontaneously  even  now,  as  they  often  have  more  than  the  one  foetus, 
and  this  is  comparatively  small,  with  regard  to  the  pelvic  diameter  ; 
while  its  bones  are  elastic  and  yielding.  But  with  such  animals  as  the 
Cow  and  Mare  the  foetus  is  nearly  always  single  and  voluminous,  and  its 
skeleton  is  rigid  and  unaccommodating,  and  can  only  undergo  a  very 
sm  ill  reduction  in  size  during  its  passage  through  the  pelvis. 


1 


444 


FCETAL  DYSTOKIA. 


Therefore  it  is  that,  in  the  larger  domesticated  animals,  such  a  devia- 
tion of  the  limbs  is  always  a  serious  cause  of  dystokia — not  so  much,  as 
Saint-Cyr  justly  observes,  from  the  increased  volume  that  the  doubled- 
up  limbs  gives  to  the  neck,  as  because  the  arms,  incompletely  extended 
on  the  shoulders,  retain  the  latter  against  the  thorax,  and  prevent  their 
being  lodged  in  the  depression  at  the  base  of  the  neck— thus  augmenting 
the  vertical  and  transverse  diameter  of  the  chest,  while,  at  the  same 
time,  the  projecting  elbows  press  against  the  border  of  the  pelvis. 

Indications. 

.  The  indications  are  in  this  case  also  obvious  :  To  find  the  retained 
limbs,  extend  the  fore-arm  of  each  on  the  arm,  and  to  straighten  the  legs 
in  the  pelvic  cavity,  as  they  are  in  normal  parturition. 


Anterior  Presentation  :    Fore-Limbs  Bent  at  the  Knees. 


These  indications  are  not  so  difficult  to  carry  out  when  the  obstetrist 
is  called  in  sufficiently  early,  and  the  head  has  made  but  little  advance 
into  the  pelvis. 

We  will  suppose  both  fore  legs  partially  retained  in  the  abdomen,  and 
flexed  at  the  knees.  The  exploration  which  has  led  to  this  discovery  has 
perhaps  also  indicated  that  one  limb  is  not  so  much  flexed  as,  or  is  more 
accessible  than,  the  other.  If  this  is  the  left  limb,  then  the  left  hand  and 
arm  must  be  employed  ;  if  it  is  the  right  leg,  then  the  right  hand  and  arm 
will  be  most  convenient  ;  but  if  both  limbs  are  alike  implicated  and  acces- 
sible, then  it  is  immaterial  which  is  first  manipulated,  so  long  as  the  cor- 
responding hand  and  arm  are  employed.  The  same  directions  are 
applicable  to  both,  keeping  in  mind  that  the  right  and  left  hands  are 
opposite.  The  object  is  to  adjust  the  direction  of  the  fore-limbs,  so  that 
delivery  can  be  accomplished.     This  adjustment  is  effected  in  four  move- 


DYSTOKIA  DEPENDING  ON  ANTERIOR  PRESENTATION.    445 

ments  : — i.  The  hand  is  passed  alongside  the  neck  of  the  foetus,  the 
fore-arm  is  seized  in  the  middle,  the  radial  border  of  the  hand  being 
upwards,  the  cubital  downwards  ;  then  bending  the  hand,  the  knee  of 
the  foetus  is  drawn  towards  the  pelvis,  while  the  elbow  is  pushed  upwards 
and  backwards  ;  2.  The  body  of  the  foetus  being  thrust  away  from  the 
pelvis,  the  metacarpal  bone  is  seized  as  the  fore-arm  was,  and  moving  it 
in  the  same  manner,  the  knee  is  raised  as  high  as,  or  higher  than,  the 
point  of  the  shoulder  (Fig.  \i2,  a\.o  b),  and  the  foot  to  the  level  of  the 
maternal  pubis  ;  3.  The  foot  is  grasped  in  the  hand,  flexed  strongly  on 
the  fetlock  and  pastern,  and  drawn  into  the  genital  canal  ;  4.  The  limb  is 
then  extended  towards  the  pelvic  outlet,  and  if  necessary  a  cord  is  placed^ 
around  the  pastern,  the  other  limb,  if  also  flexed,  being  then  sought  for 
and  treated  in  a  similar  manner. 

Lecoq,  according  to  Saint-Cyr,  has  described  another  method.  This 
consists  in  passing  the  arm  alongside  the  head,  and,  putting  the  hand  in 
a  state  of  supination,  seizing  the  foot  in  such  a  way  that  the  pastern  faces 
the  palm  and  the  fetlock  the  wrist.  The  operator  then  pushes  the  limb 
away  from  him,  at  the  same  time  flexing  the  fore-arm  on  the  arm  as  much 
as  possible,  until  getting  the  pastern  as  high  as  the  os,  he  straightens  the 


Fig.  112. 
Anterior  Presentation:    Extending  the  Fore-limb. 

leg  and  brings  it  towards  the  pelvic  canal.  Saint-Cyr  has  pointed  out, 
however,  that  this  method  of  straightening  the  limb  en  ?nasse,  and  at  once, 
is  only  possible  in  quite  exceptional  cases, — when  the  foetus  is  quite 
movable,  and  the  extremity  of  the  limb  is  sufficiently  near  the  pelvis  to 
be  easily  accessible  ;  and  he  maintains  that  the  method  by  progressive 
extension  just  described,  is  that  which  should  be  generally  adopted. 
Lecoq's  method  might  be  possible  with  the  Cow,  but  in  the  Mare  it 
would  certainly  be  most  difficult,  if  not  impossible. 

This  correction  of  knee-joint  presentation  is  easy  enough  when  the 
foetus  has  not  advanced  far  into  the  pelvis  ;  but  when  it  is  completely 
engaged,  then  the  operation  is  much  more  difficult.  Retropulsion  may 
be  necessary,  and  extension  of  the  limbs  is  sometimes  only  possible  when 
the  foetus  is  clear  of  the  inlet.  Thomas  {jfournal de  Med  Veterinaire, 
November,  1876),  while  pointing  out  that  it  is  possible,  and  often  easy, 
to  extend  the  limbs  in  the  Cow's  pelvis,  and  that  the  dimensions  of  the 
head  of  the  foetus  allow  sufficient  space  for  these  manoeuvres,  insists 
that  the  point  of  traction  should  be  at  the  lower  end  of  the  radius,  and 
not  the  knee  ;  while  Schaack's  head-collar  should  be  employed  to  extract 
the  head  at  the  same  time.  The  cord  for  the  limbs  should  have  a  run- 
ning noose. 

After  labor  has  been  in  progress  for  some  time,  the  "  waters  "  have 
long  escaped,  the  head  is  gradually  propelled  towards  the  vulva,  the  nose 


1 


446  FCETAL  DYSTOKIA. 

may  appear  between  the  labia,  the  uterus,  applied  closely  to  the  body  of 
the  foetus,  contracts  powerfully,  and  futile  attempts  at  retropulsion  fatigue 
the  operator.  Another  procedure  must  then  be  adopted.  The  hand, 
carrying  a  pliable  cord,  must  be  passed  alongside  the  head  as  far  as  one 
of  the  bent  knees ;  then  the  end  of  the  cord  is  to  be  passed  behind  the 
joint  and  brought  outside  the  vulva,  where  it  is  tied  to  the  other  end,  the 
cord  forming  a  loop  around  the  knee.  The  second  knee,  if  flexed,  is  to 
be  secured  in  the  same  manner,  and  a  cord  is  also  to  be  fixed  on  the 
head  ;  thus  there  will  be  three  points  on  which  traction  can  be  employed 
as  vigorously  as  may  be  necessary.  Some  practitioners  employ  blunt 
hooks  instead  of  cords,  but  it  may  be  doubted  whether  they  are  so  useful  ; 
hooks  are  also  sometimes  resorted  to  for  straightening  the  limbs  by  seiz- 
ing the  pasterns,  9,nd  in  some  cases  they  may  prove  serviceable.  The 
"  repeller  "  or  "crutch  "  may  also  be  most  profitably  utilized  in  retropul- 
sion, and  in  keeping  the  foetus  forward  while  the  necessary  manoeuvres 
are  carried  out ;  it  should  be  applied  to  the  head  or  chest.  Harms 
advises,  in  the  case  of  one  limb  bent  at  the  knee,  that  if  this  cannot  be 
extended  it  should  be  pushed  forward  under  the  abdomen  by  the  crutch, 
which  is  applied  to  the  humerus,  the  other  limb  and  the  head  being  corded, 
and  then  traction  employed.  If  both  limbs  are  bent  and  irreducible,  this 
plan  might  be  tried  in  the  Cow,  particularly  if  the  foetus  is  not  very  large. 
Should  none  of  these  methods  succeed,  then  embryotomy  must  be 
adopted,  the  limbs  either  being  removed  at  the  knee,  or  the  shoulder  if 
possible  ;  though  the  advantages  of  this  operation  are  not  so  great  as 
might  be  anticipated  when  the  limbs  are  only  removed  at  the  knees,  while 
removal  at  the  shoulder  is  frequently  a  most  tedious  and  fatiguing  task 
when  it  is  possible. 

2.  Vertebro-PubicTosition  of  the  Fcetus. — It  is  rare  that  this  com- 
plication is  found  in  the  vertebro-pubic  position,  and  only  a  few  instances 
are  recorded.  The  foetus  is  lying  on  its  back,  and  the  head  either 
presents  at  the  inlet,  or  is  more  or  less  advanced  in  the  pelvis,  with  the 
fore-limbs  occupying  the  sacro-lumbar  region  of  the  mother,  more  or  less 
flexed,  and  often  crossed  on  the  sternum. 

In  this  position  the  foetus  is  much  less  likely  to  become  so  firmly 
wedged  in  the  pelvis  as  in  the  one  just  described,  and  it  is  consequently 
more  easily  extracted.  If,  however,  the  uterine  contractions  are  violent, 
or  care  is  not  observed  in  attempting  delivery,  the  fore-feet,  projecting 
as  they  do  towards  the  utero-vaginal  parietes  and  the  rectum,  may  cause 
grave  mischief.  Extraction  should  therefore  be  set  about  early,  and 
with  every  precaution. 

Indications, 

Having  ascertained  the  position,  it  is  generally  a  good  plan  to  empty 
the  rectum  before  proceeding  to  extract  the  foetus.  If  the  head  is  in  the 
genital  canal,  it  may  be  advisable  to  secure  it  by  a  head-collar ;  then  the 
limbs  can  be  sought  for  and  adjusted,  an  operation  much  facilitated  by  a 
hand  in  the  rectum.  Delivery  may  now  be  accomplished  by  guiding  the 
legs  forward  into  the  pelvis — cording  them  and  exercising  traction  if 
necessary.  It  is  sometimes  very  useful,  in  more  difficult  cases,  to  throw 
the  animal  on  its  back.     Version  is  rarely  required. 

3.  Right   or   Left  Vertebro-Ilial    Position    of    the    Fcetus. — 


DYSTOKIA  DEPENDING  ON  ANTERIOR  PRESENTATION. 


447 


According  to  Saint-Cyr,  this  complication  of  the  limbs  in  this  position  ap- 
pears to  be- rare.  It  does  not  offer  any  thing  particular,  except  that  the 
undermost  limb  is  difficult  to  reach  and  adjust  by  the  hand  of  the  opera- 
tor. It  is  therefore  recommended,  after  straightening  and  cording  the 
uppermost  limb,  to  attempt  rotation  of  the  foetus,  in  order  to  bring  it  into 
a  more  favorable  position — the  vertebro-sacral,  if  possible — before  pro- 
ceeding to  the  adjustment  of  the  other  leg,  which  is  to  be  effected  in  the 
manner  already  indicated. 

4.  Fore-limbs  Completely   Retained. 

The  complete  retention  of  one  or  both  fore-limbs  of  the  foetus  in  the 
uterine  cavity  is  often  met  with  in  the  domesticated  animals,  but  perhaps 
more  frequently  in  the  Mare  than  the  Cow  or  other  creature.     It  is  always 


Fig.  IT3. 
Anterior  Presentation:    One  Fore- 


i.iMB  Completely  Retained. 


a  serious  cause  of  dystokia  in  the  Mare  and  Cow,  and  may  occur  in  either 
of  the  four  anterior  positions,  though  it  is  usually  observed  in  the  vertebro- 
sacral position.  It  is,  no  doubt,  produced  during  birth,  and  in  the  same 
manner  as  knee  flexion  ;  its  more  frequent  occurrence  with  the  foal  than 
the  calf,  is  in  all  probability  due  to  the  former  having  longer  limbs  than 
the  latter.  Under  exceptionally  favorable  circumstances,  as  Franck  re- 
marks, the  foal  or  calf  may  be  born  with  the  fore-limbs  under  the  chest 
and  abdomen,  and  without  injury  to  the  mother  or  offspring.  This  is 
much  more  likely  to  occur  when  the  foetus  is  small,  the  maternal  pelvis 
roomy,  and  only  one  limb  misplaced. 

But  when  the  foetus  is  large  and  the  pelvis  narrow,  then  birth,  especially 
of  the  foal,  is  not  possible.  Not  only  this,  but  unless  extraction  is  soon 
accomplished  the  foetus  runs  great  risk  of  dying  from  asphyxia  :  indeed, 
the  foal  is   nearly  always  delivered   dead  in  this  complication  ;  so  that 


448 


FCETAL  DYSTOKIA. 


death  of  the  foetus  may  be  said  to  be  the  rule  in  shoulder  presenta- 
tions. With  the  smaller  ruminants,  owing  to  the  formation  of  the  pelvis, 
birth  is  not  often  impeded.  With  the  Sow  and  Carnivora — multiparous 
animals — this  might  be  designated  a  normal  presentation. 

It  will  readily  be  perceived  how  one  or  both  of  the  anterior  members 
bent  back  under  the  body,  will  prove  an  obstacle  to  the  passage  of  the 
foetus,  after  what  has  been  said  with  regard  to  the  relative  dimensions  of 
the  young  creature  and  the  pelvis  of  the  mother.  The  shoulder  or 
shoulders,  and  the  muscles  in  this  region,  are  the  cause  of  dystokia — 
more  especially  the  biceps  brac/iii,  which  constitutes  a  thick  and  somewhat 
tendinous  elastic  mass  between  the  scapula  and  upper  end  of  the  fore- 
arm.    This  muscular  mass  forms  a  very  prominent  obstacle  on  the  side 


Anterior  PresentatiOiV  ; 


Fig.  114. 
Both  Fore-limbs  Completely  Retained. 


of  the  chest  when  the  limb  is  thrown  back.  There  is  also  the  large 
levator  humeri  muscle  adding  to  the  increased  volume  of  the  thoracic 
region,  as  well  as  the  elbow  and  fore-arm. 

On  exploration  in  this  complication,  the  head  is  found  to  be  in  a  good 
direction,  the  hand  encountering  it  either  in  the  pelvis  or  towards  the 
inlet^  or  it  may  even  protrude  into  the  vulva,  according  to  circumstances. 
The  foetus,  if  a  calf,  may  be  yet  alive  ;  if  a  foal,  it  is  nearly  always  dead. 
If  only  one  limb  is  completely  retained,  the  other  will  be  in  a  normal  posi- 
tion— alongside  or  under  the  head  (Fig.  113).  If  both  limbs  are  retained, 
though  the  head  may  appear  in  the  genital  canal  or  at  the  vulva,  yet 
nothing  can  be  discovered  of  the  legs  in  the  pelvis,  they  being  entirely 
lodged  in  the  maternal  abdomen.  At  each  pain  the  head  of  the  foetus  is 
propelled  outwards,  but  as  soon  as  this  ceases  it  recedes  again,  as  if 
thrown  back  by  a  spring. 

With  small-sized  Cows,  the  hand  introduced  deeply  into  the  uterus  may 


DYSTOKIA  DEPENDING  ON  ANTERIOR  PRESENTATION 


449 


find  the  extremity  of  the  fore-limb  ;  but  in  large  Cows,  and  in  the  Mare, 
particularly  if  the  abdomen  is  pendulous,  this  is  rarely,  if  ever,  the  case  ; 
indeed,  sometimes  the  limbs  can  only  be  reached  with  the  greatest  diffi- 
culty, though  there  is  generally  no  trouble  in  introducmg  the  arm.  When 
the  limbs  can  be  felt,  they  are  usually  found  to  be  in  one  of  three  posi- 
tions :  directed  nearly  vertically  downwards,  the  fore-arms  resting  against 
the  brim  of  the  pubis  ;  lying  beneath  the  abdomen  (Fig.  114)  ;  or  closely 
applied  against  the  walls  of  the  chest  and  the  flanks.  In  many  of  these 
cases,  we  have  also  the  head  in  a  vicious  position. 

In  the  larger  animals,  when  the  two  limbs  are  retained,  birth  is  nearly 
always  impossible  ;  it  may  certainly  be  sometimes  effected  by  violent 
means,  but  then  these  are  the.  resort  of  brute  force,  and  not  of  humane 
and  intelligent  device,  and  nearly  always  entail  the  death  of  the  mother. 
With  the  smaller  animals,  when  this  complication  is  a  cause  of  dystokia, 
delivery  can  generally  be  effected  by  simple  measures  and  gentle  force. 

Indications. 

The  indications  are  to  reach  the  limb  or  limbs  with  the  hand — resort- 
ing to  retropulsion  if  necessary — to  gradually  raise  and  bring  them  for- 
ward, joint  by  joint,  into  the  pelvis,  and  then  to  extract  the  foetus  by 
judicious  traction.  These  indications  are  not  attended  with  difficulty  in 
those  cases  in  which  the  head  is  yet  in  the  abdomen,  or  only  at  the  pel- 
vic inlet,  and  are  easier  carried  out  in  the  Cow  than  the  Mare,  Then  if 
the  right  limb  is  sought  for.  the  left  ha?id  is  introduced  as  far  as  possible 
into  the  uterus,  if  the  left  limb  the  right  hand ;  it  is  passed  between  the 
organ  and  the  body  of  the  foetus  as  far  as  the  shoulder  ;  then  the  fore-arm 
is  seized,  the  thumb  being  in  front  and  the  other  fingers  behind — the  index 
towards  the  scapulo-humeral  articulation,  the  little  finger  directed  to  the 
bend  of  the  knee.  The  fore-arm  is  now  used  as  a  lever  of  the  first  kind, 
and  its  upper  extremity  thrown  backward,  its  lower  end  forward,  so  as  to 
move  the  foetus  more  into  the  uterus,  and  obtain  space  to  bring  the  limb 
towards  the  pelvis,  at  the  same  time  carrying  the  knee  upwards  in  the 
direction  of  the  inlet.  The  hand  then  glides  down  to  the  metacarpal 
bone,  which  is  grasped  in  the  same  manner  as  the  radius  was — the  thumb 
forwards,  other  fingers  backwards  ;  the  knee  is  pushed  away  from  the 
inlet ;  the  fetlock,  pastern,  and  foot  are  then  successively  raised,  strongly 
flexed  in  doing  this,  and  then  extended  when  above  the  rim  of  the  pubis, 
and  brought  into  the  genital  canal.  If  the  knee  cannot  be  brought  for- 
ward or  flexed  by  the  hand,  the  lower  end  of  the  fore-arm  should  be 
corded  (running  noose),  or  the  blunt  hook  may  be  used.  When  the  end 
of  the  limb  is  brought  in  the  pelvis  it  may  be  corded,  and  gentle  traction 
exercised  by  an  assistant,  while  the  operator  adjusts  the  leg,  more  par- 
ticularly towards  the  elbow. 

Another  method  is  to  seize  the  foot,  the  pastern  being  in  the  palm  of 
the  hand,  and  to  press  on  the  front  of  the  fetlock,  so  as  to  push  back  this 
part  and  extend  the  joint,  at  the  same  time  flexing  the  fore-arm  on  the 
arm.  On  raising  the  foot  as  high  as  the  os  uteri,  the  hand  is  passed 
higher  up  the  limb,  which  is  then  draw-n  into  the  pelvis,  and  a  cord  at- 
tached. The  "crutch"  or  "  repeller  "  may  be  most  usefully  employed  in 
these  manoeuvres,  to  keep  the  foetus  forward  in  the  uterus.  When  the 
limbs  of  the  foetus  cannot  be  reached  by  the  hand,  it  is  advisable  to  raise 
the  front  part  of  the  mother  by  litter,  placing  the  fore-feet  on  a  box,  or 
even  in  the  manger. 

29 


450 


FCETAL  DYSTOKIA. 


In  other  cases  the  fore-hmbs  can  be  felt,  but  cannot  be  sufficiently 
seized  to  manipulate  them.  The  fore-arm  should  be  corded,  and  traction 
employed,  while  retropulsion  is  resorted  to  by  the  crutch,  and  also  by  the 
hand  applied  to  the  shoulder-joint.  When  the  knee  is  brought  up  to  the 
inlet,  the  other  part  of  the  operation  can  be  easily  executed  in  the  manner 
already  indicated. 

One  limb  being  secured  in  the  os,  if  the  second  is  retained  it  must  be 
brought  into  this  canal  in  the  same  way. 

It  sometimes  happens,  however,  and  especially  with  the  Mare,  and  with 
Heifers  which  have  been  rudely  manipulated  before  the  arrival  of  the 
veterinary  surgeon,  that  the  foetus  is  so  engaged  in  the  genital  canal,  that 
retropulsion  is  impossible.  In  such  circumstances  some  authorities  have 
recommended  forced  extraction,  traction  being  exerted  on  the  head  of 
the  foetus  either  by  assistants  or  mechanical  means ;  others  have  ad- 
vised decapitation — skinning  the  head  and  removing  it  at  the  first  or 
second  vertebra,  taking  care  that  the  ends  of  the  bones  are  covered  by 
the  skin  of  the  skull,  to  prevent  laceration  ;  then  retropulsion  is  possible, 
and  extraction  may  be  effected. 

With  regard  to  forced  extraction,  there  can  be  no  doubt  that  if  both 
fore-limbs  are  retained,  it  endangers  the  life  of  the  foetus,  if  it  is  still  alive, 
and  also  that  of  the  mother  ;  though  it  may  be  successfully  practised  with 
the  Sheep,  Goat,  and  other  small  animals.  When  only  one  limb  is  re- 
tained in  the  Mare  or  Cow,  forced  extraction  may,  nevertheless,  succeed  ; 
and  Rueff,  Harms,  Darreau,  and  other  practitioners  have  proved  that  it 
is  possible,  traction  being  employed  on  the  head  and  normally-presented 
leg.  Amputation  of  the  head  will  not  always  prove  advantageous  in  re- 
tropulsion ;  indeed,  it  will  often  be  found  that  it  is  a  disadvantage. 

The  most  rational  and  hopeful  operation,  is  detaching  the  shoulder 
from  the  trunk  ;  or  the  biceps  brachialis  muscle  may  be  cut  through  by  the 
curved  finger-knife  (to  be  hereafter  described)  in  its  thickest  part  at  the 
shoulder-joint,  or  above  the  elbow-joint.  Then  extraction  may  be  again 
attempted.  If  the  foetus  does  not  come  away,  then  eventration  of  the 
chest  and  abdomen  may  be  practised.  Should  delivery  be  still  impossi- 
ble (which  is  unlikely),  the  limb  should  be  detached  at  the  shoulder,  and 
the  trunk  withdrawn  from  the  uterus,  the  leg  being  extracted   afterwards. 

When  one  limb  protrudes  with  the  head,  this  may  be  removed  sub- 
cutaneously  at  the  shoulder,  as  it  is  easier  accomplished  than  amputation 
of  the  retained  limb. 

SECTION    II. — DYSTOKIA  DUE  TO  THE  HEAD. 

Obstacles  to  parturition  from  a  wrong  direction  of  the  head  are  quite 
as  frequent  as,  and  more  serious  than,  those  due  to  misdirection  of  the 
fore-limbs.  It  is  stated  that  they  occur  oftener  in  the  Mare  than  the 
Cow,  but  this  questionable  ;  though  in  the  former  animal  they  are  more 
embarrassing,  as  in  consequence  of  the  longer  neck  of  the  fcetus  the  head 
can  be  carried  back  much  farther — even  as  far  as  the  flank — while  with 
the  calf  it  seldom  goes  much  beyond  the  shoulder.*     The  complication  is 

*  Since  allusion  was  made  to  dystokia  from  excess  in  volume  of  the  head  of  the  foetus  (p.  369),  Coliin.  cf 
Wassy,  has  published  an  instructive  paper  on  the  subject  (5^^/r«rt/ rtW  jl/^<f.  Veiermaire  et  de  Zootechnie, 
Nov.,  1876,  p.  529),  which  deserves  notice  here.  Observing  that  in  very  bony  Cows  the  size  of  the  calf's 
head  is  often  an  obstacle  to  parturition,  especially  in  primipars  and  in  the  Jnrassique  breed  of  cattle,  while 
it  is  rare  in  improved  breeds,  in  which  the  head  is  small,  he  describes  the  nature  of  the  obstacle,  and 
remarks  that,  if  traction  is  ventured  upon  to  extract  the  foetus,  it  must  be  very  violent,  and  therefore  likely 
to  produce  serious,  if  not  irreparable,  injury.  To  avert  this,  he  insists  on  putting  Schaack's  head-collar  on 
the  fcetus,  or  a  cord  placed  behind  the  ears,  then  each  side  looped  round  the  lower  jaw,  to  answer  the  same 


DYSTOKIA  DEPENDING  ON  ANTERIOR  PRESENTATION. 


451 


all  the  more  serious  in  the  Mare  from  the  fact,  as  has  so  often  been  stated, 
that  obstetrical  manoeuvres  in  this  animal  are  much  more  difficult  than  in 
the  Cow  :  the  straining  being  far  more  violent,  paralyzing  arms  and  hands, 
while  the  impatience  and  restlessness  are  generally  so  great,  that  it  is 
often  necessary  to  throw  it  down  before  anything  can  be  done  in  the  way 
of  adjustment. 

Misdirection  of  the  head  usually  takes  place  immediately  preceding  or 
during  parturition,  under  the  influence  of  irregular  and  energetic  uterine 
contractions  before  the  os  is  sufficiently  dilated  ;  it  is  supposed  sometimes 
to  be  due  to  premature  escape  of  the  "  waters,"  to  injudicious  manipula- 
tion of  the  fore-limbs,  maltraction,  etc.  Some  of  fie  cases,  however, 
have  doubtless  occurred  long  before  the  period  of  parturition,  and  are  of  the 
nature  of  deformity  of  the  neck  or  head,  or  both  ;  we  have  alluded  to 
them  when  treating  of  "  Contractions,"  at  page  391. 

It  will  readily  be  understood  why  misdirection  of  the  head  should  prove 
a  serious  obstacle  to  delivery,  when  we  remember  the  part  the  nose  and 
cranium  play  in  dilating  the  os  and  genital  canal,  and  how  largely  this 
voluminous  region  must  add  to  the  bulk  of  the  neck,  and  render  expul- 
sion impossible. 

Deviations  of  the  head  may  be  met  with  in  the  four  principal  positions 
of  the  anterior  presentation  ;  and  they  may  occur  alone,  or  be  complicated 
with  misdirection  of  the  fore-limbs.  We  will  not  again  refer  to  these 
latter,  as  we  have  been  sufficiently  explicit  with  regard  to  them,  but  will 
now  study  the  head  in  three  different  deviations  from  the  normal  direction, 
as  given  by  Saint-Cyr.  These  malpositions  are  :  i.  Downward  deviation, 
the  nose  being  towards  the  chest,  and  the  "  poll "  or  upper  ridge  of  the 
neck  presenting;  2.  Lateral  deviation  to  the  right  or  left  side,  the  head 
being  carried  towards  the  shoulder  or  flank  of  that  side,  the  side  of  the 
neck  presenting  j  3.  Up7uard  deviation,  the  head  being  bent  up  and  back- 
wards in  the  direction  of  the  withers,  or  twisted  to  the  right  or  left  side  of 
the  chest,  with  the  throat,  either  straight  or  twisted,  presenting. 

Downward  Deviation. 

This  is  usually  the  deviation  of  the  head  met  with  in  hydrocephalus,  though 
it  is  not  very  uncommon  when  the  cranium  is  normal  and  the  foetus  well- 
formed.  The  deviation  may  exist  from  mere  flexion  of  the  head  at  the 
atlas — the  nose  lying  immediately  in  front  of  the  pubic  border — to  extreme 
flexion  of  the  whole  of  the  neck,  the  head  being  pushed  beneath  the  chest, 
or  even  the  abdomen.  It  is  only  met  with  in  the  vertebro-sacral  position 
of  the  foetus,  and  more  often  perhaps  in  the  Cow  than  the  Mare. 

The  cause  is  usually  ascribed  to  premature  rupture  of  the  foetal  mem- 
branes, and  the  deviation  occurs  when  the  foetus  is  entering  the  pelvis. 
If  the  head  is  not  exactly  in   the  axis   of  the   inlet,  but  inclines  a  little 

purpose.  The  head  being  thus  secured,  the  protruding  limbs  are  pushed  forward  into  the  uterus,  after  a 
cord  has  been  fixed  to  each  pastern.  If  the  genital  passsage  is  dry,  oil  is  plentifully  injected  into  it. 
Traction  being  then  exerted  on  the  head,  this  readily  clears  the  inlet  of  the  maternal  pelvis,  its  dimensions 
being  no  longer  increased  by  the  addition  of  the  limbs  ;  it  is  drawn  well  into  the  pelvic  cavity,  and  then 
the  fore-limbs  are  easily  brought  through  the  inlet,  now  only  occupied  by  the  neck  of  the  foetus.  ,  The  head 
and  feet  are  after\\-ards  simultaneously  drawn  towards  the  vulva,  and  it  is  rare,  if  the  traction  is  judicious, 
that  delivery  is  not  promptly  effected. 

Through  ha-vnng  neglected  the  precaution  of  first  pushing  the  fore-limbs  into  the  uterus,  Collin,  at  the 
commencement  of  his  career,  in  1853,  lost  two  Cows.  Since  that  time,  in  more  than  two  hundred  cases, 
he  has  been  successful  in  delivering  the  calf,  without  resorting  to  embryotomv.  Success  is  always  certain, 
provided  incompetent  persons  have  not  previously  rendered  it  impossible.  He  recommends  the  same  pro- 
cedure in  spasm  of  the  cervix  uteri,  after  reduction  of  torsion  of  the  uterus,  and  in.fcEtal  hydrocephalus. 
In  the  latter,  puncture  of  the  cranium  is  easier  if  the  fore-limbs  have  been  previously  pushed  into  the 
uterus. 


452  FCETAL  DYSTOKIA. 

downwards,  ana  is  at  the  same  slightly  flexed,  the  nose  comes  in  contact 
with  the  brim  of  the  pubis,  and  is  retained  there  ;  while  the  uterine  con- 
tractions, pushing  on  the  body,  propel  the  fore-limbs,  if  they  are  in  a 
favorable  direction,  into  the  genital  canal.  Thus  it  will  be  understood 
that,  if  the  expulsive  efforts  continue,  the  head  becomes  more  and  more 
flexed  as  the  foetal  mass  is  carried  towards  the  vulva  (as  is  delineated  in 
the  shaded  and  unshaded  foetuses  in  Fig.  115),  until,  from  vertical  and 
oblique,  the  face  becomes  horizontal,  and  rests  on  the  floor  of  the  pelvis 
of  the  mother,  the  lower  jaw  against  the  throat ;  the  neck  becomes  pro- 
portionately flexed,  and  as  labor  goes  on  the  head  is  retained,  as  well  as 
the  cervical  portioij|of  the  former  ;  so  that  when  the  obstetrist  introduces 
his  hand  into  the  genital  canal,  the  feet  are  found  presenting  towards 
the  vulva,  but  far  in  front  of  them  (or  behind  them,  as  the  explorer  stands)  ; 
this  may  be  designated  a  7ieck  ox  poll  presentation  {unshaded  foetus  in  Fig. 


Fig.  115. 
Anterior  Presentation  :   Downward  Deviation  of  the  Head. 

If,  however,  the  forehead  or  occipital  region  comes  in  contact  with 
the  brim  of  the  pubis,  the  uterine  contractions  cause  it  to  descend  below 
the  level  of  that  bone  ;  while  the  shoulders  and  crest  of  the  neck  are  im- 
pelled towards  the  inlet,  and  may  enter  it,  according  to  circumstances.  In 
this  case  the  head  lies  towards  the  abdomen  of  the  foetus,  the  neck 
bending  downwards,  and  the  mane  (if  a  foal)  alone  meeting  the  hand  ; 
while  the  fore-feet  may  protrude  in  the  vagina,  or  even  beyond  the  vulva 
(Fig.  116). 

The  diagnosis  of  this  deviation  is  not  difficult.  When  the  anterior  limbs 
are  in  a  proper  direction,  the  feet  and  upper  part  of  them  are  readily 
found,  and  their  inclination  should  be  noted  ;  but  in  a  slight  complication 
the  whole  of  the  head  cannot  be  discovered — only  the  ears,  eyes,  nape  of 
the  neck,  and  the  forelock  and  mane,  if  a  foal.  When  the  deviation  is 
greater  or  extreme,  in  the  foal  only  the  neck  can  be  felt,  and  the  direction 
of  this  is  ascertained  by  noting  its  anatomical  features  and  their  situation. 
With  the  calf,  which  has  a  shorter  neck,  it  may  be  possible  to  reach  the 
head  or  nose.  The  upper  ridge  of  the  neck  is  always  a  safe  guide  to 
follow  in  discovering  the  direction  of  the  head. 


DVSTOKIA  DEPENDING  ON  ANTERIOR  PRESENTATION.    453 

Indications. 

There  is  no  difficulty  in  adjusting  the  head,  if  the  obstetrist  is  called  in 
time,  and  it  is  movable  towards  the  pelvic  inl^t,  but  not  engaged  in  that 
opening.  It  is  merely  necessary  to  glide  the  hand  along  the  floor  of  the 
vagina  into  the  uterus,  pass  it  between  the  maternal  pubis  and  the  fore- 
head of  the  foetus,  downwards  to  the  nose,  which  is  to  be  received  into 
the  hollowed  palm  and  raised  above  the  pubic  brim,  by  flexing  the  wrist 
and  drawing  it  towards  the  vulva.  When  the  nose  is  brought  into  the 
genital  canal,  nothing  more  is' to  be  done  than  to  pull  the  head  into  the 
passage  and  complete  delivery  in  the  usual  way.  With  the  calf,  whose 
muffle  is  wider  and  cannot  be  so  readily  received  into  the  palm  of  the 
hand,  it  is  better  to  introduce  the  fingers  into  its  mouth,  using  them  like 
a  blunt  hook,  or  to  seize  the  nose  by  pushing  the  index  finger  and  thumb 
into  the  nostrils,  so  as  to  throw  the  lower  part  of  the  head  upwards. 


Anterior  Presentatio> 


Fig.  116. 
Extreme  Downward  Deviation  of  the  Head. 


When,  however,  through  delay  or  unskilful  attempts  at  delivery,  the 
nape  of  the  neck  is  firmly  engaged  in  the  inlet,  there  is  no  room  to  ad- 
just the  head,  the  lower  part  of  which  is  jammed  against  the  maternal 
pubis  below,  and  the  vertex  against  the  sacrum  above.  In  such  a  case 
delivery  has  been  effected  by  passing  the  running  noose  of  a  cord  round 
the  nose  or  the  upper  jaw  of  the  foetus,  and  while  an  assistant  pulled  at 
this,  the  operator,  by  pressing  strongly  against  the  top  of  the  head,  made 
this  swing  backwards,  the  nose  rising  into  the  passage ;  birth  was  then 
accomplished  in  a  few  minutes. 

And  ev^en  with  this  degree  of  head  deviation,  delivery  of  the  foal  with- 
out adjustment  is  not  impossible  :  for  Lecoq,  quoted  by  Saint-Cyr,  gives 
an  instance  in  which  the  upper  part  of  the   head  and  poll  jvere  so  firmly 


454 


FCETAL  DYSTOKIA. 


fixed  in  the  pelvis,  that  it  was  impossible  to  push  the  foetus  into  the 
uterus.  This  was  attempted,  however,  by  squeezing  the  head  closer  to 
the  neck,  the  hand  being  passed  alongside  the  cheek  and  the  nose  grad- 
ually raised  ;  at  the  same  moment  the  Mare  strained  doubly  hard,  and 
gentle  traction  being  applied,  the  foal  was  expelled  with  its  head  in  this 
position,  but  without  injuring  the  perineum  of  the  mother.  The  latter 
soon  recovered,  but  the  foal,  as  is  usual  in  such  cases  in  the  equine 
species,  was  dead. 

In  this  degree  of  deviation,  as  well  as  in  the  others,  great  assistance 
will  be  afforded  by  raising  the  hinder  parts,  of  the  mother  to  the  extent 
of  one,  two,  or  more  feet.  Lecoq,  Rueif,  and  others  have  recommended 
placing  the  animal  on  its  back.  It  is  perhaps  better,  however,  to  elevate 
the  hind-quarters,  and  to  resort  to  retropulsion  either  by  tne  hand  or  the 
crutch  ;  then  after  injecting  warm  water  or  oleaginous  fluids,  to  either  ex- 
tend the  head,  or  to  attempt  forced  extraction.  The  blunt  hooks  fixed 
firmly  in  the  orbits  of  the  foetus,  will  be  found  most  useful  in  the  latter 
operation. 

When  the  upper  part  of  the  neck  alone  presents,  reduction  is  still  pos- 
sible, provided  no  great  delay  has  occurred,  nor  mismangement  by  un- 
skilful people  allowed.  But  when  the  "  waters  "have  been  long  expelled, 
the  legs  pulled  at  by  amateurs,  and  the  uterus  closely  applied  to  the  body 
of  the  foetus,  the  case  is  most  difficult  j  as  then  manipulation  and  retro- 
pulsion cannot  effect  much  in  many  instances. 

The  doubled  neck  is  too  voluminous  to  enter  the  pelvis,  and  the  longer 
the  pains  continue,  so  the  farther  is  the  head  pushed  forward  from  the  in- 
let, and  therefore  away  from  the  reach  of  the  obstetrist. 

The  contractions  of  the  closely  applied  uterus  also  render  attempts  at 
delivery  almost  impossible,  by  their  paralyzing  the  hand  and  arm. 

Large  quantities  of  warm  lubricating  fluids  must  be  injected,  retropul- 
sion attempted  by  one  or  two  crutches  applied  to  shoulders  of  the  foetus 
— not  to  the  neck ;  while  the  hand  manipulates,  aided,  if  need  be,  by  the 
finger-hook  (Fig.  120).  A  blunt  hook  (Fig.  121)  inserted  on  each  side  of 
the  lower  jaw — when  this  can  be  reached,  towards  the  root  of  the  ear,  or 
into  the  orbits  ;  a  cord  round  the  neck — if  it  can  be  passed  ;  and  other 
devices  may  be  tried.  If  they  all  fail,  then  the  animal  should  be  thrown 
on  its  back  ;  indeed,  the  success  which  has  attended  this  change  of  atti- 
tude in  so  many  recorded  instances,  would  incline  the  obstetrist  to  adopt 
it  without  much  delay.  Very  often  the  altered  position  of  the  mother  at 
once  disengages  the  head  of  the  foetus  from  its  deviation  ;  if  this  does  not 
happen,  then  the  other  means  may  be  tried  as  in  the  standing  position. 
Pelvic  version  may  be  resorted  to  in  some  cases,  the  anterior  presenta- 
tion being  converted  into  a  posterior  one. 

When  reduction  cannot  be  effected,  and  delivery  of  the  entire  foetus 
cannot  be  accomplished,  then  the  obstetrist  has  no  other  course  left  open 
to  him  but  the  adoption  of  embryotomy.  The  head  may  be  amputated 
through  the  presenting  part  of  the  neck,  or  the  fore-limbs  removed  sub- 
cutaneously  at  the  shoulders — the  latter  is  to  be  preferred  in  the  majori- 
ty of  cases,  at  least  before  incision  of  the  neck  is  begun.  This  gives 
more  room  for  manipulating  the  body,  and  effecting  extraction. 

In  all  these  amputations  and  incisions,  care  must  be  observed  in  pre- 
venting the  maternal  organs  being  injured  either  by  instruments  or  ex- 
posed bones  ;  and  when  traction  on  the  limbs,  or  what  remains  of  them, 
is  resorted  to,  it  should  be  applied  to  both  alike — not  to  one,  as  this 
would  be  worse  than  useless. 


DYSTOKIA  DEPEXDIXG  ON  ANTERIOR  PRESENTATION.    455 
Lateral  Deviation  to  the  Right  or  Left. 

Hie  lateral  deviation  of  the  head  to  the  right  or  left  side  of  the  body, 
whereby  the  left  or  right  side  of  the  neck  presents  at  the  pelvic  inlet,  is  a 
very  serious  obstacle  to  birth,  and  is  only  too  frequently  one  of  the  most 
difficult  to  be  overcome.  It  is  also  one  of  the  most  frequent  deviations, 
Saake  observing  it  in  39^  per  cent,  of  his  cases  of  dystokia  ;  and  it 
occurs  far  more  often  in  the  Mare  than  the  Cow  or  other  animals.  With 
regard  to  its  origin,  as  well  as  to  its  adjustment,  a  wids  distinction  must 
be  drawn  between  it  as  it  exists  in  the  foal  and  other  young  creatures. 

The  cause  of  lateral  deviation  of  the  head  is  not  well  ascertained  in  all 
cases.  It  is  not  improbable  that,  in  very  many  instances,  it  is  due  to 
precipitate  or  tumultuous  birth,  when  the  os  is  either  imperfectly  or  not 
at  all  dilated.  In  such  circumstances,  the  uterine  contractions  propel 
the  head  of  the  foetus,  otherwise  in  a  good  direction,  towards  the  pelvis  ; 
but  as  the  os  is  not  open,  and  as  the  impelling  force  continues,  the  body 
of  the  foetus  pushes  the  nose  against  either  the  pelvis  or  the  occluded  os  ; 
this  subsequently  yields  to  one  side,  and  then  the  deviation  becomes  in- 
creased with  every  contraction.  Premature  rupture  of  the  fcetal  mem- 
branes and  escape  of  the  "  waters,"  spasm  of  the  cervix  uteri,  torsion  of 
the  uterus,  and  other  anomalous  conditions,  may  all  more  or  less  occa- 
sion it.  As  with  the  downward  deviation,  if  the  nose  is  not  in  the  axis 
of  the  pelvis,  or  indeed  of  the  os,  even  though  the  latter  may  be  partially 
dilated,  misdirection  may  occur,  and  all  the  more  rapidly  should  the  fore- 
limbs  chance  to  pass  into  the  vagina. 

The  accident  appears  to  be  most  frequent  with  primiparag.  In  108 
cases  of  lateral  deviation  of  the  head,  Saake  found  84 — or  78  per  cent. 
— in  animals  pregnant  for  the  first  time.  The  remainder  were  noted  in 
animals  which  had  previously  brought  forth,  but  in  which  labor  was  pro- 
tracted through  imperfect  or  tardy  dilatation  of  the  os. 

This  deviation  is  more  serious  when  the  foetus  is  dead  than  when  it  is 
alive  ;  and  when  the  deviation  is  only  slight,  the  head  fitting  into  the 
concavity  on  the  side  of  the  neck,  birth  may  even — though  indeed  rarely 
— occur  without  assistance,  particularly  with  rhe  foal,  which  has  a  longer 
and  thinner  head  than  the  calf.  Some  authorities  have  remarked  that 
the  deviation  is  more  frequently  to  the  right  than  the  left  side,  and  others 
the  contrary. 

In  some  instances  there  can  scarcely  be  any  doubt  that  the  deviation 
has  taken  place  some  time  before  gestation  is  completed,  and  is  the 
result  of  a  long-continued  malposition  of  the  fcetus.  In  many  foals,  at 
birth,  the  neck  cannot  be  straightened,  and  the  head  is  distorted  from 
being  pressed  against  the  neck  or  side  of  the  body  (Fig.  84),  bones, 
muscles,  and  ligaments  being  involved.  We  have  referred  to  these  in 
describing  '"  Contractions  "  of  the  fcetus  as  a  cause  of  dystokia. 

It  is  not  difficult,  as  a  rule,  to  distinguish  the  existence  of  lateral  de- 
viation. Usually  both  fore-feet  are  in  the  genital  canal,  but  birth  does 
not  progress.  But  an  important  fact  to  remember  is  that  one  limb — 
that  belonging  to  the  side  to  which  the  head  is  bent — is  shorter,  or  rather 
less  advanced,  than  the  other.  The  hand,  on  being  passed  beyond  these 
towards  the  inlet,  comes  in  contact  with  a  rounded  mass,  more  or  less 
occupying  the  whole  of  it,  and  rendering  access  to  the  uterine  cavity  dif- 
ficult. Patient  exploration,  however,  discovers  this  to  be  the  bent  neck  ; 
and  if  it  be  a  calf,  owing  to  the  short  neck,  the  head  is   soon  found,  and 


1 


4S6 


FCETAL  DYSTOKIA. 


recognized  by  the  ears,  eyes,  and  often  the  muffle  turned  towards  the 
shoulder  (Fig.  117)  ;  with  this  bovine  foetus,  in  fact,  the  greater  part  of 
the  head  in  the  majority  of  cases  hes  against  the  shoulder. 

With  the  foal,  it  is  only  too  often  otherwise.  The  much  longer  neck 
of  this  creature,  and  the  more  violent  uterine  contractions  of  the  Mare, 
generally  results  in  the  head  being  pushed  towards  the  side  of  the  thorax, 
the  abdomen,  or  even  the  flank,  where  it  cannot  be  reached.  This  diffi- 
culty is  greatly  increased  if  the  abdomen  of  the  mother  is  very  pendu- 
lous. Occasionally  this  is  also  the  case  with  the  Cow,  though  it  is  rare 
that  in  this  animal  the  ears,  or  even  the  eyes,  cannot  be  reached  by  a 
fairly  long  arm  (Fig.  118).  If  the  animal,  be  it  Mare  or  Cow,  chances 
to  be  lying,  and  the  deviation  is  only  to  the  shoulder,  it  is  most  difficult 
to  reach  the  nose  of  the  foetus  if  it   is  inclined  to  the  side   on  which  the 


Anterior  Presentation 


Fig.  117. 
Lateral  Deviation  of  the  Head  towards  the  Shoulder. 


parent  lies — i.e.,  if  the  Mare  is  on  the  left   side   and  the  deviation  of  the 
foal's  head  is  to  the  right. 

The  head  may  be  raised  as  high  as  the  back,  or  as  low  as  the  under 
part  of  the  chest  or  abdomen.  The  foetus  is  usually  in  the  first  (or  ver- 
tebro-sacral)  position,  though  the  deviation  may'also  occur  in  the  second 
(vertebro-pubic)  or  third  (vertebro-ilial)  positions  ;  in  the  latter  position 
the  neck  may  be  bent  upwards,  the  head  towards  the  maternal  sacrum, 
or  downwards,  the  head  resting  on  the  floor  of  the  uterus. 
.  This  complication  is  not  only  a  very  frequent,  biit,  as  has  been  said,  a 
very  serious  one  for  the  obstetrist,  and  it  may  be  truthfully  asserted  that 
birth  is  not  possible  without  his  assistance  ;  indeed,  it  has  been  well  re- 
marked that  "  it  taxes  all  his  strength,  patience,  and  ingenuity." 

With  the  calf,  the  neck  of  which  is  comparatively  short,  the  head  is  in 
most  cases  no  farther  back  than  the  shoulder,  though  it  may  be  as  high 
as  the  withers  or  as  low  as  the  sternum.     It  is,  therefore,  possible  to 


DYSTOKIA  DEPENDING  ON  ANTERIOR  PRESENTATION.    457 

reach  it  ;  and  though  its  relatively  large  size  is  a  great  obstacle  to  reduc- 
tion, yet  in  the  majority  of  instances  this  adjustment  can  be  accom- 
plished, and  especially  if  the  young  creature  is  alive,  as  its  spontaneous 
movements  aid  the  operation  ;  for  this  and  other  reasons  already  alluded 
to,  the  calf  is  more  frequently  extracted  alive  than  the  foal. 

As  a  rule,  reduction  of  the  displacement  is  indispensable  in  delivery, 
the  head  and  neck,  or  -shoulder,  forming  too  voluminous  a  mass  to  pass 
through  the  pelvic  canal. 

With  the  foal  the  head  may  also  not  go  beyond  the  region  of  the 
shoulder,  and  the  case  is  then  generally  not  so  serious  as  with  the  calf, 
the  head  being  smaller  and  the  displacement  more  easily  reduced.  But, 
as  has  been  pointed  out,  owing  to  the  long  and  flexible  neck  of  this  crea- 
ture, the  head  is  most  frequently  deeper  in   the  uterine   cavity  :    towards 


Fig.  118. 
Anterior  PRESEN-TATio>f :    Lateral  DEVIATIO^J  of  the  Head  towards  the  Addomz:  . 

the  side  of  the  chest,  abdomen,  flank,  or  even  the  croup.  Here  the  hand 
cannot  reach  it,  and  reduction  is  nearly  always  impossible  ;  besides,  the 
foetus  succumbs  soon  after  the  commencement  of  the  labor-pains  :  death 
being  due  in  many,  if  not  in  all,  cases  to  premature  separation  of  the 
maternal  and  fcetal  placenta.  However,  owing  to  the  thinner  and  more 
flexible  neck,  and  the  smaller  head,  when  the  latter  was  lodged  in  the 
flank  the  foetus  has  been  delivered  by  energetic  traction.  Mention  is 
made  that  both  in  the  Mare  and  Cow  delivery  has  been  effected,  though 
the  head  has  been  bent  back  on  the  neck,  side,  or  flank,  without  having 
recourse  to  embryotomy,  and  in  a  great  measure  by  the  expulsive  efforts 
of  the  mother. 

Indications. 

The  principal  indication  in  this  deviation  is,  of  course,  to  get  hold  of 
the  head,  adjust  it,  bring  it  into  a  favorable  position  in  the  genital  canal. 


458  FCETAL  DYSTOKIA. 

and  then  terminate  delivery.  But  this  indication  cannot  always  be  car- 
ried out,  especially  when  the  head  is  beyond  reach  ;  neither  is  it  always 
necessary  that  it  should  be  followed  implicitly,  so  far  as  the  foal  is  con- 
cerned, though  in  the  case  of  the  calf  it  is  an  almost  absolute  require- 
ment. For  the  latter  there  are  only  two  courses  open — adjustment  or 
embryotomy. 

With  regard  to  adjustment,  it  is  generally  recommended  that  the  lower 
part  of  the  head  should  be  secured,  either  by  the  hand  or  a  cord  passed 
round  the  lower  jaw,  and  strong  traction  employed.  But  this  necessarily 
produces  twisting  of  the  neck,  which,  in  addition  to  rendering  reduction 
very  difficult,  endangers  the  life  of  the  foetus. 

The  better  plan,  therefore,  appears  to  be  as  follows  :  Cord  the  pre- 
senting fore-feet;  push  the  foetus  into  the  uterus,  so  as  to  clear  it  from 
the  inlet ;  pushing  either  on  the  flexed  neck  or  chest,  and  not  directly 
forward,  but  rather  obliquely  to  the  side  opposite  that  to  which  the  head 
inclines,  so  as  to  bring  this  round  to  the  inlet.  This  retropulsion,  Man- 
del  asserts,  has  often  alone  brought  the  head  into  the.  natural  position. 
If  it  does  not,  then  the  operation  must  be  continued.  If  the  fore-limbs 
are  in  the  way  of  the  operator,  they  may  also  be  pushed  back  into  the 
uterus.  The  head  is  then  to  be  sought  for,  and  version  applied  to  it  in 
such  a  way  as  to  bring  its  under  surface  uppermost. 

Schaack  has  communicated  to  Saint-Cyr  his  method  of  eifecting  this  : 
The  extremity  of  the  jaws  is  employed  to  straighten  the  head,  not  by 
lowering  the  chin  and  drawing  it  below  the  neck,  but  superiorly,  after 
forcing  the  chin  and  lower  jaw  up  and  outwards — the  foetus  is  supposed 
to  be  in  the  first  position.  In  order  to  do  this,  as  soon  as  the  hand 
reaches  the  muffle  the  fingers  are  passed  into  the  submaxillary  space,  and 
pressure  is  made  on  one  of  the  branches  of  the  lower  jaw,  so  as  to  twist 
the  head  outwards  and  upwards.  When  this  is  done,  it  is  an  easy  matter 
to  put  it  in  a  good  position  by  pulling  at  the  nose,  as  traction  then  acts 
exactly  in  the  direction  of  the  atloido-occipital  and  other  joints  of  the 
vertebrae  ;  whereas,  if  practised  before  this  manoeuvre,  traction  tends  to 
twist  the  neck,  and  renders  reduction  much  more  difficult. 

The  head  being  twisted  in  this  way,  it  has  now  to  be  extended  and 
brought  into  the  inlet.  To  eifect  this,  Bordonnat  gives  these  directions  : 
Place  the  palm  of  the  hand  beneath  the  chin,  seize  each  side  of  the  lower 
jaw  by  the  fingers,  the  thumb  being  in  the  mouth  behind  the  incisors. 
This  ensures  a  solid  grip,  and  the  head  is  brought  into  a  good  position 
by  direct  traction  towards  the  axis  of  the  pelvis,  this  traction  being  ap- 
plied in  jerks  rather  than  continuously.  'i1ie  hand  must  not  relax  its 
hold  of  the  head,  when  at  the  inlet,  until  it  has  been  corded,  as  it  readily 
slips  back  again. 

If  the  hand  cannot  accomplish  this,  a  cord  should  be  placed  around 
the  lower  jaw,  behind  the  incisor  teeth.  This,  however,  is  not  always 
easy,  as  only  too  frequently  the  fingers  are  paralyzed  by  the  uterine  con- 
tractions. 

The porte-cord  (Figs.  119,  120)  maybe  usefully  employed  in  this  direc- 
tion, and  the  jaw  secured.  But  sometimes,  and  generally  with  the  foal 
(which  has  no  incisor  teeth),  the  cord  slips  off  when  traction  is  applied  ; 
it  must  then  be  given  up,  and  other  means  tried.  When,  however,  it  does 
remain  attached  to  the  jaw,  an  assistant  judiciously  pulling  at  it  will  greatly 
aid  the  operator,  whose  hand  is  manipulating  the  accessible  parts  of  the 
head.     In  this  manipulation,  even  when  the  cord  will  not  remain  on  the 


DYSTOKIA  DEPEADIXG  OX  ANTERIOR  PRESENTATION. 


459 


neck  of  the  jaw,  much  benefit  will  be  derived  by  using  the  finger-hook 
(Fig.  i2i),  which  can  be  inserted  into  the  ear,  orbit,  or  angle  of  the  mouth 
or  jaw. 

In  default  of  the  cord  round  the  jaw,  recourse  may  be  had  to  the  short 
blunt  crotchet  (Fig.  122) — some  obstetrists  prefer  the  long  blunt  crotchet 
(Fig.  123) — which  can  be  fixed  in  the  angle  of  the  jaw  behind  the  chin,  in 
the  cheek,  orbit,  or  ear,  or  on  the  under-side  of  the  head — in  fact,  wherever 


Fig.  121. 
Finger-Crotchet. 


i    c^ 


Fig.  iig. 
Straight  Porte-Cord. 


Fig.  120. 
Bent  Porte-Cord. 


Fig.  122. 
Short  Blunt  Crotchet. 


the  operator  may  deem  most  effective — the  assistant  pulling  at  the  cord 
attached  to  it,  according  to  the  directions  of  the  obstetrist,  who  guards  the 
hook  with  his  hand,  or  assists  in  straightening  the  head  by  judicious  ma- 
noeuvres. The  ear,  or  other  convenient  part,  may  also  be  secured  by  the 
serrated  forceps  (Fig.  124),  and  traction  exercised  by  the  cord  passing 
through  its  eyelets. 

In   all  these   attempts  it  is  absolutely  necessary  that  the  foetus  be  kept 


1 


460  FCETAL  DYSTOKIA. 

as  far  as  possible  from  the  inlet.  It  has  been  recommended  in  those 
cases  in  which  the  head,  lying  towards  the  flank,  cannot  be  reached,  that 
the  fore-part  of  the  mother  be  raised ;  that  the  abdomen  be  elevated  by  a 
plank,  sheet,  or  sack  ;  that  the  flank  be  pressed  upon  externally  by  an  intelli- 
gent assistant ;  that  the  animal  be  placed  on  its  back  ;  that  sharp  hooks  be 
implanted  in  the  neck,  occiput,  or  other  part  of  the  foetus,  etc.  Schaack, 
who  has  had  a  large  experience  in  such  cases,  and  appears  to  have  made 
this  subject  a  special  study,  points  out  that  all  these  devices  gain  the 
proposed  end  with  difficulty,  and"  have  one  capital  defect — they  do  not 
act  on  the  proper  part.    With  regard  to  traction,  he  says  that  it  is  neither 


n> 


Fig.  123. 
Long  Blunt  Chrotchet. 


on  the  ears,  occiput,  nor  even  the  head,  that  this  should  be  applied  in  such 
cases,  but  on  the  point  where  the  neck  is  bent.  It  is  necessary,  there- 
fore, to  introduce  the  hand  into  this  part,  and,  by  repeated  tugs  or  jerks, 
to  widen  the  bend ;  this  done  to  some  extent,  the  hand  is  moved  to  an- 
other point  nearer  the  head,  retropulsion  being  at  the  same  time  practised. 
By  acting  in  this  manner,  he  assures  Saint-Cyr  that  he  has  always  suc- 
ceeded in  bringing  the  head  sufficiently  near  to  be  able  to  manipulate  it. 
Delafoy  {Recueil  de  Med.  Veterinaire,  1832,  p.  313)  many  years  ago 
described  his  method,  which  consists  in  carrying  a  good  firm  cord,  about 
twelve  feet  long,  and  with  a  knot  at  the  end  to  hold  it  by,  by  the  hand  into 
the  uterus.  The  knot,  held  at  the  end  of  the  fingers,  is  passed  between 
the  neck  and  chest  of  the  foetus  ;  there  it  is  left  while  the  hand  seeks  for 
it  at  the  other  side  of  the  neck,  where  it  is  seized,  drawn  through,  and 


Fig.  124. 
Nelson's  Serrated  Forceps 

carried  without  the  vulva,  the  double  of  the  neck  being  included  in  it. 
The  hand  is  again  passed  into  the  uterus,  and  the  cord  is  pushed  as  near 
the  head  as  possible  ;  and  there  it  is  held,  while  an  assistant  twines  the 
two  ends  until  they  form  one  piece  closely  fixed  on  the  neck — care  being 
taken  that  the  membranes  are  not  entangled  in  it,  or  cotyledons,  if  it  is  a 
Cow.  The  hand  is  then  placed  on  the  point  of  the  sternum  or  one  of  the 
shoulders  of  the  foetus,  and  while  this  is  pushed  forward  into  the  uterus, 
the  assistant  is  told  to  pull  steadily.  If  this  movement  is  well  managed, 
the  head  of  the  foetus  is  brought  sufficiently  near  the  os  to.  be  secured  and 
adjusted.  Delafoy  states  that  he  has  practised  this  procedure  a  great 
number  of  times,  and  always  with  success ;  and  others  have  been  equally 


DYSTOKIA  DEPENDING  ON  ANTERIOR  PRESENTATION    461 


fortunate.  For  instance,  Lecoq  gives  the  following  testimony  of  his  expe- 
rience to  Saint-Cyr  :  "  During  my  sojourn  at  Solre-le-Chateau,  I  was 
called  one  morning  to  a  Cow  which  had  been  in  labor  since  the  previous 
evening,  and  which  had  passed  the  night  in  futile 
efforts,  notwithstanding  the  more  than  probable 
intervention  of  the  owner  and  his  neighbors.  I 
recognized  immediately  the  position  of  the  head, 
which  was  turned  towards  the  flank,  and  so  far 
round  that  my  fingers  could  not  seize  the  nose 
with  sufficient  firmness  to  bring  it  into  its  normal 
position.  I,  however,  soon  succeeded  in  doing 
so  by  a  very  simple  procedure.  I  passed  from 
above  to  below,  in  the  concavity  formed  by  the 
bend  of  the  neck,  a  cord,  the  end  of  which,  passed 
under  the  neck,  was  drawn  outwards,  and,  with 
the  other  end,  placed  in  the  hands  of  an  assistant. 
A  moderate  effort  by  the  latter  drew  the  fcetus 
backwards,  and  I  was  then  able,  with  the  great- 
est ease,  to  straighten  the  neck  by  getting  hold  ot 
the  jaw.     Birth  took  place  immediately." 

One  of  the  long  bent  porte-cords,  such  as  is  rep- 
resented by  Fig.  120,  that  of  Binz  (Fig.  125),  or 
those  to  be  hereafter  described,  might  be  most 
usefully  employed  not  only  in  carrying  the  cord 
or  sling  round  the  neck,  but  also  in  pulling  at 
this  part. 

In  all  these  manceuvres,  should  the  "  waters  " 


Fig. 
BiNz's   Porte-Cord. 


time,  and  the  genital  canal  and  uterus  be  dry  and  ho 


have  escaped  for  some 
frequent  injections 
of  warm  water  should  be  applied  to  them.  In  certain  cases,  when  the 
head  is  adjusted,  or  even  to  aid  in  its  adjustment.  Nelson's  blunt  forceps 
(Fig.  126)  will  be  found  of  great  service  in  seizing  the  nasal  septum. 

With  regard  to  embryotomy,  though  instances  are  recorded  in  which 
forced  extraction  in  the  Cow  has  been  successful,*  yet  it  should  never  be 
resorted  to  by  the  humane  practitioner  (and  we  earnestly  hope  veterinary 
obstetrists  are,  above  all  things,  humane).  The  great  length  and  essen- 
tially bony  structure  of  the  Cow's  pelvis,  and  the  large  volume  and  shape 
of  the  calf's  head,  prove  such  an  obstacle  to  forced  extraction  in  this 
lateral  deviation,  that,  if  persisted  in,  it  will  not  only  cause  the  death  of 
the  young  creature  in  all  probability,  but  also  that  of  the  mother,  unless 
the  fcetus  is  unusually  small  and  the  pelvis  of  the  Cow  very  wide.  In  fact, 
those  who  have  attempted  it  testify  to  its  barbarity  and  fatality. 

With  the  Mare,  the  case  is  somewhat  different.  When  the  head  of  the 
foal  is  deeply  buried  towards  its  flank  or  croup,  reduction  is  most  difficult, 
and  requires  long  and  laborious  manipulations,  which  so  irritate  the 
organs  and  exhaust  the  strength  of  the  mother,  that  it  not  unfrequently 
dies  from  their  effects. 

In  most  cases,  too,  the  obstetrist  is  called  in  when  the  foal  is  dead,  so 
that  there  is  no  necessity  for  scruples  with  regard  to  it.      On  the  other 


*  Franck  {Op.  cit.,  p.  373)  gives  an  instance  in  which  two  empirics  attempted  to  deliver  a  Cow  that  could 
not  calve.  They  mistook  this  deviation  for  a  breech  presentation,  as  they  could  not  find  the  head,  and 
they  thought  the  fore-feet  in  the  vagina  were  hind  ones.  They  consequently,  other  means  failing,  set 
about  extracting  the  calf  per  force,  and  eight  men  pulled  at  the  cords  attached  to  the  feet ;  the  young 
creature  was  removed,  but  it  was  dead.  The  Cow  was  unable  to  get  up  for  eight  days,  but  eventually 
recovered. 


462  FCETAL  DYSTOKIA. 

hand,  as  we  have  previously  said,  the  long,  thin,  and  flexible  neck,  and 
narrow  and  tapering  head,  readily  allows  the  latter  to  become  imbedded 
in  the  flank,  and  thus  to  offer  much  less  resistance  than  with  the  calf  ; 
while  the  wider  pelvis  of  the  Mare  offers  further  facilities.  Numerous  in- 
stances are  given,  in  which  forcible  extraction  of  the  foal  with  the  head 
so  deviated,  has  been  attended  with  complete  success — Darreau  had  eight 
out  of  ten  cases — and  without  much  suffering  on  the  part  of  the  Mare. 
Indeed,  so  successful  and  prompt  is  it,  that  Donnarieix,  who  has  devoted 
much  attention  to  this  procedure,  says  it  should,  as  a  rule,  be  adopted  in 
these  cases,  as  it  is  not  possible  to  restore  the  head  to  its  normal  position  ; 
delivery  by  vigorous  traction  is,  if  not  easy,  at  least  most  frequently  fol- 
lowed by  success. 

Donnarieix  operates  as  follows  :  The  Mare  is  thrown  down  near  the 
stable  door,  the  thighs  propped  against  the  threshold,  and  a  breech- 
ing and  side-line,  fixed  to  the  wall  or  held  by  assistants,  may  be  em- 
ployed to  keep  the  animal  in  position.  Each  fore-limb  of  the  fcetus  is 
corded  at  the  pasterns,  the  cords  being  confided  to  assistants,  the  number 
of  which  will  vary  according  to  the  amount  of  resistance — four  at  least 
are  necessary,  and  sometimes  six  or  eight.      On  the  word  being  given, 


Fig.  126. 
Nelson's  Blunt  Forceps. 

these  men  pull  slowly,  steadily  and  gradually,  without  jerking,  but  strongly, 
and  equally  on  both  cords.  The  foal  enters  the  inlet,  but  it  often  happens 
that,  at  a  given  moment,  it  stops  there,  owing  to  the  uterus  forming  a 
double  or  ring  at  this  part  and  opposing  progression.  Traction  must 
then  cease,  but  the  foetus  is  to  be  held  firmly  in  the  position  to  which  it 
has  been  advanced  ;  the  hand  is  to  be  introduced  between  the  latter  and 
the  uterus — the  back  of  the  hand  to  the  foetus,  palm  to  the  mucous  mem- 
brane— the  fold  sought  for,  and  dispersed  by  raising  the  back  of  the  hand. 
Then  the  tractions  are  to  be  renewed,  and  in  the  course  of  fifteen,  ten,  or 
even  fewer  minutes,  the  foal  is  extracted.  It  is  well  to  empty  the  rectum 
before  commencing  extraction. 

When  practised  with  care  and  discretion,  this  forced  removal  of  the  foal 
may  certainly  be  commended  ;  but  we  should  prefer,  when  circumstances 
will  permit,  to  give  a  trial  to  the  methods  already  enumerated  ;  seeing 
that  this  procedure  is  not  always  successful,  and  may  be  followed  by  un- 
toward consequences.  Eberhard,  for  instance  (Gurlt  and  Hertwig's 
Magazin,  185 1,  p.  269),  gives  a  case  in  which  forced  extraction  was  at- 
tempted in  a  Mare,  and  was  followed  by  rupture  of  the  abdominal  muscles, 
through  the  powerful  tractiorf  resorted  to. 

With  regard  to  embryotomy^  this  must  be  looked  upon  as  preferable  to 
forced  extraction  —  even  in  the  Mare,  but  particularly  .  in  the  Cow; 
nevertheless,  it  must  always  be  considered  as  an  extreme  measure.     The 


D  YSTOKIA  DEPENDING,   ON  ANTERIOR  PRE  SENT  A  TION    463 

operation  will  be  described  hereafter,  but  we  may  note  in  this  place 
that  the  head  or  the  presenting  limbs,  or  even  both,  may  be  removed. 
Decollation  is,  however,  a  most  difficult  business  when  the  head  cannot 
be  reached  ;  if  it  is  accessible  the  operation  can  scarcely  be  necessary. 
The  limbs  should  be  removed  subcutaneously,  the  most  advanced  being 
first  excised,  and  with  the  shoulder  if  possible.  Not  unfrequently  removal 
of  one  limb  will  be  sufficient  to  allow  the  foetus  to  be  adjusted — especially 
in  the  Mare  ;  or  it  may  permit  forced  extraction,  without  adjustment,  to 
be  easily  accomplished. 

With  the  calf,  both  limbs  have  usually  to  be  removed.  In  this  opera- 
tion, the  long  sharp  crotchet  (Fig.  127)  will  be  of  service. 

The  parturient  animal  in  which  this  head-deviation  of  the  foetus  occurs, 
has  sometimes  a  very  pendulous  abdomen,  and  manipulation  is  greatly 
retarded  by  this  conformation.  Placing  it  on  its  back  will  generally  give 
greater  facilities  for  obstetrical  operations  of  this  kind. 


Fig.  127. 
Long  Sharp  Crotchet. 


^ 


L 


Lateral  deviation  of  the  head  is  usually  encountered  when  the  foetus  is 
in  the  first,  or  vertebrosacral,  position.  It  may  nevertheless  be  met 
with,  though  rarely,  in  the  vertebro-pubic  position,  or  in  the  right  or  left 
vertebro-ilial  position,  which  is  still  more  rare. 

These  positions,  however,  do  not  modify  the  indications  for  extraction 
to  any  considerable  extent,  except  that  in  the  last,  after  correcting  the 
deviation  of  the  head,  rotation  should  be  practised,  and  the  foetus  placed 
in  the  verteBro -sacral  position,  if  possible,  before  delivery  is  attempted. 
When  the  head  is  doubled  beneath  the  body  of  the  foetus  in  these  lateral 
positions,  in  order  to  reach  it,  it  will  be  found  most  advantageous  to 
throw  the  mother  down  on  the  side  that  will  ensure  the  head  of  the. 
young  creature  being  uppermost.  Version  may  be  advisable  in  some  of 
these  positions. 

This  lateral  deviation  of  the  head  is  liable  to  be  complicated  by 
misdirection  of  one  or  both  of  the  fore-limbs,  which  may  be  flexed  at  the 
knee,  entirely  retained,  or  crossed  on  the  sternum.  Such  a  complication 
of  course  greatly  adds  to  the  gravity  of  the  case,  and  renders  it  much 
more  formidable. 

Here  it  will  be  necessary  to  adjust  the  limbs  before  interfering  with 
the  head ;  though  the  latter,  if  it  can  be  reached,  and  there  is  any  benefit 
to  be  derived  from  doing  so,  should  be  secured  by  either  a  head-collar, 
or  a  cord  round  the  neck  or  jaw.  The  feet  should  always  be  secured  by 
cords,  so  that  if  it  is  requisite  to  push  them  into  the  uterus,  they  may 
readily  be  withdrawn  again. 

Jones  {Veterinarian,  vol.  xxx.,  p.  20),  acting  on  a  suggestion  thrown  out  in  the  course 
of  a  lecture  by  Professor  Varnell,  divided  the  sacro-ischiatic  ligament  of  a  Cow  whose 
foetus  was  in  this  position  and  could  not  be  delivered.  The  calf  was  dead,  its  fore-legs 
protruding,  and  the  head  turned  back  towards  the  flank.  The  ear  or  orbit  could  not  be 
reached,  but  with  great  difficulty  the  neck  and  fore-limbs  were  corded,  and  several  per- 
sons pulled  at  the  cords ;  however,  from  "  the  size  and  unnatural  presentation  of  the 
foetus,  coupled  with  the  narrowness  of  the  pelvic  outlet, "  it  could  not  be  extracted.     A 


464  FCETAL  DYSTOKIA. 

trocar  (for  lack  of  a  better  instrument)  was  introduced  between  the  ischio-rectal  fascia 
and  the  sacro-ischiatic  ligament  to  form  an  opening,  into  which  a  probe-pointed  bistoury 
was  inserted;  with  the  other  hand  on  the  outside,  the  ligament  was  quite  divided — 
which  was  ascertained  by  feeling  the  point  of  the  bistoury  under  the  skin.  Very  little 
haemorrhage  supervened,  and  the  calf  was  removed  with  but  little  difficulty  from  the 
artificial  opening  thus  made.  A  diffusible  stimulant,  followed  by  a  laxative  draught, 
was  all  the  after-treatment  adopted.  The  small  orifice  "  was  cicatrized  over  on  or 
about  the  third  day,"  and  the  Cow  quickly  recovered. 

This  operation  has  not,  so  far  as  I  am  aware,  been  repeated. 

With  the  smaller  animals — such  as  the  Sheep  and  Goat — this  deviation 
must  be  remedied  by  forced  extraction  or  the  short  blunt  hook  or  finger- 
hook,  the  fore-limbs  of  the  fcetus  being  manipulated  so  as  to  push  away 
the  unencumbered  shoulder  into  the  uterus,  and  bring  forward  that  round 
which  the  neck  bends.  The  smallness  of  the  genital  passages  in  these 
creatures  is  an  obstacle  to  manipulation,  but  an  intelligent  boy  with  a 
small  hand  may  be  of  much  service  when  acting  under  the  direction  of 
the  obstetrist. 

With  the  Bitch  and  Sow  these  deviations  are  extremely  rare.  When 
they  do  occur  it  will  be  found  that  forceps  will  generally  effect  forced 
extraction  ;  or  a  piece  of  strong  catgut  or  brass  or  copper  wire  may  be 
passed  round  the  bend  of  the  neck.  Traction  on  this  will  either  remove  the 
fcetus,  or  by  cutting  through  the  neck  permit  it  to  be  extracted  by  the 
forceps  hereafter  to  be  described.  Placing  the  Bitch  in  a  warm  bath  for 
a  few  minutes,  and  then  laying  it  on  the  side  opposite  to  that  to  which 
the  head  of  the  puppy  is  inclined,  will  be  found  advantageous. 

Deviation  Upward  and  Backward. 

The  deviation  of  the  head  more  or  less  upward  and  backward — the 
inferior  borders  of  the  lower  jaw  being  vertical  or  turned  up. towards  the 
maternal  sacrum — appears  to  be  an  extremely  rare  complication,  and  is 
chiefly  met  with  in  the  Mare,  in  which  it  has  led  to  rupture  of  the  uterus 
and  rectum,  and  delivery  by  the  latter. 

The  cause  is  probably  the  same  as  in  the  other  deviations  of  this 
region. 

On  exploration,  in  the  vertebro-sacral  position,  the  fore-limbs  maybe 
found  more  or  less  advanced  in  the  vagina,  and  beyond  them,  at  the 
inlet,  the  hand  meets  the  chest  with  its  sternum,  and  above"  it  the  front 
part  of  the  neck  with  the  trachea  leading  upwards  to  the  head,  which 
may  be  flexed  more  or  less  back  on  the  withers  or  loins  (Fig.  128),  or 
inclined  to  one  or  other  side  of  the  foetus,  the  lower  jaw  always  facing 
the  lumbo-sacral  region  of  the  mother,  or  twisted  slightly  round  (Fig. 
129). 

Indications. 

Retropulsion  is  the  first  indication,  and  this  alone  will  often  bring  the 
head  into  its  normal  position  ;  it  should  be  practised  on  the  sternum. 
Should  the  head  not  drop  down  to  the  pelvic  inlet,  then,  still  continuing 
the  retropulsion,  the  hand  may  be  introduced,  the  lower  jaw  seized  i.nd 
brought  towards  the  os,  by  carrying  it  downwards  and  a  little  to  one  side 
if  necessary,  by  a  slightly  screwing  motion.  A  cord  on  the  lower  jaw, 
or  around  the  head,  may  be  useful  if  it  can  be  applied.  Rueff  recom- 
mends compression  in  the  rectum,  previously  emptied,  by  the  hand  of  an 


DYSTOKIA  DEPENDING  ON  ANTERIOR  PRESENTATION    465 

assistant,  while  the  operator  manipulates  in  the  uterus.     If  the  animal  is 
lying,  it  must  be  made  to  stand. 
Embryotomy  is  rarely  necessary. 


Fig.  128. 
Anterior  Presentation:    Deviation  of  the  Head  Upwards  and  Backwards. 

In  the  smaller  animals — at  least  in  the  Bitch — delivery  has  been  effected 
without  reduction  of  the  deviation. 


Fig.  i2g. 
Anterior  Presentation  :    Deviation  of  the  Head  Upwards  and  Laterally. 

1.  Charant  {Rcaieil  de  Med.Veterinaire,  r85i,  p.  895)  attended  a  Mare  in  labor.  With 
isome  difficulty  he  was  able  to  pass  his  hand  into  the  uterus,  and  then  found  that  the  foal 

lad  its  head  and  neck  reversed  on  the  back,  the  throat  pressing  strongly  against  the 
ipper  part  of  the  maternal  pelvis  and  a  little  to  one  side.  There  was  also  inversion  of 
the  bladder,  with  hernia  of  the  intestines  into  it.  Tlie  head  and  neck  were  adjusted  with 
lifficulty,  and  the  foal  extracted,  but  the  Mare  died  from  the  above  injuries. 

2.  Donnarieix  describes  a  case  of  this  deviation  in  the  Cow,  the  head  of  the  calf — 

30 


466  FCETAL  DYSTOKIA. 

which  was  dead — being  reversed  on  the  back.     Much  time  and  patience  were  required 
to  adjust  the  misplacement  and  extract  the  calf.     The  Cow  did  well. 

3.  Grad  {Briefliche  Mittheilung,  Franck,  Op.  cit.,-^.  384)  met  a  case  of  this  kind  for  the 
first  time.  It  occurred  in  a  Mare  ;  the  head  and  neck  of  the  foal  were  thrown  on  the 
back,  and  only  the  sternum  presented  at  the  inlet.  Three  shepherds  had  been  endeavor- 
ing to  pull  away  the  young  creature,  which  was  dead.  The  fore-limbs  were  in  the  vagina, 
and  as  it  was  decided  not  to  exhaust  the  Mare  by  adjusting  the  head  and  neck,  these 
legs  were  removed  subcutaneously;  then  the  head  was  sought  for.  The  hand,  pushed 
as  far  into  the  uterus  as  possible,  encountered  first  the  cervical  vertebrae,  then  the  right 
ear  was  at  last  reached  and  secured. 

It  was  now  discovered  that  the  head  lay  a  little  to  the  right  side  of  the  croup,  the 
lower  jaw  being  downwards.  The  task  of  reduction  was  a  most  difficult  one,  the  arm 
being  too  short  ;  but  at  length  the  head  was  brought  as  low  as  the  shoulder.  The  neck 
was  not  contracted,  and  a  hook  being  inserted  into  the  orbit,  the  head  was  carried  into 
the  pelvis,  and  delivery  was  then  soon  completed. 

4.  Saint-Cy  (Op.  cit.,  p.  472)  reports  the  case  of  a  Bitch  which  was  forwarded  to  the 
clinic  of  the  Lyons  Veterinary  School,  having  brought  forth  several  puppies  the  previous 
evening,  and  continuing  to  strain.  An  exploration  discovered  a  foetus  firmly  engaged  in 
the  pelvic  canal ;  two  limbs  could  be  distinctly  felt,  and  beyond  them  a  rounded  surface 
which  was  at  first  supposed  to  be  the  croup  ;  the  case  was  therefore  suspected  to  be  a 
breech  presentation.  The  two  limbs  were  seized  and  drawn  outside  the  vulva," when 
they  were  recognized  as  fore-legs.  The  head  could  not  be  discovered;  so  traction  was 
continued,  though  with  every  precaution,  and  at  last  the  foetus  was  brought  away.  It 
was  dead,  and  the  head  was  bent  back  on  the  loins,  in  which  it  had  made  a  considerable 
depression  (Fig.  129).     The  Bitch  did  not  suffer  much,  and  soon  was  quite  well. 

SECTION    III. DYSTOKIA    DUE    TO     MISDIRECTION     OF    THE     HIND-LIMBS    IN 

THE   ANTERIOR    PRESENTATION. 

Sometimes  in  the  anterior  presentation,  when  the  head  and  fore-limbs 
are  normal  and  in  a  good  position,  an  obstacle  to  birth  is  met  with  in  a 
wrong  direction  of  the  posterior  parts  of  ^ the  young  creature's  body,  and 
especially  the  limbs. 

The  anterior  parts  may  be  engaged  in  the  pelvis,  and  yet  can  advance 
no  farther,  owing  to  the  hind-legs  advancing  at  the  same  time  with  them 
into  the  canal,  or,  being  widely  abducted,  the  stifles  come  against  the 
brim  of  the  inlet  on  each  side  and  prevent  further  progress. 

This  cause  of  dystokia  we  will  now  consider,  commencing  with  the 
latter  deviation. 

Extreme  Abduction  of  the  Hind-limbs. 

In  this  deviation  birth  appears  to  be  proceeding  favorably,  the  fore- 
limbs,  head,  and  body  being  normal  and  in  the  natural  position,  and  well 
through  the  genital  canal — these  parts  being  even  more  or  less  outside 
the  vulva,  when,  just  as  parturition  is  supposed  to  be  completed,  a  check 
occurs ;  and  the  redoubled  strainings  of  the  mother,  and  even  powerful 
traction  on  the  foetus,  are  unavailing  in  bringing  it  beyond  a  certain 
point. 

This  cause  of  dystokia  appears  to  be  noticed  only  in  the  foal,  the  long 
limbs  of  which  undoubtedly  favor  the  occurrence  of  the  deviation. 

It  may  be  discovered  by  passing  the  hand  between  the  foetus  and  the 
genital  passage — between  the  fore-limbs  and  underneath  the  belly  of  the 
young  creature  ;  when  it  reaches  the  pelvic  inlet,  the  thighs  of  the  foetus 
are  found  to  be  widely  separated — the  stifles  turned  outwards,  so  that  the 
outer  aspect  of  the  thighs  is  nearly  horizontal  on  the  floor  of  the  uterus, 
and  these  joints  are  pressing  against  the  ascending  branches  of  the  ilium 
or  the  anterior  margin  of  the  pubis. 


DYSTOKIA  DEPENDING  ON  ANTERIOR  PRESENTATION.    467 

Indications. 

The  indications  for  extraction  are  the  adjustment  of  the  hind-limbs. 
This  adjustment  is  all  the  more  difficult  as  the  foetus  is  well  advanced  in 
the  pelvis,  and  energetic  traction  has  been  much  employed.  Retropul- 
sion  must  be  resorted  to,  the  hind-quarters  of  the  foetus  being  pushed 
as  far  from  the  inlet  as  possible,  so  that  the  abducted  limbs  may  be  ad- 
ducted  ;  but  retropulsion  is  not  unfrequently  very  difficult,  if  not  alto- 
gether impossible  in  some  cases.  Under  these  circumstances,  a  slight  ro- 
tation of  the  foetus  on  its  axis,  so  as  to  change  its  relations  with  the 
inlet,  and  allow  the  stifles  to  enter  the  pelvic  canal,  has  been  recommended 
and  practised  with  success. 

Heu,  quoted  by  Saint-Cyr,  gives  the  following  directions  for  this  ma- 
noeuvre :  A  double  cord  is  passed  round  the  loins  of  the  young  creature,  as 
near  the  vulva  as  possible,  the  two  ends  being  tied  and  a  stick  passed 
through  them.  Two  turns  of  the  stick  being  made  to  tighten  the  cord 
firmly  round  the  belly,  the  front  part  of  the  foetus  is  lifted  to  the  level  of 
the  vulva ;  then  the  body,  as  well  as  the  lever — the  stick — is  rotated  from 
right  to  left ;  after  a  little  manipulation  the  resistance  is  overcome.  Heu 
has  by  this  means  been  able  to  extract  a  living  calf. 

Should  this  operation  fail,  embryotomy  is  the  last  resource.  This  may 
perhaps  be  best  effected  by  removing  the  sternum  of  the  foetus  and  the 
thoracic  organs,  so  that  the  walls  of  the  chest  will  readily  fall  together  ; 
the  hand  and  arm  can  then  be  passed  between  the  foetus  and  the  pelvis 
until  the  hind-limbs  are  reached  ;  these  are  seized  by  the  upper  and 
front  part,  and  adducted  one  after  the  other.  When  this  recommenda- 
tion cannot  be  carried  into  practice,  the  trunk  of  the  foetus  should  be 
divided  {see  "  Embryotomy  "),  the  hind-quarters  pushed  into  the  uterus, 
and  version  effected,  when  delivery  can  be  accomplished  in  the  posterior 
presentation.  In  order  to  prevent  injury  to  the  uterus  or  genital  pass- 
ages, as  much  of  the  skin  as  possible  should  be  left  to  cover  the  divided 
end  of  the  spine. 

This  procedure,  however,  is  not  always  successful.  Peuch  (Saint-Cyr,  Op.  cii.,  p.  475) 
was  called  at  a  very  late  period  to  attend  a  Cow  which,  during  protracted  parturition, 
had  been  subjected  to  very  severe  handling,  violent  attempts  having  been  made  to  extract 
the  foetus  ;  this  was  consequently  so  firmly  wedged  by  the  haunches  and  croup  in  the 
maternal  pelvis,  that  Peuch  could  not  pass  his  hand  between  the  young  creature  and  the 
uterine  walls.  Finding  delivery  impossible  without  embryotomy,  he  divided  the  foetus 
at  the  loins  and  tried  to  push  the  posterior  part  into  the  uterus,  but  unsuccessfully. 
Extraction  was  impossible,  and  the  Cow  was  killed  by  the  butcher  for  food. 

Deviation  of  the  Hind-limbs  in    the  Pelvis,  the  Anterior  Part 
OF  the  Body  Presenting. 

This  malpresentation,  known  to  the  German  veterihary  obstetrists  as 
the  "  vertical-abdominal"  or  "  dog-sitting  position"  {Bauch-Vertikallage^ 
Hunde-Sitzige  Lage),  is  not  at  all  uncommon,  and  is  one  of  the  most  for- 
midable, perhaps,  which  can  be  encountered.  First  described  by  Canu 
in  1837  {Recueil  dg  Med.  Veterinaire,  1837,  p.  444),  it  has  been  alluded 
to  by  a  number  of  veterinary  surgeons,  and  it  has  also  been  mentioned 
in  every  work  on  veterinary  obstetrics  published  on  the  Continent. 

Since  that  time  it  has  been  met  with  in  the  Mare,  as  well  as  the  Cow, 
and  consists  essentially  in  the  advance  of  the  hind-limbs  of  the  foetus  in 


1 


468  FCETAL  DYSTOKIA. 

the  pelvic  canal,  at  the  same  time  as  the  anterior  part  of  the  body,  the 
position  of  the  young  creature  being  consequently  more  or  less  vertical 
and  the  body  bent  at  the  loins. 

As  in  the  preceding  deviation,  nothing  is  at  first  known  of  the  existence 
of  the  displacement.  Parturition  commences  and  appears  to  be  going 
on  favorably  ;  the  foetus,  in  the  vertebro-sacral  position,  arrives  at  the 
inlet,  the  head  and  fore-limbs  in  advance  as  in  normal  birth.  Progres- 
sive expulsion  may  continue  until  the  head  of  the  young  animal  is  beyond 
the  inlet,  and  as  far  as,  or  even  external  to,  the  vulva — sometimes  the 
head,  fore-limbs,  neck,  and  half  of  the  chest  hanging  outside  the  vagina. 
But  further  progress  is  checked,  and  neither  the  most  energetic  straining 
on  the  part  of  the  animal,  nor  the  most  violent  traction  by  those  persons 
who  may  be  with  it,  can  advance  the  foetus  beyond  this  point. 

The  obstetrist  has  great  difficulty  in  ascertaining  the  cause  of  delay 
in  birth :  the   difficulty  varying,  and   depending  upon  the   volume   of  .the 


Fig.  130. 
Deviation  of  the  Hind-limbs  in  the  Pelvis  in  the  Anterior  Presentation. 

foetus,  and  whether  its  body  more  or  less  completely  fills  the  pelvic  canal. 
The  hand  can  generally  only  be  introduced  after  much  trouble  and  tact 
into  the  passage,  and  having  got  to  a  certain  distance  it  encounters  either 
under  the  body  or  head  (Fig.  131),  to  one  side  of  the  neck  or  head,  or 
even  projecting  upwards  above  the  head  (Fig.  130),  first  one,  then  a 
second  foot  or  limb,  which  are  recognized  by  a  careful  examination  to  be 
those  of  the  hinder  part  of  the  body.  Sometimes  the  feet  and  metatarsal 
bones  have  alone  entered  the  pelvis,  the  other  parts  of  the  limbs  being 
in  the  uterus  (Fig,  131)  ;  in  other  cases  the  hocks  may  be  in  the  inlet,  or 
even  well  through  'the  passage — depending  upon  the  size  of  the  foetus 
and  the  capacity  of  the  maternal  pelvis  ;  more  rarely  the  stifles  have 
cleared  the  inlet,  and  the  hind-feet  are  arrived  at  the  vulva.  The  more 
advanced  the  hind-limbs  are,  so  the  more  is  the  body  of  the  foetus  bent 
on  itself,  and  the  greater  is  its  resemblance  to  a  dog  in  a  sitting  posture. 
It  is  needless  to  state  that  the  foetus  cannot  be  extracted  in  this  malposi- 
tion, no  matter  what  amount  of  force  may  be  exercised  ;  and  that  violent 
measures  are  certain  to  lead  to  serious  injury  to  the  mother.  The  great- 
est care  is  therefore  necessary,  in  order  to  ascertain  the  exact  state  of 


DYSTOKIA  DEPENDING  ON  ANTERIOR  PRESENTATION 


469 


affairs  ;  indeed,  in  all  cases  of  dystokia  it  cannot  be  too  often  impressed 
on  the  mind  of  the  young  practitioner,  that  a  careful  examination  is  ab- 
solutely essential  before  attempting  extraction. 

In  this  particular  form  of  dystokia,  the  life  of  the  mother  may  be  pre- 
served by  timely  and  rational  intervention  ;  while  violent  and  irrational 
interference,  even  at  the  earliest  period,  will  undoubtedly  be  followed  by 
serious,  if  not  fatal,  consequences. 

With  regard  to  preserving  the  foetus,  the  prognosis  must  generally  be 
unfavorable.  The  foal  is,  in  every  case  perhaps,  certain  to  perish  at  an 
early  period  ;  and  though  the  calf  is  more  tenacious  of  life,  and  may  con- 
tinue to  exist  for  some  time,  yet  in  the  majority  of  cases  it  succumbs,  or 
it  has  to  be  sacrificed  to  save  the  mother. 


^25««8^^1^BT^i^^l3™i«^^ 


v^-^:^^: 


5<:, 


Fig.  131. 
Hind-limb  Deviation  :    Anterior  Presentation. 

Indications. 


In  nearly  every  case  the  preservation  of  the  mother  is  the  first  object 
[to  be  attained,  the  life  of  the  foetus — if  it  be  yet  alive  when  the  veterinary 
^surgeon  is  called  in — being  quite  a  secondary  consideration  ;  though  it 
jmust  be  admitted  that  if  he  is  present  when  it  is  still  vigorous  and  not 
imuch  engaged  in  the  pelvic  cavity,  there  is  no  reason  why  it  should  not 
^be  extracted  alive.  The  indication  is,  of  course,  to  rectify  the  deviation 
^of  the  hind-limbs  ;  and  if  the  foetus  is  not  too  far  advanced  in  the  gen- 
ital canal,  this  may  be  accomplished  by  pushing  it,  if  need  be,  towards 
I  the  uterus,  and  introducing  the  hand  between  it  and  the  wall  of  the 
vagina  (often  a  most  difficult  matter),  to  carry  the  hind-feet  back — one 
after  another — into  the  uterine  cavity,  either  by  the  hand  or  the  aid  of 
the  repeller  ;  then  the  head  and  fore-limbs  being  in  a  good  position,  birth 
can  readily  be  effected.  In  this  manner  Carsten,  Harms  has  extracted  a 
foal.  And  when  the  front  part  of  the  foetus  has  not  advanced  into  the 
pelvis,  and  the  deviation  has  been  ascertained  in  good  time,  the  anterior 


1 


470 


FCETAL  DYSTOKIA. 


presentation  has  sometimes  been  successfully  converted  into  a  posterior 
one,  so  that  birth  could  take  place. 

But  such  cases  are  rarely  met  with  in  practice  ;  and,  as  a  rule,  the  vet- 
erinary obstetrist  finds  that  parturition  has  made  much  progress,  the 
foetus  being  fixed  in  the  genital  canal  and  occupying  its  entire  diameter, 
and  its  hind-limbs  well  forward  under  the  body,  each  labor-pain  wedging 
it  more  firmly  ;  and  the  case  is  perhaps  complicated  and  aggravated  by 
the  indiscreet  manipulations  of  amateurs  and  busybodies.  In  such  cir- 
cumstances, it  is  needless  attempting  to  push  the  foetus  towards  the 
uterus,  neither  can  the  hind-limbs  be  thrust  into  the  uterine  cavity  ;  as  no 
sooner  are  they  carried  from  under  the  body  for  ever  so  short  a  distance, 
than  a  succeeding  pain  brings  them  into  their  former  position.  Indeed, 
it  is  sometimes  most  difficult  to  reach  the  hind-limbs  to  apply  cords  to 
them,  and  so  by  straightening  to  bring  them  parallel  to  the  body.  In  a 
case  of  this  description  in  the  Mare,  Obich  (  Wochejischrift  fiir  Thierheil- 
kunde  und  Viehzuchi)  succeeded  in  extracting  the  foal  by  cording  the 
hind-feet  (which  were  under  the  body),  and  pulling  at  them  as  well  as 
the  head  and  fore-feet.  Donnarieix  recommends  pulling  the  posterior 
limbs  forward  beneath  the  body,  the  contents  of  the  abdomen  and  chest 
having  been  previously  removed  to  facilitate  the  operation  ;  then  cording 
the  hind-pasterns,  to  draw  fir^t  one,  then  the  other,  towards  the  vulva. 
He  admits,  however,  that  this  is  difficult,  and  one  of  his  cases  treated  in 
this  way  occupied  him  for  four  hours  ;  he  was  even  compelled  to  excise 
one  of  the  limbs  at  the  hock  before  he  could  straighten  it.  The  Mare, 
however,  lived. 

Canu  {Op.  cit.),  in  1837,  gives  another  method  in  which  embryotomy 
may  be  carried  out.  The  illustrative  case  was  that  of  a  Mare,  the  foal 
— which  was  dead — being  born  as  far  as  the  half  of  the  chest.  As  it 
was  not  possible  to  push  it  back,  the  body  of  the  young  creature  was 
divided  as  near  the  hind-quarters  as  possible,  by  making  an  incision  from 
the  sternum  to  the  spine,  behind  the  last  rib  on  each  side  ;  then  the  ab-- 
domen  was  emptied  of  its  contents,  and  the  spine  cut  through  between 
the  last  dorsal  and  first  lumbar  vertebra,  the  amputation  being  facilitated 
by  an  assistant  holding  the  lips  of  the  vulva  as  far  apart  as  possible. 
The  Mare,  which  was  very  exhausted,  did  not  offer  much  opposition 
when  the  croup  was  pushed  into  the  uterus,  and  the  hind-limbs  being 
corded,  version  was  very  easy,  and  the  operation  soon  finished.  The 
Mare  was  at  work  within  twenty  days  afterwards. 

Canu's  method  of  extraction  has  often  been  practised,  both  in  the  Mare 
and  Cow,  by  subsequent  veterinary  surgeons  ;  and  it  has  been  proved  to 
be  both  rational  and  successful — so  far  as  the  mother  is  concerned.  In 
practising  it,  the  following  directions  have  been  given  by  Saint-Cyr,  and 
their  observance  is  important : 

I.  Find  the  hind-limbs  and  secure  them  by  cords  around  the  pasterns; 
2.  Cord  the  head  and  fore-limbs,  and  pull  these  out  as  far  as  possible  be- 
yond the  vulva  ;  3.  Remove  the  abdominal  viscera,  and  divide  the  spine 
as  near  the  lumbar  region  as  possible,  taking  the  precaution  to  leave  a 
good  piece  of  skin  attached  to  the  loins,  so  as  to  cover  the  exposed 
bones  and  prevent  the  maternal  organs  being  injured  during  the  subse- 
quent steps  in  extraction  ;  4.  Obtain  a  solid  bearing  on  the  divided  spine, 
either  with  the  hand  or  the  repeller,  and  push  steadily  and  firmly 
against  it,  so  as  to  direct  it  into  the  uterus,  when  the  cords  on  the  hind- 
pasterns  being  pulled  by  assistants,  guided  by  the  hand  of  the  operator 


DYSrOKIA  DEPENDING  ON  ANTERIOR  PRESENTATION.     471 

the  remains  of  the  foetus  can  be  removed.  This  part  of  the  operation  is 
tlie  most  difficult  and  fatiguing  for  the  obstetrist,  as  well  as  the  most 
dangerous  for  the  mother,  and  requires  both  strength  and  dexterity  to 
push  back  the  loins  and  pelvis  of  the  foetus  while  advancing  the  hind- 
limbs,  thighs,  and  croup  towards  the  outlet  ;  5.  Nothing  now  has  to  be 
done  but  to  exercise  moderate  traction,  and  terminate,  in  the  lumbo- 
pubic  position  of  the  posterior  presentation,  a  birth  commenced  in  the 
vertebro-sacral  position  of  the  anterior  presentation. 

Dietrich  recommends  eventeration  of  the  fcetus,  removal  of  one  of  the 
huid  limbs,  and  the  adjustment  of  the  hinder  parts  through  the  abdom- 
inal opening  ;  if  this  cannot  be  effected,  then  these  parts  are  to  be  drawn 
into  the  vacant  cavity  of  the  abdomen. 

When  only  one  hind  leg  is  in  the  pelvis,  retropulsion  of  the  body  may 
be  tried,  the  fore  legs  and  head  being  corded,  and  the  misplaced  hind 
limb  finally  extended  backwards  in  the  uterus.  If  this  cannot  be  accom- 
plished, the  hind  leg  must  be  drawn  forward  and  amputated  at  the  hock 
or  beyond,  and  the  thigh  then  carefully  pushed  towards  the  uterus. 

Removal  of  the  abdominal  viscera  favors  these  manoeuvres. 

1.  Cartwright  describes  the  case  of  a  Cow  which  showed  signs  of  calving,  and  soon 
after  the  fore  feet  appeared,  and  subsequently  the  head.  A  variety  of  assistance  had 
been  called  in  previous  to  his  arrival,  but  the  calf  could  not  be  advanced  farther  than 
the  loins.  He  found  the  Cow  in  a  very  exhausted  state,  with  one-half  of  the  foetus 
hangnig  out.  On  examination  it  was  discovered  that  the  hind  legs  were  in  the  pelvis  ; 
'*  thus  preventing  us,  with  all  the  strength  we  could  muster,  drawing  the  foetus  away ; 
as  the  hind  parts,  together  with  the  metatarsal  and  tibial  bones,  were  doubled  up,  and 
thus  completely  blocked  tlie  passage.  Of  course,  in  trying  to  pull  it  away  in  this  posi- 
tion, the  femoral  bones  would  be  thrown  up  before  the  hind  parts  could  pass."  Cords  were 
attached  to  the  hind  legs,  the  thoracic  and  abdominal  viscera  removed,  as  well  as  the 
protruding  portion  of  the  body,  and  the  loins  were  then  forced  back,  while  assistants 
pulled  at  the  hind  legs  and  extracted  the  remainder  of  the  body  without  any  further 
dithculty.  The  Cow  received  stimulants,  but  died  in  a  short  time.  The  uterus  was 
found  to  be  ruptured  at  the  cervix. 

2.  In  the  Edinburgh  Veterinary  Review,  mention  is  made  of  a  case  in  which  only  one 
hind  leg  m  the  pelvis  proved  an  insurmountable  obstacle  to  birth.  The  abdominal  or- 
gans were  removed,  the  leg  in  the  pelvis  drawn  forward,  and  traction  at  the  same  time 
exercised  on  the  hind  and  fore  limbs.     The  foetus  was  in  this  way  removed. 

3.  Gierer  [Magazin  von  Giirlt  unci  Hertwig,  1865,  p.  78)  describes  the  case  of  a  Mare, 
which  six  men  attempted  to  deliver  by  dragging  at  the  foal.  Gierer  found  the  latter 
hangmg  dead  from  the  vagina.  Removing  the  viscera  from  the  chest  and  abdomen,  the 
hind  feet  were  reached  through  the  cavity  of  the  body  ;  the  abdominal  muscles  and 
skin  were  cut  through,  but  the  hind  legs  could  only  then  be  imperfectly  pushed  back- 
wards. With  the  help  of  five  men  pulling,  however,  the  foal  was  extracted.  There 
ensued  much  swelhng  of  the  vulva,  but  the  Mare  eventually  did  well. 

4.  Marty  (Journal  des  Veterinaires  du  Midi,  vol.  xiv.,  p.  400)  attended  a  case  in  which 
the  front  part  of  the  foal  was  born,  but  the  hinder  extremities  were  firmly  retained,  the 
hind  feet  beneath  the  body.  Dividing  the  trunk,  cording  the  hind  pasterns,  and  push- 
ing the  loins  into  the  uterus  while  the  cords  were  steadily  pulled  at,  the  Mare  was  de- 
livered and  did  well  some  time  afterwards. 

5  Walther  (6'aV/^i-m  Jahresbericht,  1861,  p.  123)  had  a  Cow  in  which  all  the  feet  of 
the  calf  presented.  The  fore  limbs  were  corded,  the  hind  ones  secured  and  drawn  to- 
wards the  vulva.  Suddenly  the  progress  of  the  calf  towards  the  outlet  of  the  pelvis  was 
checked,  and  on  examination  it  was  discovered  that  one  of  the  hind  feet  had  passed  be- 
tween the  fore  ones.  This  state  of  affairs  changed,  however,  and  the  foetus,  in  altering 
its  position  slightly,  had  both  hind  feet  jammed  against  the  pelvis,  and  the  body  pro- 
truded as  far  as  the  shoulder.  Embryotomy  was  decided  upon,  and  the  viscera  were 
removed  from  the  fcetus,  as  well  as  the  front  part  of  the  body  ;  the  hind  feet  were  corded, 
and  traction  soon  removed  them  and  the  croup. 

6.  In  the  Repertoriumfiir  Thier.heilkuttde  (1875,  P-  -57)  '■''  ^"  account  of  a  Mare  which 
had  been  in  labor  for  eighteen  hours.  The  foetus  was  dead  ,  both  the  fore  feet  were  in 
advance  and  visible,  one  hind  foot  was  fixed  against  the  side  of  the  mother's  pelvis, 
while  the  other  pressed  against  the  inlet,  the  head  being  turned  back  to  the  left  side. 


472  FCETAL  DYSrOKIA. 

The  fore  feet  were  corded,  the  hind  ones  attempted  to  be  pushed  back  and  the  head 
brought  straight ;  but  without  success.  Version  was  tried,  but  failed,  and  embryotomy 
had  to  be  adopted.  The  Mare,  however,  died  in  an  hour  after  the  operation.  The  rec- 
tal mesentery  was  discovered  to  be  ruptured,  there  was  blood  in  the  abdominal  cavity, 
and  two  small  lacerations  towards  the  neck  of  the  uterus. 

In  a  second  case  the  head  also  complicated  the  deviation  ;  embryotomy  w  as  resorted 
to,  and  the  mother-  survived. 

7.  Dus  [Recneil  de  Med-  Veterinaire,  1876,  p.  11 50)  points  out  that  in  those  cases  in 
which  there  is  deviation  of  one  or  both  of  the  hind  feet  in  the  pelvis  and  the  head 'is 
turned  towards  the  side,  it  is  better,  with  the  Mare,  to  attempt  extraction  by  making 
the  presentation  a  posterior  one  ;  for  though  it  may  be  possible  to  readjust  the  head 
and  neck  of  a  calf  and  afterwards  extract  it,  yet  with  the  foal  there  are  great  difficulties, 
and  particularly  in  those  cases  in  which  the  violent  contractions  of  the  uterus  are  op- 
posed to  the  introduction  of  the  arm  of  the  operator.  He  gives  two  instances,  almost 
identical  in  their  circumstances,  in  which  he  was  able  to  deliver  foals  without  very  great 
difficulty,  and  also  indicates  how  rupture  of  the  uterus  from  amputated  limbs  may  be 
prevented.  His  first  case  was  a  six-year-old  Mare  in  labor  only  three  hours.  It  was 
lying  on  its  sternum,  and  making  violent  expulsive  efforts  from  time  to  time.  Getting 
it  up  and  securing  it,  Dus  found  that  the  foal  was  in  the  anterior  presentation,  vertebro- 
sacral position,  the  fore  limbs  well  placed  and  projecting  beyond  the  vulva  as  far  as  the' 
knees  ;  the  neck,  however,  was  bent  to  the  left  and  the  head  inaccessible  to  the  hand  ; 
one  of  the  hind  limbs  had  cleared  the  neck  of  the  uterus,  but  lay  alongside  the  left 
shoulder,  and  jammed  against  the  right  side  of  the  vagina,  the  hoof  being  directed  up- 
wards, backwards,  and  to  the  right.  The  uterine  contractions  were  so  powerful  that  the 
organ  was  closely  moulded  on  the  foetus,  and  it  was  impossible  to  introduce  the  arm 
beyond  a  certain  limit.  It  was  therefore  determined  not  to  attempt  adjusting  the  head 
and  neck ;  though  at  first  it  was  the  intention  to  extract  the  foal  by  vigorous  traction  on 
the  fore  limbs  by  a  large  number  of  assistants,  and  to  do  this  the' hind  leg  in  the  pelvis 
must  at  least  have  been  pushed  back.  The  latter  operation,  however,  could  not  be  ac- 
complished, as  the  limb  was  so  rigid  that,  like  a  spring,  it  resumed  its  position  as  soon 
almost  as  it  was  displaced.  It  was  then  deemed  advisable  to  resort  to  version,  and  to 
attempt  delivery  by  the  breech.  After  amputating  the  fore  legs  at  the  knee,  and  having 
pushed  them  into  the  uterus. — where  they  lodged  in  the  right  flank,  not  far  from  the 
pelvis,  the  end  of  the  radius  upwards, — they  were  kept  in  place  by  an  improvised  re- 
peller  (a  short  blunt  stable-fork),  which  pressed  strongly  against  the  nearest  fore  arm 
close  to  the  shoulder,  to  the  right  and  a  little  downwards  ;  several  men  at  the  same  time 
pulled  at  the  cords  fixed  on  the  pastern  of  the  engaged  hind  leg.  As  the  traction 
brought  this  limb  outward,  it  turned  first  sideways,  the  hock  to  the  left,  then  upwards, 
as  in  a  normal  presentation. 

The  efforts  ceasing,  an  examination  was  now  made  ;  when  it  was  found  that  the 
fore  limbs  were  still  towards  the  right  flank,  the  stumps  directed  upwards,  though  the 
croup  was  much  nearer  the  pelvis,  so  that  it  was  easy  now  to  trace  the  course  of  the 
hind  limb  which  had  been  pulled  be3^ond  the  vulva  as  far  as  the  hock ;  this  was  the 
right  limb  ;  the  left  could  be  reached  by  the  hand,  and  was  nearly  vertical,  semiflexed, 
inclined  to  the  right,  the  foot  resting  on  the  belly,  towards  the  mammae.  After  several 
very  arduous  attempts,  it  was  possible  to  seize  this  limb  by  the  hock,  and,  pushing  it 
forwards  and  to  the  left,  to  pass  the  hand  to  the  shank  •,  but  it  was  only  after  most 
fatiguing  efforts  that  the  foot  could  be  reached.  This  was  pulled  into  the  vagina,  and  a 
cord  being  passed  round  the  pastern,  the  limb  was  drawn  alongside  its  fellow.  The  croup 
now  being  in  the  pelvis,  nothing  more  remained  to  be  done  but  to  pull  steadily  on  the 
two  hind  limbs,  and  birth  was  very  easily  effected.  No  sooner,  however,  had  the  foal 
been  extracted  than  the  Mare  became  dull  and  indifferent  to  every  thing  around  it ;  it 
would  neither  eat  nor  drink  ,  the  expression  was  anxious  and  the  flanks  greatly  agitated. 
These  .symptoms  indicated  an  internal  injury,  and  in  a  few  hours  the  animal  .succumbed 
after  considerable  haemorrhage  from  the  uteru.s.  There  was  a  rupture  of  the  organ, 
and  Dus  shows  that  this  fatal  injury  was  caused  by  the  stump  of  the  fore  limb  against 
which  the  repeller  was  pressed,  and  that  it  might  have  been  averted  had  he  amputated 
these  limbs  nearer  the  trunk,  or  if  he  had  torn  them  off  altogether  after  skinning  the 
fore  arm  and  dividing  the  pectoral  muscles. 

In  the  following  example,  he  testifies  that  when  the  hind  limbs  preserve  their  flexi- 
bility, it  is  not  necessary  to  have  recourse  to  this  complicated  operation  to  extract  the 
foetus,  without  danger  to  the  mother. 

He  was  called  to  see  a  Mare  which  had  been  for  some  hours  attempting  to  foal. 
Three  of  the  foal's  feet  were  visible  externally,  but  no  head  :  two  fore  limbs  protruded 
as  far  as  the  knees,  and  the  hoof  of  a  hind  foot  could  be  distinguished — the  plantar 
surface  being  upwards — the  other  hind  limb  was  found  at  the  bottom  of  the  vagina. 


D  YSTOKIA  DEPENDING  ON  ANTERIOR  PRESENTA  PI  ON 


473 


The  presentation  of  the  foetus  was  anterior,  the  position  vertebro-sacral ;  the  neck 
was  bent  on  the  body,  the  head  beyond  reach.  The  uterine  contractions  were  extremely 
energetic.  After  amputating  the  fore  limbs  at  the  knees,  they  were  put  back  into  the 
uterus,  where  they  were  kept  by  Dus's  hand ;  while  two  assistants  pulled  at  the  most 
advanced  hind  limb  by  means  of  cords,  and  brought  it  out  as  far  as  the  hock. 

Then  the  other  hind  limb  was  sought  for  and  found  at  the  inlet ;  it  was  carried  into 
the  vagina,  then  externally  by  a  cord  round  the  pastern,  while  Dus  prevented  the  fore 
limbs  from  passing  through  the  os.  This  manoevre  was  completely  successful  in  bring- 
ing the  hind  quarters  into  the  pelvis,  the  croup  upwards.  Vigorous  and  well-directed 
traction  on  the  two  hind  limbs,  during  the  throes  of  the  Mare,  resulted  in  the  birth  of 
the  foal  without  any  further  difficulty.  In  a  few  minutes  after,  the  Mare  was  feeding 
heartily,  and  apparently  none  the  worse  for  the  operation. 

Dus  notes  that  though  labor  had  only  been  going  on  for  scarcely  three  hours  \r\  both 
cases,  the  foals  were  dead  when  he  arrived. 

8.  Sparrow  (  Veterinarian,  vol.  xvi.,  p.  130)  saw  a  Mare  which  had  been  in  labor  for 
some  hours,  and  had  been  subjected  to  rude  treatment  by  amateurs  The  creature  was 
in  great  agony,  and  the  genital  organs  were  so  much  swollen  that  much  difficulty  was 
experienced  in  making  an  examination.  The  labor-pains  had  ceased  ;  the  fore  legs  of 
the  foetus  presented,  one  of  the  hind  legs  being  between  them,  and  this  at  first  led  to  the 
supposition  that  there  were  twins.  The  young  animal  was  on  its  back,  and  the  head 
could  not  be  reached.  It  was  attempted  to  force  the  fore  legs  back  and  draw  out  the 
hind  one,  but  this  did  not  succeed.  As  the  Mare  was  sinking  from  exhaustion,  stim- 
ulants were  administered,  but  death  soon  ensued.  On  post-mortevi  examination,  the 
head  of  the  foetus  was  found  lying  under  and  across  the  withers,  and  was  greatly  dis- 
torted from  pressure. 

9.  Younghusband  [Ibid.,  vol.  xxi.,  p  270)  attended  a  Cow  in  labor,  the  head  and  neck 
of  the  foetus  protruding  to  their  full  extent,  and  extremely  tumiried,  the  creature  being 
dead.  Exploration  was  impossible,  so  it  was  decided  to  perform  embryotomy.  A 
circular  incision  was  made  round  the  neck,'  close  behind  the  ears,  and  the  skin  dissected 
as  far  back  as  possible  ;  then  the  vertebra;  were  divided,  and  the  head  and  neck  removed. 
The  loose  portion  of  skin  being  placed  over  the  divided  vertebra,  this  was  pushed  into 
the  uterus,  and  the  fore  feet  and  legs  were  placed  in  a  proper  position.  A  crotchet 
being  fixed  into  the  upper  and  back  part  of  the  neck,  the  fore  legs  were  corded,  and  the 
whole  confided  to  an  assistant.  Owing,  however,  to  the  emphysematous  condition  of 
the  calf,  delivery  was  still  impossible.  A  fore  leg  and  shoulder  were  now  speedily 
removed,  but  yet  extraction  could  not  be  effected,  from  the  immense  size  of  the  thorax 
and  abdomen.  The  anterior  ribs  were  excised  and  the  contents  of  these  cavities 
removed  ;  but  as  soon  as  the  haunches  of  the  calf  reached  the  inlet,  no  further  progress 
could  be  made,  notwithstanding  the  most  strenuous  efforts.  The  lumbar-vertebras  were 
divided,  and  the  adjoining  muscles  separated,  when  there  was  more  room  for  manipula- 
tion. The  obstacle  to  extraction  was  found  to  be  the  hind  feet  and  legs,  "which  had 
become  impacted  forward,  and  were  pressing  against  the  lower  parts  of  the  pelvis,  in  a 
manner  resembling  that  of  a  dog  sitting  upon  its  haunches."  By  pushing  the  parts  in 
jitero  back,  the  hind  feet  were  easily  got  hold  of,  and  thus,  as  in  a  breech  presentation, 
with  the  belly  turned  upwards,  the  calf  was  delivered.     The  Cow  quickly  recovered. 


CHAPTER  II. 

Dystokia  depending  on  the  Posterior  Presentation. 

When  treating  of  the  mechanism  of  parturition  (p.  227),  it  was  remarked 
that  of  the  four  positions  in  which  we  have  a  breech  or  posterior  presen- 
tation, only  one  is  compatible  with  spontaneous  and  natural  delivery — the 
lumbosacral ;  but  that  this  is  only  possible  when  the  hind  limbs  are  fully 
extended  backwards,  and  are  the  first  to  enter  the  genital  canal,  so  as  to 
gradually  dilate  the  channel  for  the  passage  of  the  voluminous  and 
rounded  croup.  Birth  in  this  position,  and  without  assistance,  is  more 
frequent  in  the  bovine  than  the  equine  species,  and  the  young  creature  is 
nearly  always  alive.  V/ith  the  Mare,  parturition  is  always  longer  and 
more  laborious,  and  the  foal  quickly  perishes  after  rupture  of  the  mem- 


474 


FCETAL  DYSTOKIA. 


branes.  It  therefore  results,  that  even  when  the  latter  is  in  the  lumbo- 
sacral position,  posterior  presentation,  and  every  thing  is  favorable,  yet 
delivery  should  hastened  if  it  is  desired  to  preserve  the  life  of  the  young 
creature. 

The  other  three  posterior  positions — lumbo-pubic  and  right  and  left 
lumbo-ilial — are  unnatural,  and  demand  the  intervention  of  the  obstetrist. 

Besides,  these  positions,  as  well  as  the  lumbo-sacral,  may  be  compli- 
cated by  a  vicious  direction  of  the  limbs,  which  may  lead  to  as  great,  if 
less  varied  difficulties,  as  those  encountered  in  the  anterior  presentation. 

The  varieties  of  dystokia  met  with  in  the  posterior  presentation  depend  : 
I.  On  the  difficulties  depending  on  the  lumbo-pubic  and  lumbo-ilial  posi- 
tions ;  2.  Those  due  to  a  vicious  direction  of  the  hind  limbs  ;  3.  Those 
arising  from  the  head  and  fore  legs.  Some  writers  have  alluded  to 
dystokia  from  a  wrong  direction  of  the  tail  ;  but  this  must  be  very  rare 
indeed. 


Fig.  132. 
Lumbo-sacral  Position. 


SECTION    I. 


-DYSTOKIA    RESULTING    FROM    THE    LUMBO-PUBIC     AND    LUMBO- 
ILIAL    POSITIONS. 


LuMBo-PUBic  Position. 

In  this,  the  posterior  reversed  position,  the  foetus  is  lying  on  its  back, 
its  croup  and  loins  corresponding  to  the  floor  of  the  abdomen  or  the 
pubis  of  the  mother,  with  the  fe^  and  belly  towards  the  sacrum. 

As  a  consequence  of  this  reversed  position,  the  hind-limbs,  which 
soonest  enter  the  pelvis,  are  inclined  upwards  and  backwards  into  the 
genital  canal,  and  they  are  therefore  the  parts  that  first  meet  the  hand  in 
exploration.  Saint-Cyr  points  out  what  might  be  a  cause  of  error  in  this 
exploration,  in  the  following  terms  :  "  As  the  anterior  face  of  the  hoof  or 
claws  is  directed  upwards  and  the  plantar  surface  (sole)  downwards,  the 
explorer  might   be  inclined  to   think  that  it   was   an   anterior  vertebro- 


DYSTOKIA  DEPENDING  ON  POSTERIOR  PRESENTATION.  475 

sacral  presentation  ;  but  in  pushing  the  exploration  further,  and  follow- 
ing the  cannon  bone  with  the  hand,  the  hock  is  met  with — recognizable 
by  lis  fatness  on  each  side,  t\\Q  pomt  of  the  hock  downwards,  the /5<f«^  being 
upwards  in  the  same  direction  as  the  wall  of  the  hoof ;  whereas  the  bend 
of  the  knee  is  in  the  same  direction  as  the  sole  of  the  foot.  Beyond  the 
hock  the  hand  also  comes  in  contact  with  the  croup  and  the  tail,  lying 
towards  the  maternal  pubis. 

The  obstacle  to  birth  lies  chiefly  in  the  thighs  and  buttocks,  while  the 
hind-feet  project  against  the  mother's  sacrum,  and,  in  addition  to  increas- 
ing the  resistance,  threaten  to  lacerate  the  organs  interposed  between 
them — the  vagina  or  rectum,  or  both — and  that  bony  mass.  Besides  this, 
the  body  of  the  foetus  itself  in  this  position  forms  a  curve  exactly  the 
reverse  of  that  of  the  pelvis  ;  so  that  it  cannot  readily  accommodate  itself 
to  the  bony  canal  through  which  it  should  pass.  From  all  these  causes 
this  position  is  not  only  unfavorable  to  birth,  and  must  be  remedied,  but 
it  may  also  lead  to  serious  accidents. 

The  position  appears  to  be  more  frequently  met  with  in  the  Mare  than 
the  Cow,  Donnarieix  having  witnessed  it  at  least  a  score  of  times  in  the 
first-named  animal.  This  authority,  however,  is  of  opinion  that  it  is 
altogether  a  secondary  position :  the  foetus  at  the  commencement  being  in 
a  normal  position  (lumbo-sacral),  and  still  alive,  is  retained  at  the  pelvic 
inlet  by  its  croup,  and  soon  dies  ;  them  obeying  the  laws  of  gravity,  at  a 
moment  when  the  uterus  is  relaxed,  it  turns  upside  down.  And  he  gives 
what  he  considers  a  proof,  in  the  fact  that  breeders,  in  consequence  of 
what  he  was  always  telling  them,. — to  the  effect  that  in  the  posterior 
presentation  the  foal  does  not  live  for  longer  than  half  an  hour,  were 
always  successful  in  bringing  the  young  creature  forth  alive  when  they  at 
once  resorted  to  traction  in  such  cases  :  all  informing  him  that  the  croup 
was  above  and  the  belly  below  ;  while  in  all  the  instances  in  which  he  had 
to  interfere,  the  belly  was  upper7nost  and  the  back  dowmvards.  In  the 
latter  cases  Donnarieix  never  found  the  foal  living. 

Saint-Cyr,  however,  thinks  this  explanation  is  not  quite  satisfactory, 
that  the  opinion  is  too  absolute,  and  that  in  the  Mare,  as  well  as  in  the 
Cow,  the  lumbo-pubic  position  of  the  foetus  may  very  well  h^ primary. 
Donnarieix  himself  admits  as  much,  from  a  case  recorded  by  Rochard,  in 
which  a  living  foal  was  extracted — an  extremely  rare  event  in  the  equine 
species. 

Indications. 

The  nvajority  of  authorities  recommend  that  rotation  of  the  foetus 
should  be  practised  in  this  position,  so  as  to  convert  it  into  a  licmbo-ilial 
or  even  a  lumbo-sacral  position  ;  while  others,  and  notably  the  French 
veterinary  obstetrists,  do  not  think  of  changing  the  position,  but  readily 
effect  delivery  when  other  causes  of  dystokia  do  not  complicate  it — in- 
deed, they  look  upon  these  cases  as  the  easiest  to  remedy,  and  rarely 
requiring  more  than  a  quarter  of  an  hour. 

The  most  important  matter  for  attention  is  the  direction  of  the  hind- 
feet  during  delivery  ;  these  should  be  carefully  guided  through  the  genital 
canal  until  they  are  external  to  the  vulva,  so  as  to  avoid  those  lacerations 
and  ruptures  which  are  only  too  readily  produced. 

In  order  to  accomplish  delivery,  the  pastern  of  each  hind-limb  should 
be  corded  ;  then  the  hand  should  be  glided  along  the  flexor  tendons  until 


\ 


476  FCETAL  DYSTOKIA. 

the  point  of  the  hock  is  reached,  this  part  usually  jamming  against  the 
brim  of  the  pubis  ;  the  hock  is  now  raised,,  and  at  the  same  time  the 
corresponding  cord  is  pulled  gently  backward  and  slightly  downward,  so 
as  to  bring  the  calcis  into  the  vagina ;  this  operation  is  to  be  repeated  on 
the  other  limb,  and  then  both  feet  are  to  be  directed  by  the  hand  through 
the  canal.  This  being  accomplished,  the  cords  should  then  be  pulled 
upwards,  so  as  to  raise  the  croup  and  facilitate  its  entrance  into  the 
inlet ;  after  which  steady  traction,  proportioned  to  the  amount  of  resist- 
ance, should  be  employed  during  the  labor-pains  until  the  young  creature 
is  completely  extracted. 

Naylor  (  Veterinarian,  vol.  xxxiii.,  p.  325)  attended  a  Mare  which  could  not  foal.  He 
found  the  young  creature  lying  on  its  back,  with  its  hind-feet  presented  at  the  os  uteri, 
and  its  croup  resting  firmly  against  the  maternal  pubis.  Small  strong  cords  were  placed 
on  the  pasterns,  the  feet  were  brought  into  the  passage,  and  by  assistance  and  a  little 
manipulation,  he  succeeded  in  turning  the  foal  back  upwards,  when  it  was  soon  and 
easily  extracted.     No  mention  is  made  as  to  whether  it  was  alive. 

LuMBO-iLiAL  Positions. 

The  lumbo-ilial  positions — right  and  left — have  been  described  at  page 
230.  When  simple,  the  hind-limbs — perfectly  extended — first  enter  the 
genital  canal.  Such  positions  are  very  rare,  and  they  do  not  offer  any 
thing  very  noteworthy  ;  they  are  recognized  in  the  same  way  as  the  lumbo- 
pubic  position,  and  the  indications  are  the  same.  As  a  rule,  parturition 
in  easier  in  these  positions  than  in  the  lumbo-pubic,  as  only  one  haunch 
is  jammed  against  the  brim  of  the  pubis  :  the  other,  being  in  contact  with 
the  mother's  sacrum,  can  enter  the  inlet  without  much  difficulty. 

Judicious  traction  on  the  hind  pasterns  is  all  that  is  needed  after  the 
position  has  been  rectified. 

SECTION  II. — COMPLICATIONS  CAUSED   BY   DEVIATION    OF   THE    HIND-LIMBS. 

In  the  posterior  presentation,  the  deviation  of  the  hind-limbs  is,  in 
many  instances,  a  very  serious  complication.  Instead  of  being  extended 
backwards  into  the  passage,  one  or  both  may  be  bent  at  the  fetlocks  or 
the  hocks — the  leg  against  the  thigh,  these  joints  presenting  ;  or  the}^ 
may  be  carried  straight  forward  under  the  body,  the  buttocks  alone  rest- 
ing against  the  inlet.  So  that,  instead  of  a  wedge-shaped  mass  offering 
its  thinnest  portion  to  gradually  dilate  the  genital  canal,  the  foetus  pre- 
sents a  large  rounded  mass — the  croup  and  thighs — which  is  not  at  all 
adapted  for  effecting  a  passage  through  the  limited  space.  When  to  this 
bulk  is  added  the  flexed  portion  of  the  limbs,  it  will  be  seen  that  this 
cause  of  dystokia,  generally  most  formidable  in  all  cases,  must  be  more 
so  with  primiparai,  and  especially  if  some  time  has  been  allowed  to  elapse 
since  the  commencement  of  parturition,  if  the  "  waters  "' have  escaped, 
and  if  amateurs  and  empirics  have  been  interfering.  With  regard  to  this 
interference,  however,  it  must  be  admitted  that  it  is  less  to  be  dreaded  in 
this  presentation  than  perhaps  in  any  other;  incompetent  people  are, 
fortunately,  at  a  loss  how  to  act,  as  there  is  nothing  to  lay  hold  of,  and 
the  nature  of  the  malposition  or  the  manner  of  remedying  it  is  obscure, 
perhaps  unknown  to  them. 

In  the  diverse  complicated  positions  of  the  posterior  limbs  in  this  pre- 
sentation, it  may  be  remarked  that  they  are  more  frequent  and  difficult 
in  the  Mare  than  in  the  Cow — the  increased  difficulty  being  doubtless 
due  to  the  greater  length  of  the  limbs  in  the  foal  than  the  calf. 


DYSTOKIA  DEPENDING  ON  POSTERIOR  PRESENTATION.  477 

The  malposition  of  the  hind-limbs  may  be  cf  three  kinds:  i.  Flexed 
fetlocks,  projecting  either  against  the  brim  of  the  maternal  pelvis,  or 
jammed  against  some  part  of  the  genital  canal ;  2.  Flexed  hocks,  the 
doubled  limbs  engaged  more  or  less  deeply  in  the  passage;  3.  Hind- 
limbs  completely  retained  in  the  uterus,  and  applied  more  or  less  closely 
against  the  abdomen  of  the  foetus,  the  back  part  of  the  thighs  and  the 
croup  presenting  at  the  inlet. 

We  have  mentioned  that  one  or  both  limbs  may  be  in  a  vicious  posi- 
tion ;  even  when  the  two  are  misdirected  they  may  not  be  in  the  same 
deviation — one  leg  being  perhaps  flexed  at  the  hock  and  the  other 
extended  forward  towards  the  chest,  one  flexed  at  the  fetlock  while  the 
other  is  bent  at  the  hock,  etc. 

Fetlock  Presentation. 

This  abnormal  direction  of  the  hind-limbs  is  not  frequent,  and  when 
encountered  is  not  of  much  importance,  so  far  as  obstetrical  skill  is  con- 
cerned. The  misdirection  of  the  phalanges  can  be  quickly  detected  by 
exploration,  and  corrected  as  follows: — Extension  of  the  pastern  is 
accomplished  by  pushing  the  entire  limb  forwards  into  the  uterus,  and 
bringing  the  fetlock  towards  the  vulva  by  seizing  it  at  that  joint — the 
fingers  forwards,  and  the  hollow  of  the  pastern  and  heels  of  the  hoof  in 
the  palm  of  the  hand.  By  closing  the  hand  and  tightening  the  fingers, 
the  pastern  is  extended  and  the  foot  carried  towards  the  canal.  The 
end  of  the  limb  is  now  corded,  and  if  the  other  fetlock  is  in  a  like  condi- . 
tion,  it  is  adjusted  in  the  same  manner,  and  delivery  effected. 

Hock  Presentation, 

The  mechanism  of  hock  presentations  is  supposed  to  be  as  follows  : — 
The  foetus,  in  the  posterior  presentation,  and  impelled  by  the  uterine 
contractions  towards  the  cervix,  reaches  the  inlet  with  the  hind-limbs  not 
quite  extended,  nor  the  axis  of  the  young  creature  quite  coinciding,  per- 
haps, with  that  of  the  passage.  Consequently,  the  legs  come  in  contact 
with  the  pelvic  brim  below  by  the  posterior  surface  of  the  shank,  while 
the  croup  encounters  the  sacro-vertebral  angle  above. 

The  labor-pains  continuing,  the  croup  has  a  tendency  to  descend,  and, 
with  the  points  of  the  hocks,  to  advance  through  the  os  :  the  latter  joints 
become  gradually  flexed  until  at  last  the  cannon-bones  press  against  the 
thighs,  and  the  doubled  legs  and  croup,  jammed  in  the  inlet,  form  far  too 
large  a  mass  to  advance  further  (Fig.  133).  Labor  is  therefore  sus- 
pended, and  the  animal  becomes  exhausted  with  futile  straining. 

The  increase  in  volume  is  well  exemplified  in  the  annexed  outlines 
(Fig.  134).  In  figure  A,  we  observe  that  the  direction  of  the  femur  {a  b) 
is  much  more  oblique  than  in  figure  B,  which  shows  the  limb  extended, 
and  that  bone  {a^  P)  in  its  usual  position.  The  consequence,  in  figure 
A,  is  apparent  in  the  elevation  of  the  stifle  to  the  middle  horizontal  line, 
and  the  inclusion  of  the  hock  and  greater  portion  of  the  metatarsal  bone 
in  the  line  below,  which  only  touches  the  stifle  (a^  b^,  figure  B). 

The  mechanism  is  quite  the  same  in  the  lumbo-pubic  and  lumbo-ilial 
positions,  the  parts  of  the  pelvic  brim  against  which  the  croup  and  limbs 
impinge  being  alone  different.  One  limb  only  may  be  retained  in  this 
malposition,  as  already  remarked,  the  other  being  extended  in  a  normal 
manner  ;  but  this  does  not  in  any  way  alter  the  state  of  affairs — neither 


1 


478 


FOETAL  DYSTOKIA. 


with  respect  to  the  mechanism,  nature  of  the  complication,  nor  measures 
to  be  adopted. 

In  hock  presentation,  the  point  of  the  os  calcis  is  always  the  first  part 
the  hand  encounters   in   exploration  ;  but   it   may  be   found   at  various 


Fig.  133. 
Hock  Presentation  :   Calf. 


depths.  Sometimes  the  hocks  alone  are  in  the  canal,  the  body  of 
the  foetus  being  still  in  the  uterus  ;  while  in  other  cases  they  and  the 
croup  are  within  the  inlet,  and  are  wedged  in  the  passage. 


Fig.  134. 
Diagrams  of  the  Hind-limbs  in  Hock  Presentation. 


Indications. 

The  difficulties  vary  according  to  circumstances.  With  the  larger  ani- 
mals at  their  full  period  of  pregnancy,  birth  cannot  take  place,  as  a  rule, 
until  the  deviation  has  been  rectified  ;  and  to  attempt  delivery  before  this 
has  been  done  is  to  expose  the  Cow  or  Mare — particularly  the  latter — to 
great  danger.  With  the  Sheep,  Goat,  Sow,  and  Bitch,  the  foetus  can  be, 
and  often  is,  extracted  in  this  malposition. 

The  indication  is,  therefore,  with  the  Mare   or  Cow,  to  give  the  hind- 


DYSTOKIA  DEPENDING  ON  POSTERIOR  PRESENTATION  479 

limbs  a  favorable  direction,  by  extending  them  in  the  genital  canal ;  and 
this  is  more  easily  accomplished  in  the  second  than  the  first  of  these  ani- 
mals, owing  to  the  smaller  size  of  the  croup  and  shorter  limbs  of  the  calf. 
Some  authorities  are  even  of  opinion  that  the  latter  may  at  times  be  ex- 
tracted without  the  limbs  having  been  adjusted  ;  while  others  assert  pos- 
itively that  delivery  may  be  effected  in  the  C6w  by  mutation  of  the  foetus, 
but  that  this  is  impossible  with  the  Mare,  unless  a  particular  operation — 
to  be  noticed  immediately — is  adopted.  Saint-Cyr,  however,  has,  with 
more  or  less  trouble,  succeeded  on  four  or  five  occasions,  when  the  foal 
made  a  hock  presentation,  in  extending  the  limbs  in  the  genital  canal,  and 
effected  delivery  without  resorting  to  this  operation.  He  points  out, 
nevertheless,  that  the  foal  dies  very  quickly  in  this  position,  while  very 
often  the  calf  is  extracted  alive,  even  after  long  and  laborious  manipula- 
tions. Other  writers  corroborate  Saint-Cyr's  opinion  with  regard  to  de- 
livery. 

The  method  of  adjusting  the  hind-limbs  is  as  follows  : 

1.  Push  the  foetus  as  far  as  possible  into  the  uterus.  This  retropulsion 
can  be  effected  without  difficulty — even  in  the  Mare — at  the  commence- 
ment of  parturition,  when  the  fcetus  has  not  yet  entered  the  pelvic  inlet, 
or,  at  most,  the  points  of  the  hocks  are  only  engaged.  But  at  a  later 
period,  when  labor  is  more  advanced,  and  the  croup  is  in  the  passage 
and  on  the  vaginal  side  of  the  inlet,  the  difficulty  is  greatly  increased  in 
the  Cow,  and  retropulsion  may  even  be  impossible  in  the  Mare.  It 
should  always  be  attempted,  however,  and  in  the  Cow  the  attempt  will 
be  generally  successful. 

The  hind-quarters  must  be  raised  as  much  as  possible,  and  the  hand 
should  be  applied  against  the  buttock  of  the  young  creature,  the  thumb 
on  one  hip,  the  fingers  on  the  other,  and  immediately  below  the  tail.  If 
the  repeller  is  used  (and  it  is  very  convenient  in  these  cases)  it  should  be 
placed  across  the  thighs.  The  retropulsion  should  be  made  by  steady 
pushes  in  the  interval  between  the  labor-pains  ;  these  pushes  should  be 
directed  slightly  upward,  so  as  to  raise  the  croup.  At  first  the  resistance 
seems  to  be  insurmountable,  but  gradually  the  foetus  begins  to  move  for- 
ward, and  finally  is  entirely  propelled  into  the 'uterus,  and  at  a  sufficient 
distance  from  the  pubis  to  allow  the  limbs  to  be  extended  backwards. 

When  the  animal  persists  in  lying,  the  hind-quarters  may  be  raised  by 
trusses  of  straw ;  and  in  some  cases,  especially  with  the  Mare,  retropul- 
sion could  only  be  achieved  and  delivery  effected  by  putting  hobbles  on 
the  hind-pasterns,  and  drawing  up  the  hind-quarters  by  means  of  the  rope 
attached  to  them,  and  which  was  run  over  a  beam  in  the  ceiling. 

Rainard  points  out  that  it  often  happens,  during  this  retropulsion,  that 
the  foetus  is  pushed  into  somewhat  of  a  transverse  position, — the  head 
and  fore-limbs  approaching  the  pelvis,  where  they  may  be  seized  and  ver- 
sion effected  by  moving  them  round  into  the  anterior  presentation,  bring- 
ing them  into  the  passage,  and  then  completing  delivery.  This  fortunate 
movement,  however,  must  be  extremely  rare. 

2.  When  the  body  of  the  fcetus  has  been  pushed  sufficiently  far  from 
the  pubis  to  allow  the  limbs  to  be  seized,  the  hand  may  then  fasten  a 
cordon  each  pastern  (by  means  of  the  porte-cord,  if  necessary),  in  order  to 
assist  in  extending  the  limbs  at  the  proper  moment,  by  a  few  moderate 
pulls  in  the  desired  direction. 

3.  To  extend  the  limbs  in  the  genital  canal,  the  lower  parts  must  describe 
the  arc  of  a  circle,  the  hock  joint  being  the  centre,  the  limb  below  this 


1 


48o  FCETAL  DYSTOKIA. 

being  the  ray  ;  so  that  the  foot,  which  is  at  first  directed  forward,  may 
be  brought  directly  back  towards  the  vuh'a  of  the  mother.  The  Hmb 
which  is  most  convenient  is  first  extended.  Some  obstetrists  begin  bv 
seizing  the  hock,  the  fingers  in  front  and  below  the  joint,  the  palm  and 
thumb  on  the  calcis  and  shank  ;  the  lower  part  of  the  limb  is  then  drawn 
backwards,  while  the  thigh  i%  pushed  forward,  and  by  a  turn  of  the  wrist 
the  leg  is  carried  through  the  inlet  and  straightened.  The  same  pro- 
cedure is  carried  out  with  the  other. 

Other  practitioners  endeavor  to  flex  \h.^  limb  as  completely  as  possible, 
commencing  with  the  tibia  and  lifting  it  well  up  against  the  femur,  then 
the  hock  is  bent  ;  the  limb  is  now  seized  at  the  lower  end  of  the  cannon- 
bone,  or  even  at  the  fetlock,  and  is  then  lifted  into  the  vagina.  Schaack's 
method  does  not  differ  much  from  this.  He  flexes  the  leg  on  the  thigh 
as  much  as  possible,  raising  the  point  of  the  hock  as  near  the  buttock  as 
he  can  ;  this  elevates  the  foot  and  brings  it  nearer.  As  the  labor-pains 
usually  push  the  foetus  too  near  the  pubis,  it  must  be  thrust  forward  again 
by  acting  more  particularly  on  the  point  of  the  hock,  using  it  as  a  kind  of 
propeller.  When  sufficient  space  has  been  gained,  the  hand  descends 
along  the  cannon  bone  and  grasps  the  front  of  the  foot — the  thumb  and 
index-finger  meeting  round  the  coronet,  so  that  the  toe  is  in  the  palm  of 
the  hand  j  in  this  way  the  pastern  and  fetlock  are  forcibly  flexed,  when, 
by  a  vigorous  effort — seconded,  if  need  be,  by  the  cord  placed  round  it — 
the  foot  is  raised  above  the  pelvic  brim,  brought  into  the  vagina,  and  the 
leg  extended — an  easy  operation,  generally.  With  the  foal,  however,  it 
sometimes  happens  that,  owing  to  the  length  of  the  limbs,  the  calcis 
presses  against  the  sacrum  of  the  mother  while  the  foot  jams  on  the 
pubis.  In  such  cases  the  pastern-cord  is  most  useful,  as  the  operator 
may  allow  the  foot  to  pass  from  his  hand,  and  press  the  point  of  the  hock 
towards  the  uterus,  while  an  assistant  pulls  at  the  cord  with  such  an 
amount  of  force,  and  at  such  times,  as  the  obstetrist  may  order.  The 
other  limb  is  to  be  brought  back  in  the  same  way. 

Cartwright  mentions  that,  in  those  cases  in  which  the  limb  cannot  be 
sufficiently  extended  backwards,  the  hock  should  be  drawn  as  far  as  pos- 
sible into  the  passage,  and  the  tendon  of  the  flexor  metatarsi  divided 
above  its  point  of  bifurcation,  in  front  and  at  the  upper  part  of  the  joint ; 
this  allows  greater  mobility.  If  the  foetus  is  dead,  of  course  there  can  be 
no  objection  to  this  section  ;  if  alive,  it  will  require  consideration. 

This  is  the  method  to  be  recommended  in  every  case ;  and  it  will  very 
often  be  attended  with  success,  even  in  the  Mare,  when  the  foetus  is  not 
too  firmly  fixed  in  the  pelvis,  and  can  be  pushed  into  the  uterus.  But  it 
frequently  happens  that  retropulsion  is  not  possible,  the  hind-feet  cannot 
be  reached,  and  delivery  cannot  be  accomplished  in  the  way  indicated. 
We  must  then  adopt  other  methods  applicable  to  the  Mare  and  Cow. 

With  the  Mare,  when  the  foetus  is  wedged  in  the  pelvis,  so  that  it  can- 
not be  moved  forward,  it  may  be  presumed  that  it  no  longer  lives,  or  that 
it  will  perish  before  delivery  is  completed.  There  can  be  no  objection, 
then,  in  resorting  to  embryotomy,  so  as  to  relieve  the  Mare  as  quickly  as 
possible. 

The  hind-limbs  of  the  foetus  may  be  amputated  either  at  the  stifle  or 
the  hock — some  authorities  recommend  the  former,  others  the  latter  ;  while 
others,  again,  advise  excision  at  the  coxo-femoral  articulations.  Extraction 
of  the  foetus  has  been  effected  after  amputation  in  the  three  regions,  but 


DYSTOKIA  DEPENDING  ON  POSTERIOR  PRESENTATION.  481 

preference  is  generally  given  to  division  at  the  hock.  This  is  effected  by 
drawing  the  joint  as  far  into  the  vagina  as  possible,  either  by  the  hand 
or  a  cord  passed  round  the  part  (Fig.  135)  ;  if  it  can  be  drawn  beyond 
the  vulva,  all  the  better,  but  this  requires  much  force.  The  joint  is  then 
disarticulated,  and  the  separated  portion  of  the  limb  withdrawn  from  the 
passage.  The  other  leg  being  served  in  the  same  way,  delivery  can  be 
completed  in  the  ordinary  manner — the  obstacle  being  now  removed. 

"  Now  and  then,"  as  Cartwright  remarks,  "  we  are  not  able  to  bring  the 
legs  straight  into  the  passage,  but  have  to  get  away  the  fcetus  by  means 
of  cords  around  the  hock  or  hocks,  with  one  or  both  of  the  legs  doubled 
forward  against  the  thigh.  In  these  cases  it  will  be  advisable  to  divide 
the  tendons  at  the  back  of  the  legs,  just  above  the  point  of  the  os  calcis, 
and  also  the  flexor  tendons  below  the  hocks,  by  which  means  the  flexion 


Fig  135 
Hock  Presentation  :    Hock  Corded. 

at  the  hock-joints  will  be  more  perfect,  and  the  leg  and  thigh  approximate 
better.  After  we  have  done  this,  we  may  pull  at  the  cords  around  the 
hocks  pretty  freely  ;  but  we  must  not  omit  forcing  the  breech  into  the 
abdomen,  so  as  to  allow  the  limbs  or  the  stifles  becoming  straightened, 
and  prevent  the  stifles  wedging  against  the  anterior  part  of  the  pelvis.  .  . 
In  some  cases,  I  have  known  the  fcetus  to  come  away  in  a  breech  presen- 
tation, without  the  legs  being  straightened  at  the  stifles  ;  but  it  is  bad  prac- 
tice. In  some  cases  we  may  remove  the  leg-bone,  by  sawing  the  bone 
through,  close  up  to  the  hock,  and  afterwards  passing  a  cord  above  the 
OS  calcis  to  pull  at,  and  then  pushing  the  breech  forward." 

With  the  Cow,  the  calf  is  very  frequently  alive,  and  an  important  con- 
sideration is  how  to  deliver  it  in  this  condition.  Should  it  be  impossible 
to  effect  retropulsion,  forced  extraction  in  this  malposition  should  be  at- 
tempted ;  it  has  often  proved  successful,  and  particularly  when  only  one 
limb  was  retained.  31 


482  FCETAL  DYSTOKIA. 

To  effect  forced  extraction  with  one  limb  alone  flexed,  the  leg  extended 
in  the  vagina  should  be  corded  at  the  pastern,  or  above  the  hock  if  this 
can  be  reached.  A  cord  is  then  to  be  passed  around  the  bent  hock  by 
means  of  the  porte-cord,  and  traction  exercised  during  the  labor-pains. 

When  both  legs  are  flexed  at  the  hocks,  cords  must  be  passed  round 
each,  as  in  Fig.  135.     The  necessary  force  can  then  be  exercised. 

Should  forced  extraction  not  succeed,  the  limbs  may  be  amputated  at 
the  hocks,  as  with  the  Mare. 

It  is  well,  in  this  malposition,  when  the  hind-limbs  have  been  either  re- 
moved or  adju.-ted,  to  ascertain  the  direction  of  the  tail,  as  it  is  some- 
times thrown  back  over  the  croup  (as  in  Fig.  135),  and  may  thus  increase 
the  difficulty  to  be  surmounted.  It  may  readily  be  brought  back  to  its 
natural  position  by  passing  the  hand  from  the  root  to  its  extremity,  and 
bringing  it  into  the  vagina  by  withdrawing  the  arm.  In  some  instances 
retropulsion  may  be  necessary  before  the  tail  can  be  adjusted. 

Thigh  and  Croup  Presentation. 

The  cause  of  this  malposition  is  the  same  as  that  operating  in  hock  pre- 
sentation ;  the  deviation  is  not  at  all  unusual  in  Mares  or  Cows  with  a 
very  pendulous  abdomen. 

When  the  thighs  and  croup  alone  present  at  the  inlet,  the  joints  of  the 
hind  limbs  being  partially  or  only  very  slightly  flexed,  it  is  evident  that 
the  voluminous  mass  cannot  pass  into  the  pelvis.  Some  part  of  the  pos- 
terior region  of  the  foetus — as  the  hocks — jams  against  the  pelvic  border 
and  cannot  get  beyond,  while  the  points  of  the  buttocks,  placed  in  front 
of  the  inlet,  are  engaged  somewhat  in  the  passage.  With  the  continuance 
of  the  labor-pains,  this  part  gradually  enters  the  pelvic  cavity,  while  the 
retained  hind-limbs  are  proportionately  forced  forward  beneath  or  on 
each  side  of  the  abdomen  of  the  foetus,  until  at  last  they  are  closely  ap- 
plied to  the  body,  the  creature  has  assumed  the  position  of  an  animal 
lying  in  a  natural  manner,  and  the  posterior  part  of  the  trunk  is  firmly 
fixed  between  the  sacrum  and  pubis  of  the  mother. 

The  tall  and  buttocks  of  the  foetus  are,  therefore,  the  first  parts  that  the 
hand  encounters  in  exploring  the  genital  canal  ;  then  the  croup  and 
haunches,  and  below,  beneath  the  pubis,  are  found  the  hocks,  which  may 
be  more  or  less  accessible  to  manipulation,  according  to  circumstances  : 
though,  when  the  limbs  are  fully  extended  under  the  body,  they  are  be- 
yond reach.  Though  the  croup  and  haunches  may  have  passed  into  the 
pelvic  inlet,  yet  nothing  of  the  foetus  is  discernible  externally,  no  matter 
how  long  the  labor  may  have  been  in  progress. 

In  the  majority  of  cases,  perhaps,  the  young  creature  is  in  the  lumbo- 
sacral position  ;  while  in  others  it  may  be  in  the  lumbo-pubic,  or  right  or 
left  lumbo-ilial  positions. 

Indications. 

Authorities  are  generally  unanimous  in  asserting  that  this  is  one  of  the 
most  difficult  malpositions  the  veterinary  obstetrist  can  encounter.  Very 
frequently  the  mother  perishes  without  being  delivered  ;  and  though  some- 
times a  live  calf  may  be  extracted,  it  is  rare  indeed  that  a  living  foal  is 
obtained,  and  only  too  often  the  Mare  succumbs  after  parturition  has  been 
accomplished  by  manual  force.  The  chances  of  success  in  saving  either 
mother  or  offspring  are  diminished  in  direct  proportion  to  the  time  labor 


DYSTOCIA  DEPENDING  ON  POSTERIOR  PRESENTATION  483 

has  been  going  on,  the  fcetiis  advanced  in  the  pelvic  cavity,  and  the  ma- 
ternal genital  organs  injured  or  irritated  by  improper  manoeuvres.  The 
difficulty  is  also  greatly  increased  in  heifers,  or  animals  whose  genital 
canal  is  smaller  than  usual  ;  a  large  foetus  also  makes  the  malposition 
more  serious. 

The  rational  indication  is,  of  course,  to  extend  the  limbs  of  the  foetus 
backwards,  as  in  ordinary  breech  presentation,  and  to  give  these  and  the 
body  a  direction  in  harmony  with  the  axis  and  dimensions  of  the  pelvic 
inlet,  so  that  birth  may  be  effected  by  the  combined  efforts  of  the  mother 
and  the  obstetrist.  But  this  indication  is  often  most  difficult  to  fulfil  ; 
though  in  some  instances,  and  even  with  the  Mare,  it  is  possible  when  labor 
is  not  too  advanced,  and  when  the  foetus,  still  in  the  abdominal  cavity,  is 
movable,  and  can  be  push^  sufficiently  from  the  inlet  to  allow  the  lower 
part  of  the  limbs  to  be  seized  and  brought  into  the  vagina. 


Fig.  136. 
Thigh  and  Croup  Presentation. 


Pushing  the  foetus  as  far  into  the  abdomen  as  possible,  one  of  the  limbs 
IS  seized  above  the  hock,  and  the  thigh  and  leg  flexed  as  completely  as 
circumstances  will  permit,  by  lifting  that  joint  tow^ards  the  mother's 
sacrum.  Still  pushing  the  foetus  off  by  means  of  the  repeller,  the  hand 
is  passed  down  to  the  hoof  or  claws  until  the  toe  and  front  part  of  these 
rest  in  the  palm  of  the  hand  ;  by  adopting  this  precaution,  danger  of 
injury  to  the  uterus  or  vagina  is  averted.  Then  the  foot  is  brought  into 
the  passage  by  flexing  all  the  joints  on  each  other.  Again  pushing  the 
foetus  forward,  the  same  manoeuvre  is  repeated  with  the  other  limb,  if 
necessary;  though  forced  extraction  has  sometimes  succeeded  with  only 
one  leg  in  the  passage,  that  which  is  retained  finding  space  in  the  abdo- 
men, and  even  faciliating  the  passage  of  the  thorax,  according  to  some 
obstetrists. 


484  FCETAL  DYSTOKIA. 

This  manipulation  is  rendered  more  difficult  than  in  hock  presentation, 
from  the  fact  that  the  hocks  in  this  are  deeper  in  the  uterus,  and  jam  against 
the  brim  of  the  pelvis,  where  they  cannot  be  freed  by  the  hand.  The 
difficulty  is  surmounted  by  passing  a  blunt  hook  round  them,  or  a  cord  as 
in  Fig.  135,  the  two  ends  of  this  outside  the  vulva  being  twisted  and 
drawn  upwards  and  outwards  by  an  assistant ;  while  the  operator,  push- 
ing at  the  croup,  throws  the  body  of  the  foetus  forward,  and  thus  allows 
the  point  of  the  calcis  to  rise  above  the  pelvic  brim,  when  the  leg  can 
be  extended  backward  as  in  hock  presentation. 

This  method,  however,  does  not  succeed  in  every  case  ;  and  when  the 
croup  is  firmly  wedged  in  the  pelvic  canal  and  the  thighs  have  cleared  the 
inlet,  it  is  only  too  often  impossible  to  effect  retropulsion.  Consequently, 
there  are  but  two  courses  open  :  extraction  06  the  foetus  in  this  abnormal 
position,  or  removing  it  by  embryotomy. 


Fi 
Thigh  and  Croup  Ppesent  .t:on:   Thigh  Corded. 

Forced  extraction  of  the  foetus,  without  adjustment,  is  a  very  serious, 
because  a  very  violent,  measure,  and  is  frequently  fatal  to  the  mother,  as 
well  as  to  the  offspring.  It  should,  therefore,  not  be  lightly  adopted,  and 
every  other  measure  of  a  milder  kind  should  be  tried  if  it  has  any  prob- 
able chance  of  success.  Throwing  the  mother  on  the  back  or  side  may 
effect  a  change  for  the  better  in  the  position  of  the  foetus ;  or  if  standing 
or  lying,  then  raising  the  hind-quarters  as  high  as  may  be  without  injury 
should  be  tried. 

These  failing,  then  Lecoq's  method  may  be  resorted  to.  This  consists 
in  passing  the  hand,  furnished  with  a  cord,  between  the  wall  of  the  pelvis 
and  the  body  of  foetus  as  far  as  the  thigh  of  the  latter  ;  the  cord  is  then 
pushed  beneath  the  thigh  as  far  as  possible  and  left  there,  while  the  hand 
is  passed  above — between  the  leg  and  body,  so  as  to  bring  the  end  of 
line  up  around  the  stifle  and  back  through  the  vagina.  In  this  way  the 
thigh  is  encircled  by  a  loop,  as  in  Fig.  137.  The  other  thigh  maybe 
secured  in  the  same  way  by  another  cord,  and  this  part  of  the  operation 
will  perhaps  be  much  faciliated  by  using  the  long  bent  porte-cord  (Fig, 
148). 

Saint-Cyr  states  that  one  thigh  corded  may  be  sufficient  ;  but  it  is  un- 
doubtedly better  to  cord  both,  if  possible,  as  traction  on  the  two  limbs 
keeps  the  body  of  the  foetus  in  a  straight  direction. 


DYSTOKIA  DEPENDING  ON  POSTERIOR  PRESENTATION.  485 

The  ends  of  the  cords  being  joined  together  outside,  assistants,  under 
the  direction  of  the  operator,  pull  with  the  necessary  amount  of  force, 
while  the  hand  of  the  operator  assists  in  the  vagina,  either  in  guiding  the 
foetus,  seizing  on  and  pulling  at  any  part^that  may  offer,  or  smoothing 
down  the  folds  of  mucous  membrane  in  the  canal  which  might  otherwise 
increase  the  obstacles.  The  foetus  has  been  extracted  alive  by  this  pro- 
cedure, 

Saake's  method  {Magazi?i  vo7i  Gurlt  tmd  Jlertwig,  1869)  is  somewhat 
similar,  except  that  there  is  only  one  cord,  and  that  encircles  the  body 
instead  of  the  thigh.  The  cord  has  a  ring  or  noose  at  the  end,  and  this 
or  the  other  end  is  passed  between  the  thighs  and  brought  out  at  the 
flank  of  one  side;  then  the  other  end  is  also  brought  out  in  front 
of  the  other  flank.  Both  ends  are  carried  to  the  top  of  the  back, 
the  plain  end  is  passed  through  the  ring  (Fig.  138)  and  brought  out- 
side the  vulva.  The  body  of  the  foetus  is,  it  will  be  observed,  en- 
closed in  a  loop,  the  upper  part  of  which — that  over  the  loins — is  car- 
ried back  over  the  tail  to  the  buttocks,  so  that  the  cord  now  only  encir- 
cles the  flanks.  The  advantages  of  this  method  over  the  other  are  chiefly 
its  simplicity,  only  one  cord  being  required,  and  the  better  direction  in 
which  traction  can  be  exercised. 


Fi£.  138- 
Thigh  and  Croup  Presentation:    Body  Corded. 

In  three  cases  this  method  was  successfully  employed  by  Saake. 

There  can  be  no  doubt  that  the  foetus  may  be  removed  in  this  malposi- 
tion, with  both  the  hind-limbs  extended  forward  under  the  abdomen. 
Cartwright  says  :  "  I  perfectly  recollect,  in  one  instance,  delivering  a  Cow 
of  a  very  large  calf  with  both  of  its  hind-legs  under  its  abdomen,  and  I 
never  saw  a  Cow  after  calving  do  better."  In  those  instances  which 
are  attended  by  success,  it  will  be  found  either  that  the  foetus  is  small  or 
the  pelvis  large  and  well-formed. 

Some  practitioners  resort  to  the  sharp  crotchets,  fixing  them  in  the 
muscles  of  the  croup,  towards  the  hip  joint ;  but  unless  the  hook  has  a 
bearing  on  the  femur  the  hold  is  not  very  firm.  In  a  case  of  this  kind, 
Drouard  found  that  the  skin  and  muscles  yielded,  the  femur  was  disartic- 
ulated, and  the  hind-limb  itself  entirely  torn  away  from  the  body.  Not- 
withstanding this  diminution  in  the  volume  of  the  foetus,  delivery  was  still 
impossible  ;  the  other  limb  was  torn  away  in  a  similar  manner,  after  which 
a  crotchet  was  fixed  in  each  cotyloid  cavity,  and  the  foetus  was  then  easily 
extracted.  In  addition  to  the  malposition,  the  young  creature  was  affected 
with  hydrocephalus. 

The  use  of  sharp  crotchets  in  such  cases  is  always  attended  with  risk  ; 
should  they  slip  during  traction,  or  not  be  carefully  implanted  in  the 
foetus,  they  may  do  great,  if  not  fatal  injury  to  the  mother. 


486  FCETAL  DYSTOKIA. 

To  escape  the  dangers  which  accompany  the  use  of  the  crotchets  in 
this  way,  another  method  has  been  proposed  and  practised  by  many  vet- 
erinary obstetrists.  The  perineal  region  of  the  foetus  is  largely  incised, 
and  the  hand,  armed  with  a  crotchet,  is  passed  into  the  pelvis  by  this 
opening,  the  crotchet  being  fixed  either  in  front  of  the  symphysis  pubis, 
on  one  of  the  branches  of  the  ilium,  or,  which  is  perhaps  better,  in  one  of 
the  oval  foramina.  Two  crotchets — one  for  each  side — may  be  used.  By 
this  method,  a  more  solid  hold  is  obtained,  and  greater  force  can  be  easily 
exerted. 

Cartwright  observes :  "  In  those  cases  in  which  we  are  unable  to  ex- 
tract by  the  breech,  through  not  getting  the  legs  up  straight  by  laying 
hold  of  the  feet,  or  when  bent  at  the  hocks,  we  should  make  pretty  free 
incisions  through  the  skin  about  the  ilio-femoral  articulations  or  rump, 
and  afterwards  cut  or  tear  the  muscles  around  these  asunder,  and  then  we 
can  secure  cords  around  the  iliac  processes  and  coccygeal  bones,  and 
hooks  against  the  edge  of  the  obturator  foramen,  by  which  means  we  can 
remove  the  pelvic  and  coccygeal  bones  ;  and  having  done  so,  we  can  ap- 
ply a  cord  around  the  head  of  the  thigh-bones  and  pull  them  out.  We 
must  next  make  an  incision  into  the  abdomen  and  remove  the  viscera, 
as  they  are  sometimes  pushed  forward,  and  prevent  our  removing  the 
other  parts  of  the  foetus.  Then  we  must  either  pass  cords  around  the 
skin  that  surrounds  the  thigh,  or  insert  hooks  into  the  skin,  and  draw  the 
remainder  of  the  foetus  out  with  its  hind-legs  under  its  belly,  and  so  com- 
plete extraction." 

Rueff  proposes  to  detach  the  coxae  from  the  sacrum,  by  operating  in  the 
pelvis  of  the  foetus,  and  afterwards  to  extract  the  hind-limbs  thus  sepa- 
rated from  the  trunk.  Others  recommend  symphyseotomy — an  operation 
to  be  described  hereafter. 

When  the  foetus  is  in  the  lumbo-pubic  position,  the  same  obstacles  are 
encountered.  Very  often  the  hind-limbs  are  bent  at  the  hocks,  and  these 
wedge  against  the  floor  of  the  sacrum.  The  same  order  of  manoeuvres 
has  to  be  adopted.  Retropulsion  allows  space  to  flex  the  upper  joints, 
then  extend  the  limbs.  When  extraction  cannot  be  accomplished  with 
the  animal  in  a  standing  attitude,  it  should  be  placed  on  its  back.  When 
success  does  not  attend  the  ordinary  manipulations,  then  the  hind-limbs 
of  the  foetus  must  be  disarticulated  at  the  hocks,  or  higher. 

In  all  manoeuvres  of  this  kind,  great  care  must  be  exercised  in  pre- 
venting injury  to  the  maternal  organs  by  the  feet  of  the  young  creature, 
or  the  jagged  ends  of  bones  ;  and  while  traction  is  being  employed,  the 
hand  of  the  operator  should  be  busy  guiding  the  parts  through  the  genital 
passage. 

The  smaller  animals — Bitch,  Sow,  Ewe — may  be  delivered  by  the  for- 
ceps, small  crotchet,  or  the  tube-noose,  to  be  hereafter  described.  The 
Caesarean  section  may  also,  in  extreme  cases,  be  resorted  to  with  the 
Bitch  and  Sow. 

I.  Cartwright  [Lecture  on  ^''  Veterinary  Obstctricy ")  v/Z-S  called  to  attend  a  Cow  in 
parturition.  It  was  a  breech  presentation,  but  the  os  uteri  was  only  partially  dilated, 
though  by  gentle  manipulation  it  became  tolerably  widened.  After  much  labor  one 
hind-leg  was  raised,  but  for  a  long  time  the  other  could  not  be  found.  At  length  it  was 
discovered,  and,  through  great  exertion,  brought  into  its  proper  position  and  the  calf  ex- 
tracted. In  the  course  of  the  day  the  Cow  died.  The  difficulty  in  this  case  was  due  to 
the  fact  that  the  main  bulk  of  the  foetus  lay  in  the  body  of  the  uterus,  while  one  of  the 
hind-legs  lay  fully  extended  in  one  of  the  uterine  cornua,  the  opening  into  which  was  not 


DYSTOKIA   DEPENDING  ON  POSTERIOR  PRESENTATION.  487 

far  distant  from  the  os,  as  was  demonstrated  on  opening  the  Cow.  All  the  time  the  as- 
sistant was  striving  to  force  the  breech  back,  to  obtain  space  to  raise  the  leg,  he  was  ac- 
tually obstructing  delivery  by  impacting  the  limb.  Cording  the  hock,  drawing  it  into 
the  vagina  as  far  as  possible,  and  amputating  the  leg  at  that  or  the  hip  joint,  would  have 
been  the  proper  procedure. 

2.  The  same  practitioner  {Veterinarian,  vol.  xv.,  p.  374)  was  sent  for  to  see  a  Cow 
which  had  been  attempting  to  calve  for  a  whole  day.  An  examination  proved  it  to  be  a 
case  of  posterior  presentation,  with  the  hind  legs  down  towards  the  udder.  A  cord  was 
tied  round  each  hock,  an  assistant  pulled  gently  at  the  left  one,  while  Cartwright  at- 
tempted to  reach  the  foot  but  could  not.  The  Cow,  which  had  been  standing,  now  lay 
down  on  the  right  side,  and  the  hind-quarters  were  well  raised  by  means  of  straw.  An 
assistant  pushed  back  the  croup  of  the  calf,  while  the  operator  seized  the  foot ;  but  little 
advantage  could  be  gained.  The  Cow  being  a  "  roomy  "  one,  the  assistant  was  now  di- 
rected to  firmly  and  steadily  force  the  point  of  the  hock  forwards,  while  Cartwright 
pulled  at  the  foot ;  in  this  way  the  latter  was  got  up  and  brought  straight  into  the  pass- 
age. This  limb  being  raised,  more  room  was  allowed  to  manipulate  and  adjust  the 
other  leg  in  the  vagina.  Both  legs  were  now  corded  above  the  fetlock,  the  vagina  was 
lubricated  with  oil,  and  traction  begun.  The  passage  was,  however,  so  narrow  that  the 
calf  could  not  be  advanced ;  "  we  then  fastened  a  necking  strap  from  the  hames  around 
each  leg  just  above  the  hock,  by  means  of  which  it  made  more  room  to  pull  at  and  was 
nearer  the  'parts.  By  severe  pulling  we  got  the  hind-parts  through ;  but  when  we  arrived 
at  the  chest  the  passage  was  tighter  than  ever,  and  we  almost  despaired  of  accomplish- 
ing our  object.''  A  part  of  the  cart-rope  was  finally  tied  round  the  body  of  the  calf,  by 
which  means  two  men  pulled  with  great  effect,  and  delivery  was  completed.  The  Cow  re- 
ceived gruel  and  brandy,  and  a  truss  was  applied.     Perfect  recovery  ensued. 

3.  Naylor  {Ibid.,  vol.'xxxiii.,  p.  323)  examined  a  Mare  in  labor,  and  found  the  foal  lying 
on  its  back  with  its  hocks  at  the  os  uteri.  With  difficulty  one  limb  was  got  forward  and 
the  other  amputated  at  the  hock-joint.  A  hook  was  placed  within  the  pelvis  of  the  foal, 
and  both  hind-limbs  having  been  secured,  with  much  exertion  rotation  was  effected,  the 
back  of  the  young  creature  being  upwards.  Considerable  force  had  to  be  employed  in 
extracting  the  foetus,  during  which  the  perinaeum  gave  way.  Though  the  laceration  was 
sutured  and  the  Mare  placed  under  medical  treatment,  death  occurred  in  two  days. 

Dystokia  from  the  Head  and  Fore-limbs  in  the  Posterior  Presen- 
tation. 

• 

In  posterior  presentations,  difficulties  caused  by  the  head  or  fore-limbs, 
or  perhaps  both,  have  sometimes  to  be  overcome  by  the  obstetrist. 

With  the  fore-legs,  the  chief  obstacle  appears  to  be  offered  by  the 
elbows.  If  these  limbs  are  in  a  state  of  abduction,  and  the  elbows 
widely  separated  from  the  body,  these  latter  come  in  contact  with  the 
brim  of  the  maternal  pelvis,  and  jam  against  it ;  thus  offering  a  formid- 
able resistance  to  further  progress. 

The  head  does  not  so  readily  constitute  an  obstacle  to  birth,  though  in 
the  posterior  presentation,  being  the  last  portion  of  the  foetus  to  enter 
the  passage,  its  widest  part  may  become  fixed  either  in  the  pelvic  inlet, 
or  be  retained  by  the' cervix  uteri  when  this  has  happened  to  contract 
•earlier  than  usual.  This  sometimes  occurs  with  the  calf  and  some  of  the 
smaller  animals,  but  more  especially  puppies.  Indeed,  it  is  not  very 
uncommon  to  witness  Bitches  with  the  hind  part  of  the  body  of  a  puppy 
hanging  from  the  vulva,  the  head  being  firmly  wedged  in  the  passage. 

Indications. 

This  resistance  may  be  overcome  in  some  instances,  and  especially  if 
the  fcetus  is  dead,  by  considerable  traction.  In  other  cases,  however, 
and  more  frequently  when  the  foetus  is  alive,  this  traction  cannot  be  prac- 
tised with  impunity,  so  far  as  the  fcetus,  or  even  mother,  is  concerned. 
Rotation  of  the  foetus  is  then  to  be  recommended  ;  and  this  is  not  diffi- 
cult in  carrying  out,  considering  that  a  large  portion  of  the  body  is  al- 
ready outside  the  vulva,  and  can  be  utilized  in  effecting  the  operation. 


488  FCETAL  DYSTOKIA. 

The  fore-limbs  very  often  assume  a  favorable  position  for  extraction  dur- 
ing the  movement.  If  rotation  is  rot  successful,  embryotomy  must  be 
resorted  to. 

With  regard  to  the  head,  traction  will  also  remove  it  from  the  genital 
canal ;  the  body  of  the  foetus  being  moved  alternately  from  side  to  side, 
and  up  and  down,  so  as  to  engage  the  head  in  the  passage  by  all  its 
diameters. 

With  small  animals,  such  as  the  Bitch,  an  emollient  hip  bath  is  very 
useful  \  as  are  also  injections  of  warm  water,  oil,  or  glycerine  into  the 
vagina. 


CHAPTER  III. 

Dystokia   from    Transverse  Presentations.  • 

The  foetus  is  said  to  be  in  a  transverse  position,  when  the  hand  of  the 
obstetrist,  instead  of  meeting  with  the  anterior  or  posterior  part  of  the 
body,  comes  in  contact  with  the  trunk,  either  by  the  shoulders,  withers, 
sides,  flanks,  haunches,  loins,  back,  sternum,  or  belly,  or  (which  is  per- 
haps most  frequent)  all  of  the  limbs  collected  together.  The  foetus,  in- 
stead of  having  its  greater  axis  parallel  to  the  pelvis  of  the  mother, 
has  it  transverse,  or  more  or  less  perpendicular  to  the  antero-posterior 
diameter  of  the  pelvic  canal. 

The  possibility  of  the  foetus  assuming  a  transverse  position  in  the 
uterus  has  been  denied  on  various  occasions  by  Goubaux,  who  bases  his 
objections  on  anatomo-physiological  reasoning ;  contending  that  the 
uterus  cannot  contain  the  young  creature  when  so  placed,  if  the  various 
dimensions  of  the  latter  be  compared  with  those  of  the  gravid  organ. 
In  the  first  place,  however,  it  must  be  remembered  that  the  uterus  is  not 
an  unalterably-shaped  body  with  rigid  walls,  but  a  membranous  sac  whose 
parietes  are  soft  and  yielding  ;  and  that  its  form  may  vary  with  the  dis- 
placement of  its  contents  :  in  a  word,  that  its  transverse  diameter  may  be 
increased  at  the  expense  of  its  length.  Besides,  the  foetus  itself  is  not 
a  compact  unyielding  mass,  but  is  so  flexible  that  it  may  assume  the  most 
varied  attitudes  and  shapes. 

But  the  strongest  proofs  in  favor  of  the  possibility  of  such  presenta- 
tions are  furnished  by  obstetrical  experience  :  the  facts  published  by  a 
host  of  observers  entirely  demolishing  the  antagonistic  theoretical  no- 
tions. It  may  be  noted,  however,  that  though  the  presentations  are 
justly  designated  transverse,  yet  the  body  of  the  foetus  is  generally  a 
little  oblique  in  one  direction  or  the  other. 

Though  the  transverse  vertical  or  horizontal  presentations  are  not  al- 
together rare,  yet  they  are  much  less  common  than  the  longitudinal  pre- 
sentations, and  especially  the  anterior  presentation.  They  do  not  appear 
to  be  primary,  and  they  are  more  frequent  in  the  Mare  than  the  Cow — 
perhaps  because  of  the  more  energetic  contractions  of  the  uterus  in  the 
former  animal  not  allowing  natural  adjustment  of  the  foetus,  should  the 
latter  not  be  exactly  in  a  favorable  position  when  labor  commences. 
When  the  liquor  amnii  escapes  prematurely,  the  deviation  is  still  more 
likely  to  occur,  and  particularly  if  the  os  is  not  sufficiently  dilated.  Tor- 
sion of  the  uterus  \  spasm  of  the  cervix ;  violent  straining  and  disordered 


DYSTOKIA  FROM  TRANSVERSE  PRESENTATIONS.      489 

movements  of  the  mother  ;  deviation  of  some  part  of  the  foetus — especially 
of  the  head;  hydrocephalus,  monosomianism,  etc.,  have  all  been  noted 
at  times  as  a  cause  of  transverse  presentations.  Deformed  head  may 
also  lead  to  this  presentation,  especially  if  it  is  distorted  as  in  Fig.  84. 

These  presentations  are  essentially  dystokial  ;  as  it  is  evident  that  the 
foetus,  if  of  normal  size,  cannot  pass  cross  ways  or  sideways  through  the 
pelvic  canal,  which- barely  affords  space  for  its  passage  longitudinally. 
Birth,  therefore,  cannot  take  place  without  assistance  ;  version  must  be 
practised  in  order  to  change  the  presentation,  and  one  or  other  of  the 
extremities  of  the  oval  mass  which  the  body  of  the  foetus  represents 
must  be  brought  towards  the  inlet.  The  malpresentation,  through  hin- 
dering birth  greatly,  endangers  the  life  of  the  young  creature,  and  espe- 
cially if  it  be  a  foal. 

As  mentioned  at  page  230,  the  transverse  presentations  of  the  body 
may  be  limited  to  two  kinds  :  the  dorso-lumbar,  in  which  some  part  of  the 
back  presents  at  the  inlet  ;  and  the  sterno-abdomitial,  in  which  the  lower 
part  of  the  body  (belly)  offers.  In  the  latter  presentation,  the  limbs  first 
enter  the  os  and  genital  canal,  and  they  may  be  two  (a  hind  and  fore), 
though  more  frequently  three  or  all  of  them  may  be  engaged  j  the  head 
may  or  may  not  have  passed  into  the  inlet. 

N 

Dystokia  from  the  Dorso-lumbar  Presentation. 

To  diagnose  this  cause  of  dystokia — or  back  presentation — is  not 
always  easy.  Labor  has  being  going  on  for  some  time,  the  "  waters  " 
have  escaped,  and  though  the  straining  may  be  very  energetic — even 
violent — yet  nothiiig  is  seen  of  the  foetus.  When  the  hand  is  introduced 
into  the  genital  canal,  in  order  to  discover  the  situation  of  the  foetus  and 
the  nature  of  the  obstacle  which  hinders  birth,  it  encounters  at  first  a 
more  or  less  rounded  surface,  which  does  not  offer  any  special  character 
by  which  it  might  be  recognized.  The  hand  is  then  passed  deeper 
into  the  uterine  cavity,  and  turned  in  every  direction  over  the  body  of  the 
foetus  (for  such  it  is),  so  as  to  find  some  parts  which  may  be  distinguished, 
and  by  which  the  position  of  the  young  creature  in  the  uterus  may  be 
learned. 

By  this  methodical  exploration,  the  obstetrist  recognizes  that  the  body 
of  the  foetus  is  more  or  less  curved  in  the  back,  one  of  the  regions  of 
which  presents  at  the  inlet ;  while  the  head  and  limbs,  more  or  less  en- 
tangled with  each  other,  and  more  or  less  accessible  to  the  hand,  are 
directed  towards  the  fundus  of  the  uterus.  It  now  remains  to  discover 
the  region  which  first  met  the  hand,  and  the  following  memoranda  will 
assist  in  achieving  this  point.  The  withers  are"  recognized  by  the  prom- 
inences which  the  spinous  processes  form  at  this  part ;  the  thin  wedge- 
shaped  outline  of  the  part  ;  and  the  hair  of  the  mane  which,  in  the  foal, 
ends  here.  The  lumbar  region  may  be  distinguished  by  the  large  and 
almost  level  surface  it  offers ;  the  projecting  external  and  internal  angles 
of  the  coxae  in  its  vicinity  ;  the  hollow  of  the  flank  leading  to  the  thigh  and 
stifle.  The  dorsal  region,  or  back,  is  discovered  by  the  arches  of  the  ribs 
springing  from  each  side,  with  the  intercostal  spaces. 

Having  diagnosed  the  presentation,  the  positioti  must  now  be  determined, 
and  this  is  done  by  ascertaining  the  direction  in  which  the  head  lies. 
With  regard  to  this,  we  pointed  out  at  page  231  that  there  were  three 
positions  of  the  foetus  :   i.  The  cephalo-ilial  positions^  two   in  number,  in 


490 


FOETAL  DYSTOKIA. 


one  of  which  the  foetus  has  the  head  directed  towards  the  rightfla7ik  of  the 
mother  {right  cephalo-ilial position),  and  in  the  other  towards  the  left  flajik 
{left  cephalo-ilial  position),  the  head  and  feet  occupying  the  uterine  cornua  ; 


V\Z-  '39- 
Transverse  Presentation  :    Right  Cei'halo-iliai,  Position— Side  View- 

while  in  the  cep halo-sacral  position,  the  fcetus  looks  as  if  seated  on  the 
udder  of  the  mot/wr,  \.\\Q  \\itc\(\  hitiug  directed  forward,  the  mane  towards 
the  sacro-lumbar  region  of  the  dam.  ♦ 


Transver;  e  Presentation 


Fig.  140. 
Right  Cephalo-iliai 


Position — Upper  View. 


It  can  scarcely  be  necessary  to  mention  that  the  exact  position  of  the 
foetus  should  be  ascertained  before  attempts  at  extraction  are  ventured 
upon  ;  as  this  presentation  is,  in  nearly  every  case,  a  very  serious  one, 
and  only  too  frequently  requires  all  the  skill  and  judgment  of   the  obstet- 


D  YSTOKIA  FROM  TRA  NS  VERSE,  PRESENT  A  TIONS.       49 1 

rist  to  rectify.  The  gravity  of  the  case  will,  however,  much  depend  upon 
the  period  when  the  veterinary  surgeon  is  called  in,  and  the  condition  of' 
the  parturient  animal.  When  sufficiently  early  in  his  attendance,  however, 
a  favorable  result  may  often,  if  not  always,  be  anticipated  :  the  mother 
may  be  saved,  anfl  frequently  the  offspring — particularly  in  the  Cow  and 
Goat. 

This  favorable  issue  is  due  to  the  fact,  that  the  presentation  does  not 
admit  of  the  foetus  entering  the  inlet,  and  it  therefore  remains  in  the  ab- 
dominal cavity,  where  there  is  space  to  manipulate  it,  and  thus  remedy 
the  presentation.  The  obstetrist,  though  he  may  have  to  contend  with 
the  paralyzing  and  fatiguing  uterine  contractions,  has  not  to  overcome  the 
wedging  of  the  foetus  in  the  pelvic  canal — so  common  in  the  defective 
anterior  or  posterior  presentations. 


Fig.  141. 
Transverse  Presentation  :    Vertical  or  Cephalo-sacral  Position. 

Indications. 

The  principal  indication  in  such  cases  is  to  convert  the  dorsal  into  an 
anterior  or  posterior  presentation,  according  to  circumstances.  Hippoc- 
rates has  well  said,  that  the  foetus  is  like  a  cork  which  has  fallen  into  a 
bottle,  and  which  can  only  be  extracted  by  one  end  or  the  other. 

Certainly,  the  presentation  offers  serious  difficulties,  from  the  fact  that 
there  is  nothing  about  the  foetus  to  lay  hold  of  advantageously,  or  to 
which  cords  could  be  attached.  In  the  majority  of  instances,  a  long 
interval  has  elapsed  since  parturition  began  ;  the  "  waters  "  have  escaped, ' 
the  genital  canal  is  swollen  and  congested  from  the  attempts  of  amateurs 
at  delivery,  the  interior  of  the  uterus  is  dry  and  adhesive,  the  organ  lies 
as  close  to  the  foetus  as  a  glove  does  to  the  hand,  and  the  parent  is  ex- 
hausted with  unavailing  straining,  and  perhaps  maltreatment ;  though  the 
most  trifling  manipulation  in  the  uterus  will  excite  it  to  the  most  vigorous 
contractions. 

It  is,  ordinarily,  in  these  circumstances  that  the  veterinary  surgeon  is 
required  to  save  mother  and  offspring.  What,  then,  is  the  first,  most 
urgent,  and  indeed   the  chief  indication  ?     This   must  be   version.     The 


492  FCETAL  DYSTOKIA. 

presentation  7niist  be  converted  into  an  anterior  or  posterior  one,  and  this 
'at  tile  expense  of  much  patience,  fatigue,  and  slcill.  But  in  what  direction 
is  version  to  be  practised  ?  Rainard  lays  it  down,  as  a  rule,  that  the 
extremities  of  the  foetus  which  are  nearest  the  pelvis  are  those  which 
should  be  brought  into  the  inlet ;  and  that  if  both  ends  of  the  fcetus  are 
at  about  an  equal  distance  from  it,  the  anterior  should  be  chosen,  because 
it  is  the  easiest  for  delivery.  This  rule,  however,  has  not  been  recognized 
by  the  majority  of  the  best  authorities.  On  the  contrary,  experience,  as 
well  as  theory,  has  demonstrated  that  in  the  majority  of  cases  pelvic 
version  is  the  most  advantageous  ;  inasmuch  as,  when  this  has  been 
effected,  there  are  only  the  hind-limbs  of  the  young  creature  to  deal  with, 
whereas  in  anterior  version  there  is  the  head  in  addition  to  the  fore-legs, 
and  this  may  offer  difficulties  which  have  not  to  be  dreaded  in  the  posterior 
presentation — more  especially  if  there  is  any  thing  abnormal  in  the  condi- 
tion of  the  head.  Not  unfrequently,  and  particularly  when  the  foetus  is 
yet  alive  and  vigorous,  a  kind  of  spontaneous  evolution  is  effected  in  an 
unexpected  direction  ;  for  it  has  been  found  that,  in  acting  on  the  croup 
of  the  foetus,  this  has,  by  energetic  movements  of  its  own,  and  coincident 
with  sudden  contractions  of  the  uterus,  described  nearly  a  half-circle  )  so 
that  instead  of  the  loins  being  under  the  hand,  the  withers  and  upper 
part  of  the  neck  are  encountered,  and  delivery  is  readily  accomplished. 

Before  version  is  attempted,  the  intra-uterine  injection  of  emollient 
fluids  should  be  practised  ;  this  is  most  essential  if  the  waters  have  escaped 
for  some  time.  Then  retropulsion  must  be  had  recourse  to.  The  foetus 
must  not  be  pushed  directly  forward  into  the  uterus,  but  rather  obliquely, 
and  in  a  direction  the  opposite  to  that  of  the  part  we  wish  to  bring  before 
the  inlet.  The  hand  or  repeller  must  be  used  for  this  purpose,  and  as 
version  is  difficult,  so  must  the  intra-uterine  injections  be  frequent. 

The  retropulsion  and  injection,  together  with  the  uterine  contractions, 
have  the  effect,  in  many  cases,  of  making  the  body  of  the  foetus  glide 
around  the  inner  surface  of  the  uterus,  until  a  convenient  part  presents. 
Then  the  limbs  and  head — if  they  are  required,  or  only  the  hind-limbs,  if 
it  should  be  so  decided — are  brought  into  the  genital  canal  by  the  hand 
or  by  cords.  If  the  occasion  demands  it,  rotation  may  be  resorted  to,  in 
order  to  convert  the  vertebro-ilial  position  into  the  vertebro-sacral  or 
vertebro-pubic.       Delivery  is  completed  by  moderate  traction. 

The  manipulations  will,  of  course,  vary  with  circumstances  ;  but  it  will 
generally  be  found  that,  in  all  cases,  raising  the  hind-quarters  of  the 
mother  will  render  them  much  easier  of  accomplishment. 

When  these  manoeuvres  have  failed,  embryotomy  has  been  practised. 
The  intestines  and  other  organs  can  be  extracted  by  an  incision  in  the 
flank  ;  the  vertebras  may  be  divided  at  the  presenting  part,  and  the  entire 
body  cut  through  at  this  division  ;  then  each  half  can  be  extracted  in  the 
'best  and  easiest  manner  possible. 

The  following  are  a  few  illustrative  cases  of  this  presentation  : 

I.  Lecoq  [Mem.  de  la  Societe  Veterinaire du  Calvados,  No.  vi.),  in  1824,  was  summoned 
to  assist  a  Mare  in  parturition.  The  "  waters "  had  escaped  three  hours  previously. 
On  the  hand  being  introduced  into  the  uterus,  an  undistinguishable  mass  was  encoun- 
tered. After  a  long  exploration  the  withers  and  mane  were  distinguished,  and  it  was 
ascertained  that  the  foetus  was  almost  in  a  sitting  attitude,  the  head  and  neck  curved 
upwards  and  forwards  towards  the  sacro-lumbar  region  of  the  mother.  A  sharp  hook 
was  fixed  about  an  inch  in  depth  in  the  middle  portion  of  the  neck,  near  its  upper  margin  ; 
the  handle  was  given  to  an  assistant,  while  Lecoq  placed  his  hand,  in  supination,  a  little 
higher  than  the  withers.     The  foetus  was  carried  towards  the  fundus  of  the  uterus  by 


DYSTOKIA  FROM  TRANSVERSE  PRESENTATIONS.       493 

pulling  at  the  hook.  Either  through  this  traction,  or  perhaps  owing  to  the  pain  caused 
by  the  hook,  the  foetus  made  a  sudden  movement  which,  seconded  by  the  hand  of  the 
operator,  produced  a  somewhat  considerable  displacement.  .  .  .  The  crotchet  was 
again  fixed  towards  the  neck,  but  only  through  the  skin.  Slight  traction  was  made, 
while  the  hand,  resting  on  the  upper  and  anterior  part  of  the  shoulder,  pushed  it  sufifi- 
ciently  to  allow  the  top  of  the  head  to  be  reached,  then  the  lower  jaw  ;  so  that  the  foal 
was  brought  into  the  vertebro-pubic  position,  anterior  presentation,  and  delivery  was 
effected.    ' 

The  foal  was  born  alive — an  unusual  circumstance  in  such  a  protracted  labor,  and  the 
wounds  made  by  the  crotchet  had  healed  in  eight  days. 

2.  Saint-Cyr  [Op.  ciL,  p.  501)  reports  that,  in  1852,  a  female  Ass,  aged  six  years,  was 
brought  to  the  Lyons  Veterinary  School.  It  was  twelve  days  over  its  time  of  foaling, 
and  eight  days  before  its  admission  it  had  shown  the  first  symptoms  of  parturition,  but 
nothing  appeared ;  the  labor-pains  had  nearly  ceased,  but  every  day  the  creature  was 
becoming  more  enfeebled.  It  was  in  a  very  unfavorable  condition  when  examined ; 
from  the  vulva  escaped  an  extremely  foetid  brownish  fluid.  A  uterine  exploration 
established  the  fact  that  there  was  a  dead  and  putrefying  foetus ;  it  was  lying  on  the  right 
side,  the  body  very  much  curved ;  the  limbs  were  entangled  and  could  be  touched 
towards  the  left  flank;  the  head  was  placed  on  the  left  side  of  the  chest,  where  it  could 
also  be  felt ;  the  back  lay  in  front  of  the  inlet,  into  which  no  part  of  the  foetus  was 
engaged.     The  uterine  contractions  were  feeble. 

The  case  being  diagnosed  as  a  back  presentation,  right  cephalo-ilial  position,  version 
was  decided  upon.  Placing  the  open  hand  upon  the  withers,  the  body  of  the  foetus  was 
energetically  pushed  forward,  downward,  and  to  the  right.  After  several  fruitless 
efforts,  the  foetal  mass  began  to  move  on  the  lower  surface  of  the  uterus  in  the  direction 
indicated,  and  in  this  way  changed  the  position,  as  well  as  the  presentation :  the  croup 
being  brought  towards  the  inlet,  while  the  withers  were  farther  removed  from  it  ;  the 
body  had  begun  a  rotation  movement,  for  the  belly,  which  had  been  forward,  now  looked 
obliquelv  upward;  while  the  hind-limbs,  which  were  more  accessible  to  the  hand,  were 
nearthe'sacro-vertebral  angle.  The  left  hind-pastern  was  corded  and  brought  into  the 
vagina,  then  the  right,  which  was  situated  deeper.  The  body  of  the  foal  was  now 
pushed  to  the  right,  while  assistants,  pulling  at  the  cords  as  they  were  ordered,  drew  it 
into  the  axis  of  the  pelvis  by  drawing  a  little  towards  the  right.  Under  the  influence  of 
these  combined  efforts,  the  limbs  were  extended  in  the  pelvic  canal,  the  foetus  turned 
round— the  withers  advancing  towards  the  fundus  of  the  uterus,  the  croup  entering  the 
inlet ;  while  at  the  same  time  the  whole  body,  rotating  on  its  axis,  assumed  the  lumbo- 
pubic  position.  The  foetus  was,  consequently,  in  this  posilion,  posterior  presentation  ; 
there  was  nothing  to  hinder  its  extraction,  and  this  was  accomplished  by  a  few 
well-managed  pulls.  The  entire  operation  did  not  occupy  more  than  a  quarter  of  an 
hour.  Unfortunately,  however,  the  Ass  was  in  a  sinking  condition  when  brought  to  the 
school  ;  the  foetus  and  its  envelopes  were  decomposed,  and  the  genital  canal  was 
violently  inflamed.  No  wonder,  then,  that  three  and  a  half  days  after  delivery,  and 
notwithstanding  the  greatest  care,  the  poor  creature  died  from  the  combined  effects  of 
metro-peritonitis  and  septikaemia. 

3.  Thierry  {Reciieil  de  Med.  Vetcrinaire,  1874,  p.  762)  attended  a  Cow  seveViteen  days 
beyond  its  period  of  calving,  and  which  had  been  in  labor  for  some  time,  but  nothing 
had  appeared  ;  an  empiric  had  been  called  in,  but  he  could  find  nothing  save  the  back. 
The  Cow  was  lying,  back  arched,  and  making  violent  and  almost  continuous  efforts. 
On  exploration  the  back  of  a  large-sized  foetus  was  found  ;  the  creature  seemed  to  be 
lying  on  the  right  side,  its  bodv  greatly  curved,  the  head  and  fore-legs  situated  in  the 
right  flank,  and  the  tail  and  hind-legs  in  the  left  flank.  Pushing  the  hand  deeper,  the 
posterior  ribs  and  left  flank  of  the  foetus  were  felt  ;  to  the  right  the  shoulder  could  not 
be  reached ;  but  to  the  left,  the  left  stifle  was  discovered.  The  calf  had  evidently  been 
dead  for  some  days,  as  the  skin  came  away  in  shreds,  as  well  as  the  envelopes. 

By  the  right  hand  a  corded  crotchet  was  fixed  in  the  lower  part  of  the  left  flank,  close 
to  the  stifle  ;  by  the  left  hand  another  very  long  solid  crotchet  was  fixed  in  the  costal 
region,  as  near  as  possible  to  the  shoulder,  and  twisted  round  several  times.  With  the 
latter  an  assistant  was  to  push  the  foetus  forwards,  while  another  assistant  pulled 
towards  him  with  the  corded  crotchet,  with  the  view  of  bringing  the  foetus  into  the 
posterior  presentation.  At  the  same  time  that  the  assistants  executed  this  task,  Thierry 
pushed  his  left  arm  as  far  as  possible  towards  the  felt  flank  of  the  Cow,  and  after  great 
exertion  got  hold  of  the  left  hock.  Gradually  the  excessively  violent  contractions  of  the 
uterus  enabled  him  to  secure  the  hind-foot  and  bring  it  into  the  passage,  but  the  right 
foot  could  not  be  touched.  A  cord  was  attached  to  the  hind-pastern,  and,  withdrawmg 
the  crotchets,  several  people  pulled  at  it  and  brought  the  limb  beyond  the  vulva  ;  the 
tail  being  now  seized,  powerful  traction  was  combined  with  the  expulsive  efforts  of  the 
mother. 


494 


FOETAL  DYSTOKIA. 


The  right  limb,  however,  was  still  an  obstacle  to  birth  ;  the  attempts  at  extraction  had 
occupied  two  hours  and  a  half,  and  the  Cow  had  stood  all  the  time  ;  now,  however,  it 
fell,  and  the  leg  of  the  foetus  secured  outside  the  vulva  tore  away  from  the  pelvis.  A 
strong  cord  was  passed  through  the  left  foramen  ovale,  and  the  long  solid  crotchet  was 
inserted  in  the  loins,  towards  the  thirteenth  rib  ;  while  another  smaller  hook  was  fixed  in 
front  of  the  pubis.  By  these  means  an  enormous,  but  well-formed  calf,  was  soon  brought 
away. 

With  careful  subsequent  treatment,  the  Cow  quite  recovered. 

4.  Wernert  [Bulletin  de  la  Soc.  Centrale  de  Med.  Veteriiiaire,  1877,  P-  74)  reports  the 
case  of  a  Cow  which,  during  the  later  period  of  pregnancy  especially,  had  the  belly  so 
large  that  it  was  supposed  to  have  twins.  The  foetus  could  be  seen  moving  at  the  left 
and  right  flank,  but  when  the  period  of  gestation  had  expired  an  accident  caused  its 
death.  Parturition  commenced,  but  the  efforts  were  not  vigorous  ;  the  position  of  the 
foetus  could  not  be  ascertained  by  the  farm  people.  The  Cow  lay  on  its  left  side,  and 
Wernert,  exploring  the  vagina  and  uterus,  found  only  the  back  of  the  calf ;  to  the  right, 
at  the  level  of  the  ilium,  the  tail  and  buttock  were  discovered,  and  to  the  left,  on  the 
same  level,  the  withers  and  ridge  of  the  neck.  Neither  feet  nor  head  could  be  reached, 
nor  yet  the  elbows  or  hocks  ;  the  umbilical  cord  was  not  to  be  found.  Mutation  upwards 
was  attempted,  with  a  view  to  placing  the  foetus  on  its  belly ;  with  great  difficulty  a  knee 
was  seized,  and  this  was  secured  by  a  cord.  Pushing  on  the  spine  with  the  right  hand, 
and  pulling  at  the  same  time  with  the  left  hand  on  the  fixed  limb,  the  operator  contrived 
to  effect  a  slight  version,  which  allowed  him  to  get  hold  of  another  foot  by  the  claws. 
Exhausted  by  his  efforts,  Wernert  was  obliged  to  desist  for  half-an-hour.  At  this  period 
a  hind  and  fore-limb  had  been  brought  into  the  passage  ;  beyond,  in  front  of,  and  across 
the  pelvis,  were  a  haunch,  the  back,  and  the  withers.  Resuming  his  efforts,  the  secured 
limbs  were  strongly  pulled  at,  and  exploration  discovered  the  other  knee  and  the  second 
hock  accessible  to  the  hand ;  these  were  flexed  and  brought  into  the  vagina.  In  this 
new  position  the  calf  had  executed  a  complete  half-turn  forward  and  upward:  from  the 
left  side,  the  limbs  in  front,  it  was  placed  on  the  right  side  with  the  limbs  behind,  the 
tail  being  still  to  the  right  and  withers  to  the  left.  At  this  moment,  and  for  the  first 
time,  the  head  could  be  felt  beneath  the  belly  of  the  calf,  the  neck  being  bent  between 
the  limbs  and  resting  on  the  sternum.  The  cord  was  taken  off  the  hind-limb  and  fixed 
on  the  second  fore-leg  ;  the  hind-limbs  were  bent  and  pushed  back  as  far  as  possible 
into  the  uterus  ;  the  neck  was  straightened,  the  head  properly  placed,  and  the  lower  jaw 
corded.  Powerful  traction  then  brought  away  the  calf,  which  was  very  large  and  much 
swollen  by  infiltration,  presenting,  as  it  did,  evidences  of  advanced  decomposition.  The 
Cow  died  the  following  day ;  though  the  cause  of  death  is  not  mentioned. 

Dystokia  from  the  Sterno-abdominal  Presentation. 

The  sterno-abdominal  presentation  is  a  rather  common  one,  particularly 
in  the  Mare.  The  foetus  is  lying  on  its  side,  with  the  sterno-abdominal 
region  and  crossed  limbs — either  flexed  or  extended — presenting  at  the 
inlet  or  engaged  in  the  passage,  while  the  dorsal  region  is  towards  the 
fundus  of  the  uterus. 

There  is  no  difficulty  in  discovering  this  malpresentation,  the  hand 
encountering  the  feet — usually  all  four — in  the  uterus,  and  generally  two 
or  more  of  them  in  the  canal.  Nevertheless,  as  we  have  two  positions  in 
the  presentation,  it  is  necessary  to  distinguish  which  of  them  we  may 
have  to  deal  with.  The  situation  of  the  head,  of  course,  defines  the 
position  ;  so  that  we  may  have  a  rig/il  cephalo-ilial,  in  which  the  foetus  is 
lying  on  its  left  side,  the  head  directed  towards  the  right  flank  of.  the 
mother  ;  and  a  left  cephalo-ilial,  the  reverse  of  the  preceding.  In  the 
majority  of  cases,  either  the  hind  or  the  fore  part  of  the  body  is  nearest 
the  inlet  ;  so  that  the  limbs  belonging  to  one  part  are  more  advanced 
than  those  of  the  other.  When  the  head  can  be  felt  there  is,  of  course, 
no  difficulty  in  distinguishing  the  position,  but  generally  the  head  is 
beyond  reach. 

Then  the  position  must  be  ascertained  by  a  careful  examination  of  the 
limbs^  before  any  attempt  at  mutation  is  made  ;  and  in  this  we  have  to 
distinguish  between  the  fore  and  the  hind-legs,  as  these  alone  can  inform 


DYSTOKIA  FROM  TRANSVERSE  PRESENTATIONS.      495 

us  as  to  the  situation  of  the  head,  this  being  always  of  course  in  the  direction 
■of  the  anterior  limbs.  In  order  to  be  able  to  do  this,  retropulsion  has 
often  to  be  employed. 

We  have  mentioned  that  the  limbs  are  always  the  first  to  appear  at  the 
inlet  in  this  presentation,  and  that  four,  three,  or  only  two  may  be 
engaged — the  others  being  flexed  and  retained  beneath  the  body  of  the 
foetus.  When  only  two  limbs  are  at  the  inlet,  they  are  necessarily  a  hind 
and  fore.  The  head  may  or  may  not  accompany  the  presenting  limbs, 
or  lie  so  deep  in  the  uterus  as  to  be  inaccessible  to  the  hand  of  the 
obstetrist. 

From  this  circumstance,  there  are  eight  varieties  in  this  presentation,  all 
of  which  are,  nevertheless,  fundamentally  the  same.  They  are  as  fol- 
lows :  (i)  Hind  and  fore-limb  presenting,  with  or  (2)  without  the  head  ; 
(3)  Two  fore  and  a  hind-limb,  with  or  (4)  without  the  head  ;  (5)  A  fore 
and  two  hind-limbs,  with  or  (6)  without  the  head  ;  (7)  All  the  limbs, 
with  or  (8)  without  the  head. 


Fig.  142. 
Sterno-abdominal  Presentation,  Head  retained  :  Calf. 

A  verj^  careful  examination  will  lead  to  the  discovery  of  the  fore  and 
hind  limbs,  should  the  head  not  be  within  reach.  We  have  already 
pointed  out  how  they  may  be  distinguished  by  the  hand.  But  in  this 
presentation  it  has  to  be  remembered  that,  when  they  are  engaged  in  the 
genital  canal,  they  cross — the  hind  crossing  the  fore-limbs  in  such  a  way 
that  the  latter  are  directed  towards  the  hinder  part  of  the  body  of  the 
foetus,  and  the  former  towards  the  anterior  region.  The  hind  and  fore- 
feet, when  engaged,  may  also  be  some  distance  forward,  should  one  end 
of  the  body  be  nearer  the  inlet  than  the  other. 

Indications. 

In  the  ooinion  of  some  obstetrists,  this  is  one  of  the   most  serious 


496 


FCETAL   DYSTOKIA. 


presentations  the  veterinary  surgeon  can  meet  with  ;  while  others  assert 
that  it  is  not  so  formidable.  The  gravity  of  the  case  will  depend,  as  in 
some  of  the  other  presentations,  on  circumstances,  which  we  need  not 
here  again  allude  to. 

When  the  limbs  have  been  distinguished,  it  is  n  good  plan  to  secure 
them  by  cords  specially  marked  either  by  colored  tape  or  knots,  so  that 
the  operator  may  know  which  are  the  hind  and  which  the  fore-legs. 

As  delivery  is  impossible  so  long  as  the  young  creature  remains  in  this 
presentation,  the  first  indication  is  version.  This  should  be  so  effected 
as  to  bring  the  hind-quarters  of   the  foetus,  if  possible,  towards  the  inlet 


Fig.  143. 
Sterno-abdominal  Presentation,  Head  and  Feet  Engaged:   Foal. 

— convert  the  presentation  into  a  posterior  one,  and  the  lumbo-sacral  or 
lumbo-pubic  position.  The  reason  for  preferring  this  to  the  anterior 
presentation,  is  that  we  have  only  two  members  to  deal  with  ;  whereas, 
in  the  latter,  we  have  three,  one  of  which  is  the  head,  and  this  is  only  too 
frequently  difficult,  if  not  impossible,  to  secure. 

In  order  to  effect  posterior  version,  the  hind-feet  are  corded  ;  if  only  one 
is  in  the  passage,  the  case  is  then  troublesome,  but  the  missing  one  must 
be  sought  for,  brought  into  the  vagina  in  the  manner  already  explained, 
and  secured — the  cords  being  given  to  assistants.  If  the  head  is  engaged 
in  the  passage,  it  must  be  pushed  through  the  inlet,  and  as  far  as  pos-' 
sible  into  the  uterus.  It  is  recommended  by  some  authorities  to  push  the 
fore-limbs  as  well  i-nto  the  abdomen,  and  in  some  cases,  when   the  foetus 


DYSTOKIA  FROM  TRANSVERSE  PRESENTATIONS. 


497 


is  small  and  short-limbed,  and  the  maternal  pelvis  roomy,  this  can  be 
done.  But,  as  a  rule,  it  is  not  advisable  to  attempt  it,  for  the  simple 
reason  that  they  become  jammed  either  against  the  sacrum,  ilium,  or 
pubis  of  the  mother  ;  and  if  traction  is  then  resorted  to,  rupture  of  the 
uterus  will  be  the  result.  But  if  this  does  not  happen,  the  straining  of 
the  mother  only  too  frequently  throws  the  returned  limbs  again  into  the 
passage  immediately. 

Therefore  it  is  that  Donnarieix,  after  much  successful  experience  of  the 
plan,  advises  that  the  fore-limbs  be  corded,  brought  one  after  another  as 
far  as  possible  into  the  passage  by  slow  and  gradual,  yet  firm  pulling,  and 
disarticulated  at  the  elbow-joint. 

Darreau,  however,  either  from  want  of  practice  in  this 
method,  or  the  difficulty  in  practising  it,  only  succeeded  in  am- 
putating the  limbs  after  great  trouble  ;  and  even  then  the  op- 
eration was  generally  followed  by  serious,  sometimes  fatal, 
accidents.  He  therefore  adopted  the  following  method,  which 
he  declares  has  yielded  excellent  results.  After  cording  the 
hind-limbs,  an  olive-shaped  repeller,  armed  with  a  noosed  cord 
(Fig.  144),  is  attached  to  each  of  the  fore  pasterns,  the  cord 
passing  through  a  ring  in  the  handle.  This  cord  is  drawn 
tightly  around  the  pastern,  and  the  free  end  fastened  to  the 
handle  of  the  instrument.  By  this  means  each  repeller  be- 
comes a  solid  fixture  to  the  fore-limbs,  and  it  is  confided  to 
an  assistant.  The  operator  then  pushes  back  the  fore-limbs 
as  far  as  possible,  while  each  assistant  seconds  his  efforts  with 
the  repellers.  When  all  has  been  conveniently  adjusted,  trac- 
tion is  made  on  the  hind-limbs,  the  repellers  still  being  em- 
ployed to  overcome  the  resistance  of  the  foetus,  and  follow  its 
movements. 

These  instruments,  however,  are  not  always,  nor  yet  often, 
at  hand  ;  and  there  can  be  no  doubt  that  retropulsion  may  be 
employed  by  the  hand,  wdih  care,  and  often  successfully,  es- 
pecially with  the  calf,  whose  limbs  are  comparatively  short. 

But  cases  may  occur  in  which  anterior  versio7i  may  be  pref- 
erable, and  particularly  when  the  head  and  fore-limbs  are 
most  engaged  in  the  pelvic  canal ;  many  instances  are  re- 
corded in  which  it  has  been  resorted  to  with  perfect  success. 

Then  the  hind-limbs  must  be  pushed  into  the  uterus,  after 
being  corded  ;  and  this  retropulsion  may  be  -greatly  aided  by 
the  cords  previously  fixed  on  them,  as  these  can  be  run  through 
the  porte-cords,  which  may  then  be  employed  as  repellers,  as 
with  Darreau's  olive-shaped  repeller. 

In  some  instances,  retropulsion  and  version  are  impossible , 
and  should  the  foetus  be  dead,  there  ought  to  be  no  hesitation 
in  resorting  to  embryotomy.  It  will  generally  be  found  the 
best  plan  to  remove  the  fore-limbs  subcutaneously,  either  at 
the  knee  or  elbow-joints — the  lower  part  of  the  legs  being  re- 
moved, the  remaining  portion  can  be  more  readily  pushed 
back  into  the  uterus. 

I.    Gierer   [Oesterr.    Vierteljahrschrift,    1867,    p.   84)   attended   a   Mare 
which  could  not  foal,  and  it  was  thought  the  fcetus  was  a  monstrosity, 
from  all  the  feet  being  in  the  passage.     Gierer  found  the  animal  lying  on  the  left  side, 
the  vulva  greatly  swollen,  and  the  vaginal  mucous  membrane  dark-colored.     The  feet  of 

32 


Darreau's 

Ol.IVE-SHAPED 

Repeller. 


1 


498  FCETAL  DYSTOKIA. 

the  fcetus  projected  about  five  inches  beyond  the  vulva,  and  a  close  inspection  of  them 
led  to  the  discovery  that  the  two  fore  ones  were  in  the  upper  angle  of  the  vulvular 
opening,  the  hind  ones  on  the  floor  of  the  vagina;  a  cross  presentation  was,  therefore, 
diagnosed,  the  fore  part  of  the  foetus  lying  to  the  left,  the  hinder  parts  to  the  right  in 
the  uterus.  It  was  decided  to  perform  version,  and  convert  the  presentation  into  a  pos- 
terior one  ;  for  this  purpose  it  was  deemed  necessary  to  excise  the  fore  limbs  at  the 
knee.  This  was  done  subcutaneously,  from  the  fetlock  to  the  knee,  the  skin  being  pre- 
served to  cover  the  end  of  the  arm-bones.  No  difficulty  was  experienced  in  pushing 
the  remaining  portion  of  the  fore-legs  into  the  uterus  ;  but  great  trouble  was  experienced 
with  the  hind-limbs,  as  they  could  not  be  withdrawn,  though  traction  had  been  exerted 
on  them  by  six  strong  men.  The  foal  was  extracted'  as  far  as  the  hocks,  and  then  re-' 
mained  in  a  lateral  position,  and  it  seemed  as  if  the  Mare  could  have  been  more  easily 
moved  by  pulling  than  the  young  creature ;  the  left  side  of  the  croup  and  tail  of  the 
latter  was  wedged  in  the  pelvic  canal.  Through  energetic  and  steady  pulling,  however, 
the  foal  was  at  last  extracted.  The  head  was  found  to  be  of  a  concavo-convex  shape, 
as  in  Fig.  85,  and  this  deformity  was  evidently  the  cause  of  the  malposition.  The  Mare 
recovered. 

2.  The  same  authority  {Ibid.,  1871,  p.  130)  mentions  that  he  was  called  to  a  fine  and 
valuable  Mare  which  had  been  in  labor  for  ten  hours,  but  no  progress  had  been  made 
in  birth.  On  his  arrival  he  found  that  the  foal  was  dead  ;  that  the  four  limbs  were 
crossed  on  each  other,  and  projected  beyond  the  vulva  as  far  as  the  fetlocks.  Gierer 
decided  to  push  the  fore  part  of  the  foal  into  the  uterus,  and  deliver  by  the  posterior 
presentation.  The  fore-limbs  were  skinned  as  high  as  the  knees  and  removed  at  these 
joints,  the  skin  being  here  also  used  to  cover  the  cut  surface,  so  as  to  prevent  injury  to 
the  maternal  organs.  The  stumps  were  with  great  difficulty  thrust  forward  into  the  ute- 
rus ;  then  the  hind-limbs  were  energetically  pulled  at,  after  the  tail  of  the  foal  had  been 
brought  into  the  passage,  and  delivery  was  at  length  accomplished.  During  the  opera- 
tion the  Mare  lay  a  good  deal ;  it  rested  for  seven  days  before  recovery  took  place. 

3.  In  the  Compte  rendu  of  the  Brussels  Veterinary  School  for  1872-73  {Annates  de  Med. 
Veterinaire  de  Bruxelles,  1874,  p.  389),  Degive  describes  two  cases  of  this  presentation. 
The  first  occurred  with  a  heavy  draught  Mare,  eight  years  old,  which  had  been  eigh- 
teen hours  in  labor,  and  had  been  roughly  handled  by  incompetent  persons.  It  was 
brought  into  the  school  infirmary,  ^^'here  it  appeared  somewhat  prostrated,  but  it  did 
not  make  any  expulsive  efforts.  Two  feet  of  the  fcetus  were  apparent  in  the  vulvular 
opening.  The  vulva  was  swollen,  and  the  vaginal  mucous  membrane  was  deeply  con- 
gested and  abraded,  an  abundant  dirty-red  fluid  escaping  from  the  opening.  On  explor- 
ing the  canal  the  foetus  was  found  to  be  dead,  its  fore-limbs  in  the  passage  and  their 
feet  beyond  the  vulva.  One  of  the  hind  limbs  was  directed  slightly  upwafd,  backward, 
and  to  the  right,  and  lay  against  the  side  of  the  maternal  pelvis;  the  other  hind-limbs, 
not  so  advanced,  lay  on  the  left,  and  the  foot  was  jammed  against  the  brim  of  the  pubis. 
The  base  of  the  neck  could  be  felt,  and  the  head  seemed  to  be  curved  obliquely  for- 
ward, upwards,  and  a  little  to  the  left.  The  case  was  deemed  a  serious,  if  not  a  hope- 
less, one,  particularly  because  of  the  Mare's  exhaustion. 

Attempts  were  made  to  straighten  the  neck,  by  first  cording  the  protruded  fore-feet, 
trying  to  push  the  hind  ones  into  the  uterus,  and  bringing  the  head  forward  ;  the  Mare 
at  one  time  standing,  at  another  lying  with  the  hind-quarters  raised.  These  attempts 
were  futile,  and  as  it  was  considered  impossible  to  rectify  the  direction  of  the  head  and 
neck,  it  was  sought  to  convert  the  presentation  into  a  posterior  one.  This  also  was  a 
failure,  and  even  the  fore-limbs  could  not  be  returned  into  the  uterus.  Excision  of  the 
latter  was  therefore  decided  upon,  and  it  was  executed  by  making  a  circular  incision 
around  the  fetlock,  then  a  longitudinal  incision  through  the  skin  from  the  fetlock  to  the 
shoulder  on  the  inside  of  one  limb,  outside  of  the  other  for  convenience ;  the  legs  were 
now  torn  off,  after  dividing  the  pectoral  muscles,  and  some  of  those  at  the  neck  and 
withers.  The  foetus  was  then  easily  extracted  by  pulling  at  the  hind  feet.  The  Mare 
rapidly  sank,  however,  and  died  in  about  an  hour  afterwards.  The  uterus  was  found  to 
be  ruptured.  The  head  of  the  foetus  was  distorted  laterally,  and  the  neck  was  also  de- 
viated, depressed,  and  atrophied  on  the  side  to  which  the  head  was  bent :  deformities 
which  had  evidently  occurred  some  time  before  birth.  The  attempts  at  extraction  of 
the  foetus  had  occupied  three  and  a  half  hours,  the  greater  part  of  the  time  having  been 
devoted  to  version  attempts,  and  trying  to  straighten  the  neck.  Failure  was  attributed 
to  retraction  and  loss  of  elasticity  in  the  uterus,  and  the  foetus  being  dead.  It  is  ad- 
mitted that  a  different  result  might  have  been  attained  had  the  fore-limbs  been  ampu- 
tated earlier :  this  operation  being  always  easy,  and  generally  followed  by  great  ad- 
vantages. 

In  the  second  case  the  presentation  was  the  same,  but  the  Mare  was  not  nearly  so 
exhausted,  having  been  only  a  few  hours  in  labor;  it  had  also  escaped  the  maltreatment 


DYSTOKIA  FROM  TRANSVERSE  PRESENTATIONS.      499 

of  amateurs.  It  was  soon  discovered  that  the  head  of  the  foetus  could  not  be  adjusted, 
and  that  version  was  impossible ;  ablation  of  the  fore-limbs  was  therefore  i-esorted  to 
early,  and  carried  out  as  in  the  other  case.  Extraction  of  the  foetus  was  soon  accom- 
plished, and  in  five  days  the  Mare  was  convalescent. 

4.  Recordon  {Rerueil  de  Med  VeterinairCy  1877,  p.  26)  was  called  to  assist  a  Cow  in 
parturition.  Before  his  arrival  it  had  already  given  birth  to  a  living  and  well-formed 
calf  without  any  difficulty,  and  in  the  normal  position.  The  Cow  was  lying  on  the  left 
side,  making  a  few  expulsive  efforts ;  all  the  limbs  presented,  the  body  of  the  Calf  was 
horizontal — transversal  to  the  greater  axis  of  the  uterus ;  it  lay  on  the  right  side,  the 
head  turned  back  in  the  left  flank  of  the  mother,  the  hind-quarters  corresponding 
to  the  right  flank.  The  head  could  be  reached  with  great  difficulty,  and  the  belly  was 
the  only  part  that  was  readily  accessible.  The  calf  being  dead,  embryotomy  was  had 
recourse  to,  as  no  change  could  be  effected  in  the  position  of  the  foetus.  A  bistoury 
cachee  in  the  right  hand  removed  the  left  shoulder  of  the  calf  in  about  ten  minutes,  and 
this  reduction  in  volume  allowed  the  head  to  be  reached  and  brought  towards  the  inlet, 
but  it  could  not  be  brought  into  it.  The  abdomen  was  opened  throughout  its  length, 
and  the  asternal  ribs  cut  across  ;  the  viscera  were  then  removed,  and  the  great  reduction 
in  volume  which  resulted  permitted  the  head  to  be  seized  and  carried  outside  the 
vulva  ;  slight  traction  on  the  head  and  fore-limbs  caused  the  immediate  expulsion  of  the 
foetus  ;  but  to  the  astonishment  of  the  operator  and  his  assistants,  a  third  calf  appeared 
in  the  natural  presentation ;  this  was  born  in  its  envelopes,  though  it  was  dead.  So 
that  of  the  three  calves,  two  were  in  the  normal  presentation,  and  the  other  was  hori- 
zontal and  transversal.     The  Cow  did  well,  rumination  having  recommenced  next  day. 


500  OBSTETRIC  OPERATIONS. 

BOOK   HI. 

OBSTETRIC  OPERATIONS. 

In  the  various  malpresentations  and  malpositions,  as  well  as  for  the 
other  causes  of  dystokia  already  enumerated,  the  indications  for  adjust- 
ment and  extraction  were  alluded  to  and  described  at  sufficient  length, 
and  the  means  to  be  adopted  for  carrying  them  out  were  likewise  men- 
tioned. It  was  shown  that,  in  many  cases,  it  is  sufficient  to  correct  the 
abnormal  presentation  or  position,  and  rectify  the  deviation  of  limbs, 
neck,  or  head,  to  effect  delivery  in  the  ordinary  manner  by  means  of  the 
hand  alone.  For,  as  has  been  well  said,  the  practised  hand  is  the  best 
and  most  perfect  of  all  instruments,  and  it  can  effect  in  obstetrical 
operations  what  no  instrument  is  competent  to  achieve.  Therefore  it  is 
that  an  operator  with  a  long  and  powerful  arm,  and  a  small  hand,  with 
strong  fingers,  possesses  many  advantages  as  an  obstetrist,  and  is  in  a 
better  position  to  afford  relief  than  one  with  a  short  arm  and  large  hand 
— especially  in  the  correction  of  those  deviations  which  are  so  frequent, 
and  oftentimes  so  baffling. 

Extraction  by  the  hand  alone  ma}^  be  effected  in  many  cases  of  diffi- 
cult parturition,  when  these  rectifications  have  been  made  ;  though  even 
then  it  is  essential  that  the  os  uteri  be  fully  dilated,  the  vagina  and  vulva 
dilatable,  and  sufficiently  prepared  to  allow  the  young  creature  to  pass 
through  ;  it  is  likewise  necessary  that  such  a  relationship  in  proportions, 
between  the  volume  of  the  foetus  and  the  capacity  of  the  pelvis,  should 
exist,  that  extraction  can  be  accomplished  without  much  difficulty. 
Finally,  it  is  particularly  desirable  that  the  uterus  retain  its  contractile 
power,  and  that  its  regular  contractions  second  the  efforts  of  the 
operator. 

In  only  too  many  cases  of  dystokia,  however,  one  or  more  of  these 
conditions  are  absent,  and  the  unaided  hand — no  matter  whether  it  be 
ever  so  well  endowed  and  practised — fails  to  effect  delivery :  so  that,  in 
order  to  overcome  the  difficulties,  recourse  must  be  had  to  various  surgi- 
cal instruments  and  appliances,  and  there  must  be  practised,  either  on  the 
mother  or  fcetus,  more  or  less  complicated  and  serious  operations,  which 
demand  strength,  expertness,  and  an  accurate  knowledge  of  anatomy  and 
physiology  and  ev^en  of  mechanics,  in  addition  to  a  thorough  acquaint- 
ance with  surgical  pathology.  Some  of  the  obstetrical  operations  have 
already  received  attention  from  us  ;  l^ut  it  is  necessary  to  study  them  as 
a  whole,  in  order  to  master  their  special  features,  and  particularly  the 
manner  in  which  they  are  performed  ;  as  upon  the  exactness  of  our  knowl- 
edge with  regard  to   them,  will  generally  depend  their  successful  results. 

These  operations  have  for  their  object  either  to  supplement  the  forces 
of  nature,  which  are  insufficient  to  secure  the  birth  of  the  young  crea- 
ture ;  to  diminish  the  size  of  the  latter  when  it  is  either  too  large,  too 
deformed,  or  too  deviated  or  distorted,  to  pass  through  the  maternal  pas- 
sages;  to  enlarge  the  latter,  or  to  extract  the  foetus  by  an  artificial  pas- 
sage, when  these  last  do  not  admit  of  extraction.  This  leads  to  a  con- 
sideration (i)  of  the  Mechanical  means  of  extraction  of  the  foetus ;  (2) 
Etnbryotomy^  or  extraction  by  mutilation  of  the  foetus  ;  (3)  Vaginal  hyster- 
otomy ;  (4)  Gastro-hysterotomy  or  the  Ccrsarean   Section ;  (5)  Symphysiot- 


MECHA  NIC  A  L  EXTRA  CTION  OF  THE  FCE  TUS.  5  o  i 

omy.  In  all  these  operations  the  obstetrist  requires  the  aid  of  assistants, 
who  only  too  often  have  to  be  instructed  in  the  part  they  are  called  upon 
to  perform,  at  the  very  moment  their  services  are  required. 


CHAPTER  I. 
Mechanical  Means  for  the  Extraction  of  the  Foetus, 

Mechanical  means  for  the  extraction  of  tfhe  foetus  are  required  when 
the  expulsive  efforts  of  the  parent,  and  perhaps  the  hands  of  the  obstet- 
rist, are  insufficient  to  produce  delivery.  These  means  have  for  their 
object  the  application  to  the  foetus  of  extractive  force  sufficient  to  over- 
come the  resistance  offered  by  the  obstacle  to  birth  ;  they  comprise  a 
number  of  articles,  the  chief  of  which  are  cords,  crotchets  {hooks),  and  for- 
ceps of  various  kinds.  The  uses  and  advantages  of  these  we  will  now  no- 
tice. But  before  doing  this,  we  must  again  point  out  the  great  advantage, 
should  the  "  waters  "  have  escaped,  and  the  genital  canal  and  interior  of 
the  uterus  be  dry  and  tenacious,  of  moistening  these  parts  well  before  re- 
sorting to  the  mechanical  means.  Tepid  emollient  fluids,  such  as  oil, 
glycerine  and  water,  bran  water,  soap  and  water,  or  ev^en  water  alone, 
should  be  plentifully  introduced,  either  by  a  syringe,  a  simple  tun-dish  or 
funnel  to  which  a  long  piece  of  india-rubber  or  leather  tubing  is  attached, 
or  a  bladder  tied  to  a  tube.  A  stomach  pump,  or  the  common  enema 
syringe,  the  pipe  of  which  is  attached  to  a  piece  of  tubing,  the  other  end 
of  the  latter  being  tied  to  the  body  of  the  instrument,  enables  the  operator 
to  carry  the  water,  or  lubricating  fluid,  into  the  uterus  and  around  the 
body  of  the  foetus.  By  raising  the  hind  quarters  of  the  animal  sufficiently 
high,  the  fluid  gravitates  to  the  interior  of  the  cavity.  With  the  Bitch 
and  other  small  animals,  a  tepid  bath,  as  well  as  injections,  may  be  re- 
sorted to. 

Cords  and  Bands. 

Cords  and  bands  are,  of  all  mechanical  means,  the  most  useful  in  veter- 
inary obstetricy,  and  are  more  to  the  animal  obstetrist  than  the  forceps 
are  to  the  human  obstetrist.  They  have  the  additional  advantage  that 
they  are  readily  procurable  everywhere,  are  cheap,  very  portable,  and  can 
be  employed  where  and  when  other  means  are  inapplicable.  Owing  to 
their  pliability,  they  can  be  pulled  in  any  direction  desirable,  without 
much  danger  of  injury  to  the  maternal  organs.  In  all  cases  of  difficult 
parturition,  it  is  an  axiom  with  the  experienced  veterinary  obstetrist  that 
the  first  thing  to  be  done  is  to  cord  the  presenting  limbs ;  or  if  they  do 
not  present,  to  seek  for  and  cord  them  as  soon  as  possible.  When  this  is 
done,  then  they  may  be  returned  to  the  uterus,  or  put  out  of  the  way,  as 
the  cords  will  always  bring  them  to  hand  again  when  required.  While 
they  are  admirably  adapted  for  exercising  traction  upon,  they  may  also  in 
certain  cases  be  of  great  utility  in  changing  a  malposition  of  the  foetus,  as 
we  have  already  shown  in  our  illustrative  examples,  and  particularly  in 
Darreau's  method  of  mutation  by  means  of  cords  applied  by  the  porte- 
cord  to  the  pasterns  (page  497). 

They  are  used  with  the  view  of  applying  traction  to  the  fcetus,  and  they 
can  be  attached  to  the  head,  body,  limbs,  or  tail,  according  to  circum- 


502 


OBSTETRIC  OPERATIONS. 


stances.  The  limbs  are  more  particularly  the  parts  upon  which  they  can 
be  most  usefully  employed,  because  of  the  length  and  solidity  of  these, 
the  facility  with  which  they  can  be  seized,  and  the  prominences  of  the 
joints  and  hoofs,  which  prevent  the  cords  from  slipping.  The  head  can- 
not be  so  advantageously  "  corded,"  though  it  is  a  most  important  region 
of  the  body  to  secure  in  certain  cases.  The  neck  can  be  corded,  as  can 
also  the  loins  and  croup,  as  already  shown. 

The  cords  vary  in  thickness  and  length  ;  they  are  usually  about  five  or 
six  feet  long,  though  they  may  be  nine  or  ten  feet ;  and,  if  spun  rope, 
from  quarter  to  half-inch  or  ipore  thick.  At  one  end  is  a  small  loop,  or 
iron  ring,  by  which  to  form  a  running  noose  (Figs.  145,  146,  149).  Some 
practitioners  recommend  strands  of  Manilla  hemp,  and  in  particular  in- 
stances, as  when  a  somewhat  rigid  loop  is  required,  it  is  very  useful  to 
have  a  long  piece  of  copper  wire  twined  in  the  cord  or  hemp.  Other  ob- 
stetrists  prefer  a  leather  band. 

The  Manilla  hemp,  and  web  or  leather  band,  are  resorted  to  in  order  to 
prevent  damage  to  the  foetus  during  traction — the  cords,  from  their  hard- 
ness, thinness,  and  strands,  being  liable  to  cut.  But  this  accident  need 
not  be  rAuch  feared,  and  the  durability,  convenience,  and  other  advan- 


Traction  Cord  and  Band,  and  the 
Manner  of  Applying  them. 


Fig.  146. 
Schaack's  Traction  Cord. 


tages  possessed  by  the  cords,  are  greatly  in  their  favor.  They  retain  their 
hold  better  than  any  thing  else,  and  particularly  if  they  have  only  a  simple 
loop  at  the  end,  instead  of  an  iron  ring. 

Whatever  is  used  for  this  purpose  should  be  very  pliable,  and  yet  suf- 
ficiently strong  to  withstand  energetic  pulling.  A  very  good  cord  is  that 
used  by  Schaack. 

This  is  merely  a  cord  with  a  running  noose  at  one  end,  and  a  small 
piece  of  round  wood  at  the  other,  to  give  the  assistant  a  better  hold,  and 
enable  him  to  use  more  force  (Fig.  146). 

When  cords  are  employed  on  the  limbs,  they  are  generally  applied  to 
the  pasterns,  as  these  parts  are  most  accessible,  and  afford  the  most  se- 


MECHANICAL  EXTRACTION  OE  THE  ECETUS.  503 

cure  hold.  They  can  also  be  applied  above  the  knees  and  hocks,  when 
it  is  necessary  to  amputate  the  limbs  at  these  joints.  The  head  may  be 
secured  around  the  lower  jaw,  though  this  does  not  afford  a  very  secure 
hold.  It  is  better  to  pass  the  noose  into  the  mouth  and  around^'the  top 
of  the  head,  like  a  gag-rope. 

When  the  cords  are  to  be  applied  to  the  limbs,  either  of  two  modes  can 
be  resorted  to  with  this  object.  If  the  limb  is  bent,  it  must  be  extended 
and  brought  opposite  the  inlet,  or  into  the  genital  canal,  as  the  case  may 
be.  Then  Rainard  recommends  that  the  fingers  be  gathered  together 
and  slightly  bent,  so  as  to  form  a  sort  of  cone,  on  which  the  running 
noose  of  the  cord — sufficiently  wide  to  pass  over  the  foot  of  the  foetus — is 
placed,  as  in  fig.  145.  The  noose  is  kept  in  its  place  on  the  fingers,  in 
tightening  the  cord  by  the  free  portion  which  passes  along  the  under  side 
of  the  hand  and  arm  ;  unless  this  precaution  is  adopted,  the  noose  will  be 
pushed  back  over  the  hand  when  introduced  into  the  vagina,  and  cannot 
easily  be  got  forward  again.  The  hand  and  cord  being  oiled,  are  intro- 
duced into  the  passage,  and  when  the  foot  is  reached  it  is  seized  in  the 
fingers  ;  these  are  then  suddenly  bent,  so  as  to  shorten  the  cone  and 
cause  the  noose  to  run  on  to  the  pastern  by  a  gentle  pull  of  the  cord, 
which  can  then  be  tightened  and  given  to  an  assistant. 

The  other  method,  which  is  Schaack's,  and  by  some  obstetrists  con- 
sidered preferable  to  that  just  described,  consists  in  placing  the  middle  of 
the  noose  on  the  dorsal  aspect  of  the  ends  of  the  two  middle  fingers,  the 
finger  on  each  side  holding  it  against  these,  while  the  thumb  keeps  it  in 
the  palm  of  the  hand  (Fig.  155).  The  left  hand  maintains  the  cord  suffi- 
ciently tense  to  assist  in  keeping  the  noose  on  the  hand  ;  and  if  the  part 
of  the  cord  which  runs  through  the  loop  i^  placed  towards  the  thumb,  the 
latter  can  readily  increase  the  size  of  the  noose.  The  hand  is  passed 
into  the  vagina  sideways,  the  little  finger  downwards,  and  when  the  foot 
is  reached,  the  thumb  and  index  finger  are  placed  within  the  noose,  which 
they  enlarge  in  separating  from  each  other,  while  the  remaining  fingers, 
flexing  on  the  hand,  are  passed  around  the  foot,  and  cause  the  noose  to 
glide  over  the  hoof  on  to  the  pastern.  The  fingers  now  press  oji  the  loop, 
while  the  other  hand,  drawing  at  the  cord  outside  the  vulva,  tightens  the 
noose  around  the  limb. 

When  the  limb  is  flexed  and  cannot  be  extended,  as  at  the  knee  or 
hock,  the  looped  cord  may  be  employed  ;  though  a  long  cord,  doubled, 
will  be  found  to  answer  very  well.  This  is  passed  round  the  flexure,  the 
doubled  end  pulled  to  the  vulva,  and  the  other  end  passed  through  it  ; 
this  done,  the  loop  may  be  tightened,  passed  up  to  the  elbow  or  stifle,  or 
down  to  the  pastern. 

The  lower  jaw  is  "  corded  "  in  a  similar  manner ;  the  mouth  of  the 
foetus  being  opened,  the  noose  is  passed  around  the  neck  of  the  jaw,  and 
the  knot  or  loop  placed  beneath  the  chin. 

As  we  have  already  remarked,  when  treating  of  certain  presentations, 
in  some  cases  in  which  the  use  of  cords  is  urgently  indicated,  the  arm  is 
not  sufficiently  long  to  pass  them  to  the  region  where  they  may  be  most 
effectively  employed ;  while  the  energetic  uterine  contractions  paralyze 
the  hand,  and  often  prevent  it  manipulating  accessible  parts  which  it  is 
desirable  to  secure  by  these  means.  In  these  cases,  \\\q.  porte-cord  \s  of 
great  service.     These  porte-cords  are  of  two  kinds — straight  and  curved. 

The  straight  porte-cord  is  a  rod  of  three-eight  inch  iron,  about  three 
feet  in  length,  a  handle  at  one  end,  and  an  eyelet  at  the  other,  to  receive 
the  cord  (figs.  147,  148). 


504 


OBSTETRIC  OPERATIONS. 


The  curved  porte-cord  has  the  end  through  which  the  cord  passes  more 
or  less  bent  or  curved,  and  in  certain  cases  it  is  more  useful  than  the 
staight  one,  from  which  it  only  differs  in  this  curvature  (Figs.  149,  150). 

We  ha»e  already,  at  page  461,  described  another  from  of  curved  porte- 
cord  introduced  by  Binz,  so  large  that  it  can  be  passed  round  the  doubled 
neck  of  the  foatus,  while  its  shortness  allows  it  to  be  easily  manipulated 


^  :teto-«aft|^ 


^v 


Fig.  147.  Fig.  148.  Fig.  149.  Fig. 

Caktwright's  Darreau's  Gunther's  Curved  Porte-  Darreau's 

PoKTE-CoRD.  Porte-Cord.  Cord  and  Blunt  Crotchet,  Curved  Porte-Cord. 

armed  with  a  Cord  and  Ring. 


in  the  uterus.  It  is  from  twelve  to  sixteen  inches  long,  and  made  of 
wood  or  iron  ;  at  the  bent  end  is  an  opening  through  which  the  cord 
passes.  The  instrument  (named  ?^  geburtsso7tde\>^ \\\q  Germans)  is  passed 
to  the  middle  of  the  cord,  and  may  then  be  introduced  into  the  uterus, 
where,  from  its  curvature  and  its  shortness,  it  can  be  pushed  behind  or 


\ 


MECHANICAL  EXTRACTION  OF  THE  FCETUS.  505 

between  the  limbs,  in  the  double  of  a  bent  neck,  etc.  The  hand  seeks 
the  one  half  of  the  cord  on  the  opposite  side  of  the  part,  and  pulls  it  into 
the  vagina  ;  the  instrument  is  then  withdrawn,  and  the  part  is  ready  to  be 
pulled  at  by  the  cord  left  encircling  it. 

Tyvaert  (Annales  de  Med.  Veterinaire,  June,  1876,  p.  320)  has  for  a  long 
time  made  profitable  use  of  a  simple  porte-cord.  This  is  composed  of  a 
somewhat  short  piece  of  iron  wire,  about  the  thickness  of  a  goose-quill, 
and  bent  a  little  round,  the  length  and  curve  varying  with  the  part  to  be 
secured.  One  end  is  turned  to  form  a  small  ring,  while  the  other  is  bent 
to  make  a  hook,  a  little  longer  than  wide.  A  cord  being  attached  to  the 
ring  end,  the  wire  is  passed  round  the  part  it  is  sought  to  seize  ;  the  hook 
end  remains  free,  and  afterwards  receives  the  traction  cord,  serving  to 
form  a  running  noose  on  the  part.  This  porte-cord  is  very  simple,  and 
may  be  made  on  the  spot  when  required  ;  it  has  proved  most  useful  for 
securing  the  neck  or  hocks. 

Giinther  {Handbuch  der  praktischen  Veterindr  Geburtshiilfe)  has  pro- 
posed a  complicated  porte-cord,  not  unlike  a  long  "  ball-gun,"  and  pro- 
vided at  the  end  with  two  jaws,  which  hold  the  cord,  and  release  it  when 
necessary  by  means  of  a  spring  at  the  handle. 

An  ordinary  walking-stick  may,  on  an  emergency,  and  by  a  little  inge- 
nuity, be  readily  made  to  serve  as  a  useful  porte-cord — the  bent  handle  of 
the  stick  being  utilized  as  the  curve. 

The  straight  porte-cord,  when  required  to  be  used,  has  the  cord  passed 
through  the  eyelet  at  the  end,  the  noose  remaining  beyond  the  end,  and 
of  sufficient  size  to  pass  over  the  foot,  or  around  the  neck  of  the  lower 
jaw,  as  in  Figure  144.  One  hand  is  introduced  into  the  noose  in  either 
of  the  ways  already  indicated,  while  the  other  hand  seizes  the  handle  of 
the  instrument,  which  is  then  introduced  into  the  genital  canal — the  hand 
with  the  noose  preceding  it.  When  the  foot  or  jaw  is  reached,  the  noose 
is  slipped  over  it,  and  tightened  by  pushing  on  the  handle  of  the  porte- 
cord,  Cartwright  has  employed  his  straight  porte-cord  (Fig.  147)  to 
carry  the  cord  over  the  head  of  the  foetus  and  on  to  the  neck. 

If  the  iron  of  the  straight  instrument  is  soft,  it  may  readily  be  con- 
verted into  a  bent  porte-cord  (Fig.  149),  and  in  this  altered  form  render 
good  service  in  the  case  of  flexed  limbs  or  bent  neck,  and  in  some  mal- 
positions of  the  posterior  presentation.  The  instrument  is  introduced  in 
the  same  manner  as  the  other  form,  but  with  only  the  loop — no  noose — 
at  the  end  of  the  cord  ;  the  curved  portion  is  pushed  around  the  part  to 
be  secured,  and  the  hand,  leaving  it,  is  passed  to  the  opposite  side  of  the 
part,  where  it  searches  for  the  loop  or  ring,  which,  when  found,  is  drawn 
into  the  genital  canal.  The  instrument  is  then  withdrawn,  the  cord  re- 
maining around  the  part ;  the  free  end  of  the  cord  is  passed  through  the 
loop  or  ring,  and  being  pulled  at,  the  limb,  neck,  body,  or  whatever  it 
may  be,  is  secured  in  the  noose  so  formed,  and  traction  can  in  this  way 
be  directly  exerted  upon  it. 

Head-cord,  or  Head-collar. 

In  addition  to  the  limbs  and  other  parts,  we  have  stated  that  the  trac- 
tion-cord can  often  be  advantageously  applied  to  the  lower  jaw.  Indeed, 
in  the  anterior  presentation,  even  when  the  fore-limbs  are  "corded,"  and 
the  head  is  in  a  favorable  position,  it  will  generally  be  found  very  useful 
to  apply  traction  to  the  head  in  addition,  as  not  unfrequently  pulling  at 
the  fore-limbs  alone  only  fixes  them  more  firmly  in  the  passage. 


5o6 


OBSTETRIC  OPERATIONS. 


We  have  also  mentioned  that  the  interdental  space,  or  "  neck  "  of  the 
lower  jaw,  is  the  most  convenient  for  the  attachment  of  the  cord ;  but 
nevertheless  it  will  be  found  in  practice  that  this  does  not  afford  nearly 
so  firm  a  hold  as  the  limbs,  and  that  if  the  noose  does  not  slip  off  the 
jaw,  which  is  often  the  case,  should  the  traction  be  at  all  energetic,  the 
bones  will  probably  be  smashed,  the  foetus,  if  alive,  irreparably  damaged, 
and  an  important  accessory  means  to  extraction  lost.  Should  the  head 
be  turned  back  towards  the  side,  cording  the  neck  does  not  reduce  the 
deviation,  but  only  allows  this  to  be  brought,  in  a  doubled  condition,  into 
the  genital  canal. 

It  is  therefore  most  important  that  means  be  at  hand  to  secure  the 
head  firmly  and  solidly,  either  with  a  view  to  correct  deviation  when  this 
part  is  in  malposition,  or  to  exercise  traction  upon  it  when  it  is  adjusted, 
but  the  foetus  remains  immovable  by  pulling  at  the  fore-limbs. 


Fig.  isi. 
BiNz's  Simple  Head-collar. 


Rueff's  Head-collar. 
No.  I. 


Rueff's  Head-collar. 
No.  2. 


We  have  suggested  that  the  noose  of  the  cord,  sufficiently  widened, 
instead  of  being  placed  on  the  lower  jaw,  should  be  first  passed  into  the 
mouth  of  the  foetus,  then  carried  up  over  the  head  and  behind  the  ears — 
the  loop  of  the  noose  remaining,  of  course,  tightly  drawn  in  the  mouth, 
as  this  must  be  the  direction  from  w^hich  the  traction  is  exercised  ;  if 
pulled  at  from  behind  the  ears,  the  noose  would  be  drawn  off.  In  plac- 
ing the  noose  in  this  position,  the  straight  porte-cord — and  especially 
Mr.  Cartwright's  pattern — will  be  found  very  useful. 

Instead  of  this  simple  noose,  which  can  readily  be  made  when  needed, 
various  kinds  of  head-stall  have  been  proposed  by  veterinary  obstetrists 
from  time  to  time,  and  some  of  these  possess  certain  advantages.  Giin- 
ther,  many  years  ago,  pointed  out  the  advantages  of  a  head-band  like 
that  represented  in  Fig.  145,  the  upper  part  of  which  was  passed  behind 
the  ears,  while  the  lower  part  with  the  running  knot  lay  between  the 


MECHANICAL  EXTRACTION  OF  THE  FCETUS. 


507 


branches  of  the  lower  jaw.  Binz  soon  after  proposed  a  kind  of  head- 
collar,  or  halter,  which  could  be  adapted  to  different-sized  heads  (Fig. 
151)  :  it  has  a  long  cord  attached,  which  can  be  used  by  assistants  to  pull 
at.  This  halter  is  held  between  the  thumb  and  index-finger  by  its  upper 
part,  and  passed  into  the  uterus,  where  it  is  put  over  the  occiput  of  the 
young  creature's  head,  and  the  sides  applied  to  the  cheeks  ;  the  lower 
portion,"*  which  was  open,  is  now  closed  by  running  the  end  of  the  cord 
through  the  loop,  by  which  the  head  is  firmly  secured,  as  in  the  figure 
(151).  Rueff  has  described  two  similar  halters  (Figs.  152,  153)  which, 
having  a  long  cord  on  each  side  of  the  head,  must,  of  course,  exercise 
more  direct  traction — sometimes  an  important  consideration. 

Binz's  halter  is  made  by  a  cord  which  has  at  one  end  an  eyelet  or  loop, 
and  at  a  certain  distance  a  loop-knot.  When  the  other  end  of  the  cord 
is  passed  into  the  first  eyelet,  it  forms  a  long  semicircle,  and  when 
passed  through  the  second,  a  circle  which  may  be  enlarged  or  decreased 
at  will  in  pulling  at  this  end.  Rueff  makes  his  halter  in  a  similar  manner, 
but  instead  of  having  the  loop  at  the  very  end,  it  is  placed  some  distance 
from  it ;  this  of  course  gives  a  halter  with  two  lead  or  traction  ropes. 


I 


Fig-  154- 
Binz's  Forceps-band. 

Binz  has  devised  a  special  head-apparatus  (Fig,  154),  to  which  he  has 
given  the  name  of  "  Forceps-band  "  {Zangenbtmd).  This  is  a  band  of 
flax,  silk,  or  some  other  woven  material,  which  is  at  its  widest  part  about 
four  inches  broad,  and  in  length  it  is  about  six  or  seven  feet.  At  one 
end  is  a  moderately  large  opening,  while  the  other  is  divided  into  two 
portions  to  within  some  distance  of  the  loop  ;  these  last  pass  through  a 
round,  movable,  cork-shaped  piece  of  wood,  metal,  or  leather.  The 
head  of  the  foetus  is  passed  between  the  divided  ends  of  this  band,  which 
are  then  tightened  behind  the  jaw  by  running  the  keeper  close  up  to  the 
chin,  the  undivided  portion  being  brought  over  the  forehe,ad  towards  the 
nose.  In  this  way  powerful  and  direct  traction  can  be  made  on  the  head, 
above  and  below,  by  means  of  the  upper  part  with  the  hole  at  the  end, 
and  the  two  portions  beneath.  It  has  been  found  particularly  useful  in 
cases  of  hydrocephalus. 

Schaack,  in  1848,  introduced  another  kind  of  head  apparatus,  which  he 
designated  a  "  sliding  head-stall  "  {tetiere  a  coulanl),  but  which  is  perhaps 
better  known  in  France  as  a  "  forceps  hTihev''  (licol-forceps),hY  reason 
of  its  shape  and  use.  It  is  composed  of  two  doubled  cords,  one  of  which 
(Fig.  155,  I,  i)  forms  the  head-stall^  while  the  other  (3,  3)  makes  the  nose- 
band. The  two  are  united  by  a  metallic  runner  (5),  which  allows  the 
apparatus  to  be  increased  or  diminished  in  size  at  will.  The  runner^ 
which  forms  the  key  of  the  apparatus,  is  a  piece  of  brass  or  pewter  a  little 
more  than  an  inch  in  length,  about  an  inch  in  breadth,  and  half  an  inch 
in  thickness.  It  is  perforated  by  three  holes,  two  of  which  are  parallel 
and  pass  through  the  wider  part  of  the  metal,  while  the  third,  placed  be- 


5o8  OBSTETRIC  OPERATIONS. 

tween  them,  runs  through  its  narrower  surface.  The  two  ends  of  the 
head-stall  loop  go  through  the  parallel  holes,  the  cord  composing  this 
being  nine  or  ten  feet  long  and  one-third  of  an  inch  thick,  the  loop  itself 
being  intended  to  lie  behind  the  ears  of  the  foetus.  One  side  of  the  loop 
is  fixed  in  the  runner,  by  rings  of  waxed  pack-thread  above  and  below 
the  hole  ;  this  waxed  thread  being  also  run  up  on  the  loop,  to  give  it  a 
certain  degree  of  rigidity.  The  other  half  of  the  cord  is  freely  movable 
in  its  hole  in  the  runner,  and  a  knot  tied  near  its  end  allows  it  to  be  dis- 
tinguished from  the  fixed  half.  Tho-nose-bafid  (3,  3)  is  made  of  two  strong 
but  soft  strips  of  leather  sewn  one  within  the  other,  and  doubled  in 
the  middle  to  constitute  a  loop  eight  to  ten  inches  long  :  the  two  portions 
being  made  into  a  single  cord  (4)  between  three  and  four  feet  long,  and 


Fig.  155.  Fig.  156, 

Schaack's  Forceps-Halter.  Manner  of  Placing 

1,  I.  Head-stall ;  2,  2.  Two  Cords,  its  continuation ;  Schaack's  Halter. 

3,  3.  Nose-band ;  4.  Single  Cord  forming  a  con- 
tinuation of  the  Loop  constituting  the  Nose-band  ; 
5.  Metal  Runner,  uniting  the  several  parts  of  the 
Halter. 

which  passes  through  the  single  hole  across  the  runner.  The  middle 
part  of  the  nose-loop  has  a  kind  of  shield  or  button  of  thin  leather,  to 
prevent  the  loop  slipping  through  the  hole. 

This  was  the  apparatus  first  devised  by  Schaack,  but  recently  he  has 
somewhat  modified  and  simplified  it,  by  dispensing  with  the  nose-band 
altogether,  as  he  found  that  the  nose  of  the  foetus  could  be  better  guided 
and  held  by  the  hand.  Experience  has  proved  that  this  simplification 
allows  the  halter  to  be  more  easily  applied. 

The  manner  in  which  the  original  halter  was  employed  is  described  as 
follows  : — The  head  of  the  foetus  being  in  front  of  the  inlet  and  readily 
accessible  to  the  hand,  the  nose-loop  is  pulled  through  the  runner  until 
stopped  by  the  leather  button  ;  while  the  head  stall  loop  is  made  suffi- 
ciently wide.  The  middle  of  the  latter  is  placed  at  the  end  of  the  middle- 
fingers,  the  movable  part  of  the  cord  being  between   the  middle   and  in- 


MECHANICAL  EXTRACTION  OF  THE  FCETUS.  509 

dex-finger,  the  fixed  side  between  the  ring  and  little  finger  (Fig.  156). 
The  apparatus  is  at  first  held  by  the  index  and  middle-fingers  against  the 
other  fingers,  as  well  as  by  the  thumb,  which  keeps  both  cords  in  the 
palm  of  the  hand  ;  and,  finally,  by  the  left  hand,  which,  drawing  lightly 
on  the  three  cords,  keeps  them  sufficiently  tight.  The  runner  should  be 
at  the  wrist,  the  button  of  the  nose-loop  towards  the  hand. 

The  apparatus  being  so  disposed,  the  hand  is  introduced  sideways 
(little  finger  downwards)  into  the  vagina,  until  it  arrives  at  the  head  of  the 
fcetus  j  then  the  nose  of  the  latter  is  passed  into  the  head-stall  loop,  which 
is  pushed  forward  by  one  side  of  the  face — say  the  right — towards  the 
neck  and  over  the  ear  ;  the  other  half  being  now  carried  on  the  opposite 
side  towards  the  left  ear,  and  then  the  runner  is  seized  below  the  jaw. 
In  this  way  the  hand  has  passed  round  the  length  of  the  head-stall  from 
its  fixed  to  its  movable  part — the  latter  readily  allowing  the  loop  to  en- 
large and  pass  over  the  salient  portions  of  the  head,  the  loop  being  nev- 
ertheless kept  sufficiently  tense  by  the  right  hand  pushing  the   runner  up 


Fig.  157- 
Schaack's  Halter  Placed  on  a  Calf's  Head,  the  Right  Fore-pastern  being  also  Corded. 

towards  the  throat ;  while  the  left  hand,  pulling  at  the  movable  cord  (rec- 
ognized by  the  knot  at  its  end — tightens  it  as  much  as  may  be  necessary. 
The  nose-loop  is  placed  by  introducing  the  index-finger  of  the  right  hand 
under  the  button,  and  drawing  the  loop  through  the  runner  to  a  sufficient 
length,  the  left  hand  keeping  the  other  two  cords  tight ;  the  end  of  the 
nose  is  passed  into  the  loop,  which  is  lifted  as  high  as  need  be.  This 
done,  the  right  hand  is  withdrawn  from  the  uterus  and  vagina,  along, 
while  keeping  tight,  the  three  cords.  These  are  tied  together  in  a  knot 
outside  the  vulva,  and  the  head  is  thus  securely  and  solidly  fixed. 

Saint-Cyr  and  others  highly  recommend  this  apparatus  of  Schaack's, 
which  in  its  modified  form  differs  but  little  from  that  described  by  Binz 
some  years  previously.  Saint-Cyr  remarks  that  its  extreme  simplicity, 
its  trifling  cost,  the  facility  with  which  it  can  be  placed  after  a  little  prac- 
tice, its  solidity,  \vhich  enables  it  to  withstand  any  amount  of  traction, 
and  its  absolute  innocuousness — all  combine  to  render  it  one  of  the  best 
and  most  precious  instruments  required  in  veterinary  obstetricy.  In  the 
first  place,  when  it  is  properly  applied,  it  cannot  slip,  and  all  the  amount 
of  force  necessary  under  the  circumstances  may  be  employed  without 
fear;  next,  being  formed  of  small  and  flexible  cords,  which  are  well  oiled 
before   use,  it  cannot  injure   the  maternal   organs   in    any  way  ;  thirdly, 


1 


5IO  OBSTETRIC  OPERATIONS. 

from  the  manner  in  which  it  acts  on  the  neck,  the  lower  jaw,  and  the  face, 
and  the  impossibility  of  its  becoming  tighter  when  once  it  is  fixed,  it  is 
absolutely  inoffensive,  so  far  as  the  foetus  is  concerned  ;  and,  finally, 
owing  to  the  nose-loop,  it  always  keeps  the  head  in  a  good  direction,  pre- 
vents it  from  deviating,  and  compels  it  to  follow  the  course  most  favor- 
able for  its  extraction  :  in  the  words  of  Schaack  himself,  "  Without  exag- 
geration, the  forceps  of  the  accoucheurs  could  not  answer  better  for  the 
human  foetus."  As  an  agent  of  prehension  and  traction — but  particu- 
larly the  latter,  Saint-Cyr  asserts  that  he  does  not  know  of  any  thing 
superior  to  this  apparatus. 

Schaack's  halter  is  more  especially  applicable  to  the  bovine  foetus,  the 
head  of  which  is  so  much  larger  and  squarer  than  that  of  solipeds,  and 
sometimes  requires  such  energetic  pulling  at  to  remove  from  the  pelvis. 

Crotchets  or  Hooks. 

Obstetrical  crotchets  or  hooks  are  iron  or  steel  instruments  of  variable 
dimensions,  more  or  less  curved  at  one  end — which  is  blunt,  sharp,  or 


Fig.  158.  Fig.  159. 

Short  Blunt  Crotchet.  Blunt  Finger  Crotchet. 

pointed  ;  the  other  end  having  a  ring  or  eyelet  if  short,  a  handle  if  long. 
The  latter  are  from  thirty  to  thirty-six  inches  in  length  (including  the 
handle),  and  act  directly  on  the  foetus  without  any  other  appliance  inter- 
vening ;  while  the  short  hooks  have  cords  attached  to  them,  or  they  may 
fit  on  the  finger  of  the  operator  by  means  of  a  ring.  Some  sharp  crotchets 
are  jointed  at  the  end  curve,  so  as  to  permit  them  to  be  more  readily  and 
safely  introduced  into  the  genital  passage  by  bringing  the  sharp  point 
near  the  stalk,  the  curve  being  restored  by  a  spring  when  the  foetus  is 
reached.  But  the  advantages' of  the  joint  hooks  are  very  few,  while  their 
strength  is  impaired  and  their  expense  increased.  In  using  the  long  or 
short  pointed  crotchets,  risk  of  injury  to  the  maternal  organs  may  be 
obviated,  if  the  hand  is  not  found  sufficient  to  guard  the  instrument  dur- 
ing its  intromission,  by  fixing  the  point  in  a  piece  of  cork  or  soft  wood, 
to  which  a  long  piece  of  twine  is  attached  ;  when  the  crotchet  is  required 
to  be  implanted  in  the  foetus,  this  shield  may  be  removed  from  the  point, 
and  withdrawn  from  the  genital  organs  by  pulling  at  the  end  of  the  twine 
outside  the  vulva. 

Blunt  and  sharp  crotchets  are  much  employed  in  veterinary  obstetrics, 
and  are  very  valuable.  The  blunt  crotchets  are  more  particularly  resorted 
to  when  the  foetus  is  alive,  and  it  is  hoped  to  extract  it  before  it  is  dead  ; 
they  are  most  serviceable  in  correcting  deviations  of  the  head  or  limbs, 
and  the  long  crotchet  is  especially  useful  in  finding  and  straightening  the 
latter.  The  curve  should  be  about  four  inches  wide.  The  finger  crotchet 
may  be  usefully  employed  when  the  hand  is  fatigued  or  paralyzed  by  the 
uterine  contractions.  Blunt  crotchets  of  a  much  smaller  size  than  those 
required  for  the  larger  animals  can  be  most  successfully  employed  in 
delivering  the  Sow,  Sheep,  Goat,  Bitch,  or  Cat. 


MECHANICAL  EXTRACTION  OF  THE  FOETUS. 


5" 


Gunther's  long  porte-cord  (Fig.  149)  can  be  most  effectively  used  as  a 
blunt  crotchet  at  the  same  time  as  a  carrier  of  the  cord,  A  German  long 
blunt  crotchet  has  a  concealed  sharp  blade  in  the  concavity  of  the  curve  ; 
by  means  of  a  spring  in  the  handle,  this  blade  can  be  projected,  and  the 
instrument  wiil  then  do  good  work  in  embryotomy. 

With  the  sharp  crotchet,  the  curve  should  certainly  not  be  very  wide  ; 
the  smaller  it  is,  the  more  readily  it  can  be  passed  into  the  genital  pas- 
sage, and  the  less  chance  of  injurv  is  there  to  the  mother  or  operator  ;  it 
should  not  be  greater  than  the  hand  can  cover.  At  the  same  time,  if  the 
curve  is  too  small,  the  crotchet  does  not  obtain  sufficient  hold  of  the  foe- 
tus, is  readily  torn  out,  and  for  this  reason  may  be  most  dangerous.  The 
point  should  be  so  bent  as  to  penetrate  readily  into  the  part  in  which  it 
is  determined  to  fix  it,  and  the  angle  of  the  curvature  should  be  such  that 
the  more  the  crotchet  is  pulled  at,  the  deeper  and  more  firmly  the  point 
will  enter. 


Fig.  160.  Fig.  161. 

Short  Sharp  Crotchet,  Short  Sharp  Crotchet, 

WITH  Broad  or  Flanged  Point.  with  Round  Point. 

So  it  is  that  the  point  should  not  be  turned  round  in  a  semicircular 
manner,  but  rather  at  an  acute  angle,  as  in  Figs.  164,  165. 

There  is  rather  a  diversity  of  opinion  with  regard  to  the  preference  to 
be  accorded  to  the  crotchets  ;  some  practitioners  preferring  the  short 
ones,  as  they  can  be  readily  carried  into  the  uterus  guarded  by  the  hand 
and  moved  about  there,  so  as  to  be  implanted  in  the  most  convenient 
part  of  the  foetus  ;  while  the  cords  attached  to  them  allow  traction  to  be 
made  in  the  most  favorable  direction.  Other  obstetrists  prefer  the  long 
rigid  crotchet,  which  they  affirm  is  more  easily  placed — one  hand  guiding 
the  point  though  the  passage,  the  other  hand  acting  on  the  handle. 

These  preferences  depend  very  much  upon  whether  the  operator  is 
more  practised  in  the  use  of  one  or  other  of  the  crotchets,  and  also,  doubt- 
less, upon  circumstances  peculiar  to  each  case  requiring  the  employment 
of  such  instruments.  Both  long  and  short  crotchets  are  most  useful,  and 
the  obstetrist  should  have  several  of  each,  and  of  various  forms  and  dimen- 
sions, so  as  to  be  able  to  select  that  which  is  best  adapted  to  meet  the 
requirements  of  particular  cases. 

It  must  be  observed  also,  that  many  practitioners  are  not  in  favor  of 
crotchets,  and  decry  their  use.  But  we  are  of  opinion  that  there  is  some- 
thing unreasonable  in  this,  and  the  experience  of  almost  every  day  goes 
to  prove  that  these  instruments  afford  a  simple  and  ready  means  of  get- 
ting hold  of  the  foetus  in  regions  of  its  body  which  the  hand  cannot  pos- 
sibly reach,  or  if  it  could,  where  it  could  do  very  little  service  either  from 
the  shape  of  the  part,  its  slipperiness,  or  from  the  paralyzing  effect  of  the 
uterine  contractions  on  the  hand  and  arm  of  the  operator.  They  can 
also  be  profitably  employed  in  cases  in  which  cords  and  halters  are  use- 
less ;  for  not  only  will  they  serve  in  allowing  traction  to  be  made  on  parts 
which  actually  present  at  the  inlet,  but  they  can  also  be  utilized  in  effect 


512 


OBSTETRIC  OPERA  TIONS. 


ing  those  mutations  which  are  necessary  in  order  to  bring  particular  parts 
of  the  young  creature  in  front  of  the  pelvic  opening,  or  though  the  genital 
canal,  and  which  the  hand  could  not  seize  or  move. 

It  is  no  doubt  true  that  the  sharp  or  pointed  crotchets  have  certain  dis- 
advantages which  must  not  be  lost  sight  of,  and  which  impel  us  to  give 
the  preference  to  the  cords  or  halter  when  they  can  be  employed.  In  the 
first  place,  their  introduction  into  the  uterus  is  not  such  an  easy  matter 
as  it  might  appear  without  trial  or  consideration ;  for  the  contractions  of 


iP^ 


0 


Fig.  162. 

Fig.  163. 

Fig.  164.            Fig.  165 

Long  Blunt 

Long  Pointed 

Long  Pointed  Crotchets, 

Crotchet. 

Crotchet. 

Darreau's  Pattern. 

this  organ  may  paralyze  the  hand  which  carries  the  instrument,  and 
causes  the  latter  to  escape,  or  its  point  to  wound  either  the  mother  or  the 
operator.  Their  employment  often  produces  serious  lesions  in  the  body 
of  the  foetus,  which  are  certainly  of  no  importance  when  this  is  dead,  but 
may  be  of  much  consequence  should  it  be  alive.  Then,  again,  the  tissues 
into  which  they  are  implanted  are  not  very  firm  or  resisting,  so  that  only 
a  moderate  degree  of  traction  can  be  expected  from  them,  and  which  is 
often  insufficient  to  overcome  the  resistance  that  prevents  the  birth  of  the 
foetus.  In  such  a  case,  if,  through  forgetfulness  or  maladroitness,  the 
tissues  suddenly  give  way  and  the  crotchet  slips  into  the  maternal  organs. 


MECHANICAL  EXTRACTION  OF  THE  FCETUS.  513 

serious,  if  not  fatal  injuries  may  be  inflicted  ;  or  the  hand  or  arm  of  the 
operator  may  be  the  part  torn  by  it. 

These  are  undoubtedly  disadvantages  of  a  weighty  kind  ;  nevertheless, 
the  veterinary  obstetrist  has  always  to  contend  with  disadvantages  in 
cases  of  dystokia,  and  must  overcome  them  by  prudence,  patience,  and 
skill.  When  using  the  crotchets  the  same  qualities  must  be  brought  to 
bear.  His  hand  must  diligently  guide  them,  and  note  their  effects  and* 
movements  ;  while,  at  the  same  time,  he  must  vigilantly  exercise  his 
judgment  in  directing  his  assistants  as  to  the  amount  and  direction  of 
the  force  they  are  to  use,  so  as  to  proportion  it  according  to  the  resist- 
ance of  the  tissues  in  which  the  crotchet  is  fixed,  and  to  desist  from 
traction  as  soon  as  there  is  a  likelihood  of  the  instrument  breaking  away 
or  slipping.  With  the  evidence  before  us  as  to  the  numerous  and  in- 
contestable advantages  offered  by  these  appliances,  and  the  knowledge 
that  their  disadvantages  can  be  overcome  by  intelligent  watchfulness,  we 
have  every  reason  to  recommend  their  adoption  in  those  cases  which 
call  for  their  employment. 

'*  In  all  cases  where  the  head  of  the  foetus  is  back,"  Cartwright  writes 
to  us,  "  I  am  very  partial  to  using  the  long  sharp-pointed  hook  in  the 
orbit ;  even  if  the  head  is  at  the  extreme  distance,  with  care  we  can  insert 
it  in  the  otbit  and  get  the  head  in  the  passage.  Of  course,  it  requires 
great  care  in  watching  that  the  hook  does  not  break  loose  and  do  mis- 
chief. I  have  found  that  we  may  pull  by  the  hook  in  the  orbit  with 
great  force,  without  tearing  the  skin  of  the  calf,  provided  the  latter  is  not 
in  a  decomposed  state.  From  my  experience,  I  can  speak  highly  of  the 
hooks  ;  indeed,  you  cannot  get  the  head  up  without  them  sometimes." 
And  in  embryotomy  the  crotchets  may  be  most  usefully  resorted  to  for 
many  purposes. 

We  will  now  briefly  refer  to  the  parts  of  the  foetus  upon  which  the 
crotchets  can  be  most  effectively  employed,  and  the  manner  of  employ- 
ing them. 

Parts  into  which  the  Crotchets  may  be  Implanted  — The  parts 
into  which  the  crotchets  may  be  implanted  are  numerous,  but  those 
which  are  selected  by  the  obstetrist  will  not  only  depend  upon  the  na- 
ture of  the  malpresentation  or  malposition,  but  also  upon  the  simplest 
indications  for  the  adjustment  of  these.  When  the  desirable  part  has 
been  reached,  the  point  of  the  crotchet  is  inserted  in  such  a  way  that  the 
instrument  is  directed  towards  the  source  of  traction — the  assistant. 
When  blunt  crotchets  are  employed,  except  in  cavities,  it  will  be  neces- 
sary to  make  an  incision  through  the  skin  before  they  can  be  inserted. 
Cartwright  states  that  sometimes  the  sharp  crotchets  cannot  be  used 
without  making  these  preliminary  incisions  ;  but  then  the  instruments 
must  be  rather  blunt.  The  best  parts  for  implantation  are  (i)  the  mus- 
cular tissues,  (2)  the  head,  (3)  the  spine,  and  (4)  ihe  pelvis. 

I.  The  Muscular  Tissues. — These  tissues  are  not  advantageous  for  the 
employment  of  the  crotchets,  for  although  they  are  easily  inserted,  they 
are  as  easily  torn  out.  Nevertheless,  these  instruments,  when  fixed  in 
certain  muscular  regions,  such  as  the  croup,  thighs,  loins,  and  neck — 
more  especially  the  latter,  may  render  useful  service  in  rectifying  devia- 
tions, as  the  skin  offers  a  good  amount  of  resistance.  But,  from  the 
fragile  and  yielding  nature  of  the  textures,  it  must  be  borne  in  mind  that 
the  hand  of  the  obstetrist  should  never  leave  the  crotchet  while  traction 

2>Z 


514  OBSTETRIC  OPERATIONS. 

is  made  on  it,  and  that  its  position  in  them  must  be  most  attentively 
noted,  in  order  to  guard  against  accidents  arising  from  its  tearing  away. 
2.  The  Head. — The  head  offers  many  good  points  for  implanting  the 
crotchets — such  as  the  symphysis  of  the  lower  jaw,  the  palate,  and  the 
orbit,  as  well  as  the  ear  and  angle  of  the  inferior  maxilla,  on  particular 
occasions. 

•  It  must  be  observed,  however,  that  all  these  points  are  not  of  equal 
value.  The  maxillary  symphysis  is  convenient,  but  not  very  firm  ;  mod- 
erately strong  traction  will  rupture  it,  and  damage  may  then  occur.  Still, 
there  are  times  and  occasions  when  this  part  may  be  advantageously 
seized  by  the  crotchet,  which  may  be  inserted  in  two  ways  :  the  point  of 
the  instrument  may  be  passed  from  below  the  chin  into  the  mouth,  or 
from  the  cavity  of  the  latter  through  the  mucous  membrane  beneath  the 
tongue,  to  below  the  chin.  The  first  is  generally  preferable.  When 
traction  begins,  the  operator  must  be  on  the  lookout  for  tearing  away  of 
the  two  branches  of  the  jaw. 

The  orbital  cavity  is  the  best  part  of  all  the  head  for  a  solid  hold. 
Some  authorities  have  expressed  doubts  as  to  the  propriety  of  fixing  a 
crotchet  in  the  ocular  cavity  of  a  living  foetus,  from  a  belief  that  the  eye- 
ball must  be  damaged,  and  Rainard  goes  so  far  as  to  advise  that  it  should 
only  be  done  when  the  creature  is  dead  ;  though  he  adds  that,  if  there  is 
no  other  means  of  remedying  a  deviation  of  the  head  in  the  living  calf, 
it  is  well  to  attempt  it,  "  as  it  is  better  to  have  a  living,  if  blind  calf,  than 
a  dead  one  with  both  its  eyes  intact." 

But  it  is  rare  indeed  that  the  eyes  are  seriously  damaged  by  fixing  the 
crotchet  in  their  socket  ;  and  innumerable  instances  testify  that,  if  the 
foetus  is  alive,  the  ocular  globe  is  retracted  to  the  bottom  of  the  cavity 
when  the  instrument  begins  to  be  inserted,  and  so  escapes  injury. 
Schaack,  who  has  freely  resorted  to  this  mode  of  adjusting  the  head  or 
neck — in  the  sheep  and  goat  more  particularly  (the  smallness  of  the  pel- 
vis not  allowing  any  other  means  to  be  employed) — describes 
Ibis  manner  of  operating  as  follows  :  "  The  crotchet  I  use," 
says  he,  "  is  a  solid  (or  long)  one  ;  the  point  is  blunt  and 
slightly  flattened  (Fig.  i66).  When  it  is  desired  to  pull  at 
the  head  of  the  foetal  goat  or  lamb,  the  left  hand  at  first 
seizes  the  nose,  and  the  crotchet  is  fixed  in  the  right  orbit ; 
with  the  right  hand  the  other  instrument  is  passed  into  the 
left  orbit,  the  thumb  of  the  left  hand  keeping  the  hook  in  the 
other  orbit  by  pressing  the  stalk  against  the  cheek.  In  this 
way  I  can  pull  wi^h  the  two  hands  on  both  orbits,  so  as  to 
keep  the  nose  in  a  good  direction."  He  has  never  seen  the 
point  of  the  crotchet  cause  the  slightest  injury  to  the  globe  of 
the  eye,  although  he  has  had,  in  the  majority  of  cases,  to  pull 

ivery  hard.  The  means  has  answered  very  well.  And  Cart- 
wright  informs  us  that  "  it  is  astonishing  how  wounds  heal 
up  in  the  cheek  where  hooks  have  been  in  the  orbit.  I  have 
had  two  or  three  men  pulling  at  the  rod  (of  the  crotchet),  and 
the  hook  did  not  break  out." 

This  immunity  from  injury,  in  the  case  of  the  living  foetus. 

Fig.  166.      does  not,  however,  absolve  the  operator  from   exercising  all 

Schaack's    due  care  in  fixing   and  pulling  at    the   crotchet.     The   inner 

Crotchet,    ^gp^^^j-  q£  ^j^g  orbital  cavitv  is   thc  most  favorable,  and  if  the 

foetus  is  alive,  the  blunt  instrument  must  be  first  tried,  the  sharp-pointed 


MECHANICAL  EXTRACTION  OF  THE  FCETUS.  515 

one  being  kept  in  reserve  until  this  has  failed,  or  it  may  be  used  at  first 
when  the  young  creature  is  dead. 

The.  pa/atifte  arch  affords  a  very  solid  and  useful  point  of  attachment 
for  the  crotchet,  and  many  obstetrists  have  successfully  utilized  it  in  ex- 
tracting the  foetus  ;  some  authorities — among  them  is  Schaack — assert- 
ing that  hooking  this  part  is  easier,  and  the  results  more  certain  and 
direct,  than  fixing  the  instrument  in  the  orbit.  The  stalk  of  the  crotchet 
is  somewhat  long ;  the  hook  end  is  passed  sideways  into  the  mouth  of 
the  foetus,  and  over  the  tongue  until  it  gets  be3^ond  the  palate,  when  it 
is  turned  point  upwards,  and  seizes  the  base  of  the  vomer.  According 
to  Schaack  and  others,  a  very  strong  degree  of  traction  can  be  made  on 
this  part  without  inconvenience  to  the  young  creature.  It  appears  to  be 
an  excellent  situation  to  plant  the  crotchet  in  the  calf — particularly  if  it 
is  de^d,  and  it  is  desired  to  effect  extraction  as  quickly  as  possible.  It 
may  be  also  employed  in  the  foal,  the  only  risk  being  more  or  less  dis- 
union of  the  palate,  which  may  render  sucking  difficult  or  imperfect  for  a 
short  time  after  birth. 

Of  course,  the  head  must  be  in  a  good  position  either  in  the  inlet  or 
in  the  genital  canal,  before  the  crotchet  can  be  placed  behind  the  palate. 
The  traction  must  also  be  moderate  and  steady,  and  the  usual  precau- 
tions observed. 

3.  T/ie  SpiJie. — When  embryotomy  is  practised,  or  the  foetus  is  dead, 
the  vertebrae,  their  transverse  processes,  or  the  ribs,  afford  excellent  hold 
for  hooks,  though  care  must  be  observed  in  placing  them  securely,  and 
guarding  them  when  they  are  being  pulled  at. 

4.  The  Pelvis. — In  posterior  presentations,  when  cords  cannot  be  em- 
ployed to  the  hind  limbs,  the  loins,  or  the  croup,  or  when  they  have  not 
sufficient  power,  then  crotchets  must  be  resorted  to  \  and  with  this  view 
the  foetal  pelvis  offers  several  very  advantageous  points.  After  removal 
of  one  or  both  hind-limbs,  the  cotyloid  cavities,  by  their  depth  and  the  hard- 
ness of  their  walls,  are  admirably  adapted  for  receiving  the  hooks  and 
withstanding  energetic  pulling.  If  both  limbs  are  amputated  from  the 
hip  joints,  then  a  hook  may  be  placed  in  each  cavity  ;  if  ablation  of  only 
one  limb  has  been  effected,  then  one  hook  will  be  most  useful, 

The  pubic  arch  and  the  oval  foramina  of  the  pelvis  are  likewise  well 
suited  for  crotchet  traction  in  the  posterior  presentation,  when  the  foetus 
is  dead.  In  some  cases  the  sharp-pointed  crotchet  may  be  passed 
directly  through  the  rectum,  and  pushed  forward  so  as  to  seize  the  ante- 
rior border  of  the  pubis,  the  margin  of  one  of  the  oval  foramina,  the  base  of 
the  sacrum,  or  the  shaft  of  the  ilium  ;  care  being  taken  that  the  point  does 
not  pass  through  the  skin.  Or  the  crotchet  may  be  passed  from  without 
inwards — the  safest  method — after  the  pelvic  bones  have  been  denuded 
as  much  as  possible  of  their  soft  tissues.  This  is,  perhaps,  the  most  prac- 
ticable method,  if  the  hind-limbs  have  been  already  removed.  But  if  they 
have  not,  then  Saint-Cyr  recommends  that  all  the  soft  tissues  of  the  foetus 
from  the  root  of  the  tail  to  the  ischial  arch,  should  be  largely  incised,  and 
the  hand  passed  through  the  incision  into  the  pelvds,  which  is  emptied  of 
its  viscera.  The  crotchet  is  then  pushed  into  it,  and  planted  either  on 
the  brim  of  the  pubis,  or  in  the  oval  foramen. 

It  is  always  safer  to  pass  the  hook  from  without  inwards,  whenever  this 
is  possible,  as  the  point  is  then  in  the  pelvic  cavity  of  the  foetus. 

Forceps. 

The  introduction  of  forceps  into  human  obstetricy  marked  a  new  era  in 


5 1 6 .  OBSTE  TRIG  OPERA  TIONS. 

the  accoucheur  s  art,  and  has  been  productive  of  the  greatest  benefits  in 
difficult  cases  of  parturition  in  woman.  But  they  have  not  yielded  much 
service  to  the  veterinary  obstetrist,  except  with  the  smaller  animals  ,  not- 
withstanding that  Hurtrel  d'Arboval,  at  the  commencement  of  this  century, 
asserted  of  the  forceps  that  there  are  circumstances  in  which  great  advan- 
tages might  be  derived  from  them,  that  their  use  is  perhaps  the  best 
means  of  completing  parturition  when  it  cannot  be  terminated  naturally, 
etc.  Attempts  have  been  made  at  various  times  to  introduce  them  into 
general  use  for  the  larger  domesticated  animals,  and  various  models — 
more  or  less  modifications  of  the  human  patterns — have  been  proposed, 
but  with  very  little,  if  any,  success. 

The  forceps  used  by  the  accoucheur  of  woman  are,  as  is  well  known, 
composed  of  two  branches  or  blades,  which  are  nearly  or  quite  alike,  and 
form  levers  of  the  first  order  ;  they  are  united  at  the  middle  by  a  fixed  or 
sliding  joint,  and  one  end — the  "bow,"  or  widest  part — which  is  intehded 
to  grasp  the  foetus,  is  fenestrated,  or  perforated  by  a  wide  opening  ;  at  the 
other  end  is  the  handle. 

The  reason  why  the  forceps  has  never  come  into  general  use  in  vet- 
erinary obstetric  operations — except  with  the  smaller  animals,  as  already 
said — is  not  so  much  from  a  prejudice  against  novelties  and  innovations, 
as  because  they  are  really  not  adapted  for  this  kind  of  practice,  unless  in 
a  very  modified  form,  to  be  presently  noticed.  Rainard  ( Op.  cit.,  vol  ii., 
p.  98)  remarks :  "  Medical  men  will  be  astonished  that  I  have  not  men- 
tioned the  forceps,  from  which  they  derive  such  great  advantages.  This 
instrument,  which  can  seize  a  round  head,  like  that  of  a  child — when  each 
blade  fits  exactly  throughout  its  whole  length — will  have  much  less  hold 
on  that  of  animals,  which  is  elongated,  flattened  at  the  sides,  and  otherwise 
but  little  yielding.  When  the  forceps  is  applied  to  the  foal  or  calf,  it 
slips  and  is  useless.  Otherwise,  the  readiness  with  which  cords  can  be 
attached  to  the  head  and  limbs,  renders  these  in  every  way  preferable  to 
this  instrument.  What  the  forceps  cannot  do,  the  cords  can  ;  and  they 
have  the  additional  advantage  that  they  scarcely  occupy  any  space  in  the 
pelvic  canal.  Tlie  pelvis  of  our  animals  is  nearly  rectilinear ;  with  the 
cords  we  pull  in  a  straight  line  ;  what  more  could  the  forceps  do }     The 


Fig.  167. 
Simple  short  Crotchet-Forceps. 

entire  hand  can  be  introduced  freely  into  the  pelvis,  and  moved  about 
easily.  This  cannot  be  done  in  human  accouchements."  And  Saint-Cyr 
justly  asserts  that  there  is  no  known  forceps  capable  of  affording  such  a 
solid  purchase,  and  at  the  same  time  one  so  harmless,  as  a  good  cord 
fixed  on  the  pastern,  or  Schaack's  head-stall  properly  placed  on  the  head. 
Though  an  instrument  resembling  the  human  forceps  is  not  at  all 
adapted  for  extracting  the  foetus  in  such  animals  as  the  Mare  or  Cow  ; 
and  though  in  the  cords  and  head-stall  an  excellent  substitute  is  found  ; 
yet  modified  forceps,  which  might  be  designated — if  not  from  their  shape, 


MECHANICAL  EXTRACTION  OF  THE  FCETUS. 


517 


at  least  from  their  3.c\.\on~^crott/iet-forceps^  have  been  long  employed  by 
veterinary  obstetrists,  and  with  much  advantage  in  certain  cases.  The 
simplest  of  these  consists  merely  of  two  short  crotchets,  the  points  oppo- 
site each  other,  and  a  cord  passing  through  both  eyelets  (Fig.  167).  The 
hooks  can  be  inserted  near,  but  opposite  to,  each  other,  on  each  side  of 
the  spine,  pelvis,  head,  flanks,  etc.,  the  cord,  when  tightened,  bringing 
them  closer  together,  and  so  concentrating  the  traction.     A  longer  crot- 


Fig.  t68. 
LoMG  Simple  Crotchet-Forceps. 


chet-forceps,  with  a  wider  curve  at  the  points,  is  not  unfrequently  used 
with  success  in  breech  presentations  with  the  hind  limbs  retained  ;  the 
points  are  inserted  towards  each  flank,  penetrating  as  far  as  the  shaft  of 
the  ilium. 


Fig.  i6g. 
Gunther's  Long  Crotchet-Forceps. 


Fig,  170. 
Jointed  Crotchst-Forceps. 


Gunther  has  spoken  highly  in  favor  of  a  long  blunt  crotchet-forceps  to 
answer  the  same  purpose,  but  which  has  what  is  considered  an  advantage 
— a  series  of  notches  on  each  side  towards  'the  traction-rope,  on  which 
runs  a  clip  that  binds  them  together,  and  prevents  their  flying  outwards 
while  the  assistants  are  pulling  (Fig.  169). 

The  two  crotchets  A  B,  C  D,  are  brought  together  at  A  C  by  the  cord 
C,  which  passes  through  their  eyelets  ;  d  is  the  clip  on  the  ratchet,  e  e ;  //, 
the  curve  of  the  crotchets  ;  and  gg,  their  blunt  points. 

To    render  their   hold  more  secure,  these   crotchet-forceps   are  some- 


5i8 


OBSTETRIC  OPERATIONS. 


times  jointed  ;  and  in  this  form  they  are  preferred  by  some  practitioners. 
Fig.  170  represents  a  very  useful  model,  the  points  being  sharp,  and  one 
point  lying  in  a  slight  notch  on  the  opposite  one,  to  render  their  introduc- 
tion into  the  uterus  more  safe,  and  also  to  prevent  accidents,  should  the 
tissues  in  which  the  points  are  implanted  give  way.  A  cord  passes 
through  eyelets  at  the  extremities  of  the  blades,  as  in  the  other  models  ; 
but  sometimes  the  eyelets  are  in  opposite  directions,  and  the  ends  of  the 
branches  in  which  they  are  pierced  are  bent  towards  each  other  ;  this 
variation  is  supposed  to  be  accompanied  by  certain  advantages,  as  in 
Nelson's  blunt  and  serrated  forceps  (Figs.  171,  172),  some  of  the  uses  of 
which  have  already  been  noticed. 


Fig.  171. 
Nelson's  Blunt  Crotchet-Forceps. 


Fig.  172. 
Nelson's  Serrated  Crotchet-Forceps. 


Some  of  the  models  of  crotchet-forceps  have  a  spring  introduced  be- 
tween the  branches,  and  behind  the  joint,  as  in  Tallich's  short  instrument 
(Fig.  173),  the  jaws  of  which  are  bent  to  one  side,  and  toothed  ;  it  is  intend- 
ed to  secure  a  hold  of  the  foetus,  and  make  traction  on  parts  to  which 
neither  cords  nor  crotchet  can  be  applied  :  as  the  skin  of  the  cheek,  or 
the  nose  or  ear,  when  the  head  is  thrown  back  towards  the  flank,  in  the 
anterior  presentation. 

Another  instrument  of  this  description  has  been  devised  bv  a  Belgian 


Fig.  173. 
Tallich's  Short  Bent  Crotchet-Forceps. 

veterinary  surgeon,  Andre',  which  he  designated  as  2.  pi?ice-forceps  or  accro- 
che-foetus.  This  is  not  unlike  the  instrument  fixed  in  the  nose  of  a  bull  in 
order  to  lead  the  animal.  The  points  of  the  jaws  are  bevelled  to  fit  into 
each  other,  the  bevel  being  grooved.  In  one  of  the  jaws  is  a  small 
hole,  into  which  is  fixed  a  string  that  passes  through  the  eyelet  at  the 
end  of  the  opposite  branch,  and  which  is  pulled  at  when  it  is  desired  to 
open  the  jaws.  The  two  branches  behind  the  joint  are  very  short,  and 
through  the  eyelet  of  each  passes  a  strong  cord,  the  two  ends  of  which 
soon  unite  into  a  single  piece  (Fig.  174).  When  this  is  pulled  at  the  jaws 
close,  as  in  the  other  jointed  examples,  and  they  remain  all  the  more 
firmly  closed  as  the  traction  is  great.  In  order  to  use  the  instrument,  it 
is  passed  by  the  hand  into  the  uterus  ;  the  jaws  are  fixed  on  the  part  to 
be  drawn  at,  by  first  pulling,  outside  the  vulva,  at  the  string  which  opens 
them,  pushing  the  points  against  or  over  the  part,  then,  when  this  is  be- 
tween the  points,  drawing  at  the  single  cord  which  closes  them.     This  is 


MECHANICAL  EXTRACTION  OF  THE  FCETUS.  519 

acknowledged  to  be  rather  an  instrument  for  holding  or  fixing  a  certain 
region,  and  not  for  exercising  tractile  force  upon.  Andre  has  often 
applied  it  successfully  to  the  lower  and  upper  jaw,  or  the  ear,  to  bring  the 
head  into  a  good  position ;  to  the  te7ido-Achilles  in  order  to  raise  a  hind 
limb,  which  the  hand  alone  could  not  do  ;  to  the  fore-limbs,  etc. 

With  regard  to  the  smaller  animals,  such  as  the  Bitch,  Sow,  Sheep,  or 
Goat,  in  them  we  may  often  use  the  crotchet,  the  ordinary  forceps,  or  a 
small-sized  model  of  the  human  forceps,  with  advantage.  Various  pat- 
terns are  in  use,  some  of  them  fenestrated,  others  not ;  some  resemble 
polypus-forceps,  while  others  again  are  grooved,  serrated,  or  toothed,  at 
the  ends  of  the  blades.  An  essential  which  should  not  be  lost  sight  of  in 
the  forceps  for  such  small  animals  as  the  Bitch  or  Cat,  is  that  the  blades 
should  be  sufficiently  long  to  seize  not  only  the  head,  but  much,  if  not  all 
of  the  body  of  the  fcetus.  If  they  are  short  in  the  blades,  they  cannot 
be  made  to  grasp  sufficient  of  the  foetus  to  remove  it  ;  while  the  joint 
being  close  to  the  vulva,  or  even  within  the  vagina,  is  likely  to  pinch  the 
mucous  membrane  and  cause  them  other  considerable  pain. 

Hill,  of  Wolverhampton,  who  has  had  extensive  experience  in  this 
direction,  uses  a  small  and  slightly  modified  form  of  the  human  forceps 
for  Bitches  ;  there  is  a  spring  between  the  branches  of  the  handle  (Fig. 
175)- 


Fig.  174. 
Andre's  Crotchet-Forceps. 

Weber  has  proposed  a  forceps  for  these  small  animals,  and  it  has  been 
preferred  by  some  authorities  to  the  ordinary  model.  It  is  a  modification 
of  one  for  a  long  time  employed  by  Leblanc,  which  again  was  fashioned 
after  an  instrument  designed  by  Hunter.  This  is  composed  of  an  iron 
stalk  about  ten  inches  in  length,  with  a  wooden  handle  at  one  end,  and 
two  blades  or  bows  at  the  other.  On  this  stalk  glides  a  long  enveloping 
metal  tube,  which,  near  the  handle,  has  a  wide  ferule  or  shield,  that  allows 
it  to  be  pushed  along  by  the  thumb  of  the  hand  holding  the  instrument, 
and  thus  to  bring  the  blades  together.  A  nut  or  female  screw,  running 
on  a  screwed  portion  of  the  stalk  near  the  handle,  is  intended  to  assist 
the  pressure  of  the  thumb,  when  this  is  insufficient  (Fig.  176).  A  finger 
of  the  other  hand  introduced  into  the  vagina  guides  the  instrument,  and 
allows  the  part  of  the  fcetus  to  be  seized,  to  be  reached  by  the  operator, 
either  v/ith  the  view  of  extracting  the  young  creature  or  changing  its 
position,  according  to  the  indications. 

Defays  concludes  that  the  forceps  employed  by  veterinary  surgeons  in 
the  accouchement  of  the  smaller  animals  should  not  be  merely  a  reduc- 
tion in  size  of  those  employed  in  human  practice,  but  ought  to  be  some- 
thing like  that  of  Palfin.  It  is  most  difficult,  he  truly  says,  to  apply  an 
instrument  in  shape  like  that  of  the  accoucheur's  ordinary  forceps,  owing 
to  the  neck  of  the  ftus  in  carnivoraoe  being  so  thick,  and  the  difference  in 


520 


OBSTETRIC  OPERA  TIONS. 


volume  between  it  and  the  head  far  less  than  in  the  human  foetus.     So 
that,  when  the  forceps  is  used,  the  bow  of  the  blades  presses  on  the 


BiTCH  Forceps. 


Fig.  176. 
Weber's  Forceps. 


Fig.  177- 
Defays'  Forceps. 


neck,  slips  under  the  throat,  and  the  head  escapes  from  them.     To  rem- 


MECHANICAL  EXTRACTION  OF  THE  FCETUS. 


521 


edy  this  imperfection,  he  has  made  forceps  with  the  extremity  of  the  blades 
notched  or  hollowed  out  (Fig.  177),  while  the  end  of  one  of  the  branches 
has  a  piece  of  metal  with  a  slot  in  it  attached  by  a  hinge,  and  which  is 
intended  to  hold  the  blades  together  when  the  foetus  is  seized. 

Though  this  forceps  has  sometimes  proved  of  service,  yet 
cases  occur  in  which  it  is  not  so  useful. 

When  the  Bitch  is  large,  or  of  moderate  size,  forceps  may 
be  employed  with  advantage,  though  they  must  be  of  various 
dimensions.  But  when  the  animal  is  very  small,  as  is  usually 
the  case  in  difficult  parturition  in  this  species,  the  space  oc- 
cupied by  the  bows  of  the  forceps — if  they  are  ever  so  thin 
— so  increases  the  volume  of  the  mass  which  has  to  pass 
through  the  pelvic  canal,  that  this  instrument  cannot  be  used. 

As  we  pointed  out  when  studying  the  anatomy  of  this 
region,  the  pelvis  is  cylindrical  in  carnivora,  and  if  we  sup- 
pose its  diameter  to  be  three  inches,  and  that  of  the  head  of 
the  foetus  a  trifle  less,  it  will  be  seen  that  birth  must  neces- 
sarily be  difficult ;  and  this  difficulty  will  be  increased  if  the 
vagina  is  narrow  and  rigid.  When  the  forceps  is  used,  the 
difficulty  is  further  exaggerated  ;  for  when  the  blades  are 
passed  on  the  head,  the  foetus  is  then  augmented  in  size  by 
a  quantity  equal  to  their  breadth  multiplied  by  their  thick- 
ifess — the  whole  constituting  a  mass  greater  than  the  pelvic 
cavity  will  permit  tp  pass  through  it ;  so  that  delivery  be- 
comes impossible.  Forceps,  therefore,  in  small  bitches,  in- 
creases the  difficulties  of  parturition,  and  these  difficulties 
are  all  the  more  embarrassing  as  the  animal  is  diminutive. 
Recourse  to  this  instrument  is  consequently  contra-indicated, 
and  if  delivery  is  to  be  effected,  a  means  must  be  substituted 
which  presents  less  inconvenience.  As  a  rule,  the  loss  of 
one  or  two  puppies  is  not  a  matter  of  much  moment,  the 
principal  object  being  to  save  the  mother  by  bringing  the 
act  of  parturition  to  a  prompt  termination.  Tiie  desideratum 
is  to  apply  an  apparatus  which  will  exert  its  force  behind  the 
head  of  the  foetus,  as  if  the  sum  of  the  expulsive  efforts  was 
directed  from  behind ;  or  as  if  a  new  force  had  been  devel- 
oped in  the  uterine  cavity,  which  presses  directly  on  the 
summit  of  the  head. 

After  much  consideration,  Defays  finally  produced  an  ap- 
paratus which  fulfils  these  indications,  and,  besides  its  inge- 
nuity, is  very  simple  and  easily  applied.  It  consists  merely 
of  two  rather  fine  brass,  or  very  pliable  iron  wires,  which 
can  be  easily  twisted,  and  are  yet  strong  enough  to  with- 
stand a  moderate  amount  of  strain.  The  wires  should  be 
at  least  sixteen  inches  in  length,  and  looped  in  the  middle, 
so  as  to  be  applied  to  the  foetus  in  t'lie  following  manner  : 
The  first  finger  of  the  left  hand  being  passed  into  the  vagi- 
na, serves  to  guide  one  of  the  loops  towards  the  summit  of 
and  behind  the  foetal  head  ;  and  it  then  conducts  the  loop  of 
the  other  wire  beneath  the  head  behind  the  jaw.  This  done, 
the  two  wires  on  each  side  are  twisted  by  a  little  machine 
(Fig.  178)  composed  of  a  thin  iron  rod  in  a  handle,  the  other  end  of 
which  is  thickened  and  pierced  by  holes  running  nearly  parallel  to  the 


Defays'  Wire- 
Extractor 

WITH  THE  Tor- 
sion Rods. 


522 


OBSTETRIC  OPERATIONS. 


stalk.  Into  these  holes  the  two  wires  of  one  side  are  passed  ;  the  machine 
on  each  side  is  pulled  up  as  close  as  possible  to  the  head  of  the  foetus, 
and  then  each  being  turned  round  three  or  four  times,  the  neck  is  en- 
closed in  a  kind  of  noose  or  collar  formed  by  the  two  wires  (Fig.  179). 

The  rods  are  now  withdrawn  from  the  latter,  and  the  foetus  can  be  ex- 
tracted by  exercising  traction  on  the  ends  of  the  four  wires  outside  the 
vulva.  By  this  contrivance,  delivery  is  effected  without  injury  to  the 
Bitch,  and,  unless  it  is  much  decomposed,  without  separating  the  head  of 
the  foetus. 

We  have  tried  Defays'  apparatus,  and  can  speak  highly  of  it ;  not  un- 
frequently  we  have  succeeded  in  extracting  the  puppy  alive,  and  when  the 
use  of  forceps  would  have  been  impossible.     - 


Fig.  179. 
Defays'  Wire-Extractor  Applied.  ^ 

A  much  simpler,  readier,  and  perhaps  more  successful  apparatus  (so 
far  as  our  experience  enables  us  to  speak),  is  that  devised  by  Breulet,  of 
Marche,  Belgium,  which  meets  every  requirement  in  the  accouchement  of 
small  Bitches,  and  might  be  successfully  employed  with  Sows,  Ewes,  and 
Goats.  This  apparatus  is  the  same  in  principle  as  Defays'  wire-extractor, 
but  there  is  only  one  wire.  The  principal  part  of  the  invention  is  a 
noose-tube,  consisting  of  a  tubular  piece  of  round  wood,  from  four  to  six 
inches  long,  and  half  an  inch  thick.     The  wire  may  either  be  of  copper, 


Fig.  I  So. 
Breulet's  Tube  and  Noose. 

brass,  or  iron,  about  sixteen  int:hes  long  (we  have  generally  used  a  piece 
of  catgut,  and  prefer  it) ;  this  is  doubled,  passed  through  the  tube  to  a  cer- 
tain extent,  so  as  to  form  a  loop  or  noose  at  the  end  (Fig.  180).  When  it 
is  to  be  used,  the  first  finger  of  the  left  hand  carries  the  loop  into  the  va- 
gina of  the  Bitch,  and  slips  it  behind  the  occiput  of  the  puppy  ;  then  the 
two  ends  of  the  wire  are  passed  through  the  tube,  and  this  is  pushed  into 
the  vagina  under  the  chin  of  the  foetus  ;  the  operator  now  tightens  and 
secures  the  wire,  by  giving  it  a  turn  round  the  first  finger  of  his  right 
hand,  placing  his  thumb  at  the  end  of  the  tube  (Fig.  181).  A  little  trac- 
tion then  extracts  the  foetus,  and  without  doing  it  or  the  Bitch  the  least 
damage.  We  now  employ  no  other  instrument  in  canine  obstetricy,  and 
our  success  has  always  been  complete,  even  with  the  tiniest  toy  terriers. 
When  our  assistance  has  been  sought  for  in  time,  we  have  generally 
managed,  expeditiously  and  easily,  to  extract  the  puppies  alive. 


MECHANICAL  EXTRACTION  OF  THE  FCETUS. 


523 


It  will  be  seen  that'the  noose  is  not  unlike  the  "  fillet  "  used  in  human 
obstetrics. 

The  Employment  of  Force  in  Dystokia. 

In  connection  with  the  foregoing  obstetric  operations,  a  rather  impor- 
tant question  to  be  considered  is  the  employment  oi  force  in  the  artificial 
extraction  of  the  foetus.  For,  as  we  have  seen,  more  or  less  energetic 
traction  is  very  frequently  needed  to  remove  the  fcetus  from  its  parent, 
and  those  who  do  not  understand,  or  are  inexperienced  in  animal  obstet- 
rics, are  sometimes  astonished,  if  not  horrified,  at  hearing  of  the  amount 
of  pulling  which  the  foetus  has  to  undergo,  and  the  parent  to  sustain, 
before  delivery  can  be  effected  in  some  cases.  Yet  force  is,  as  a  rule, 
absolutely  necessary ;  and,  though  some  of  the  various  points  with 
regard  to  it  are  not  yet  sufficently  ascertained,  and  differences  of  opinion 
exist  with  regard  to  them,  yet  it  is  a  subject  well  deserving  the   attention 


Fig.  181. 
Breulet's  Noose  fixed  on  the  Fcetus. 

of  the  obstetrist,  and  especially  the  junior  practitioner.  Saint-Cyr  has, 
with  his  usual  ability,  discussed  it  carefully ;  and  we  will  therefore,  to  a 
certain  extent,  follow  him  in  noticing  it. 

The  direction,  intensity,  and  nature  or  means  of  developing  the  force  to  be 
employed,  have  first  to  be  considered,  after  which  it  will  be  desirible  to 
compare  manual  with  mechanical  force,  and  point  out  their  respective 
advantages  and  disadvantages  from  an  obstetrical  point  of  view. 

Direction  of  Traction. 

Since  the  forceps  was  introduced  into  human  obstetric  practice,  the 
direction  which  the  foetus  should  be  made  to  follow  in  the  pelvic  cavity 
of  woman  has  been  continually  discussed,  and  has  been  acknowledged  to 
be  a  very  difficult,  as  well  as  a  very  important  problem  to  solve.  This 
difficulty  is  mainly  due  to  the  fact  that -the  pelvic  canal  in  the  human 
female  is  not  uniform  in  its  dimensions,  and  that  the  head  of  the  foetus 
must  pass  through  it  by  always  offering  its  greatest  diameter  to  that  of 
the  cavity.  Consequently,  it  must  execute  during  its  passage  a  rotatiofi 
movement  in  one  or  other  direction,  according  to  the  presentation — a 
movement  necessitated  by  the  different  planes  of  the  cavity.  In  addi- 
tion, the  canal  is  curvilinear,  its  axis  not  being  represented  by  a  straight, 
but  by  a  curved  line,  whose  form  and  direction  are,  besides,  modified  by 
those  deformities  of  the  pelvis  wdiich  are  so  frequent  and  varied  in  woman, 
and  which  constitute  one  of  the  principal  indications  for  the  use  of  the 
forceps.  Therefore  it  is,  that  all  the  difficulty  in  the  question  is  to  de- 
termine, in  a  rigorous  manner,  the  direction  in  which  to  exercise  traction 
with  this  instrument ;  though  it  is  generally  agreed  that  it  should  be 
made  according  to  the  pelvic  axis. 


524  OBSTETRIC  OPERATIONS. 

With  animals,  the  problem  is,  of  course,  much  less  complicated,  as 
their  pelvis  is  somewhat  cylindrical  ;  and  its  axis — almost  rectilinear — 
can  readily  be  determined  by  a  line  passing  from  the  centre  of  the  an- 
terior circumference  to  the  centre  of  the  vulva,  or  somewhat  towards  the 
middle  of  the  line  uniting  the  two  superior  ischiatic  tuberosities.  Saint- 
Cyr  justly  points  out  that  traction  should  be  made  in  the  direction  of 
this  axis  (Fig.  182,  A  B)  ;  and  that  this  line  of  traction,  happily  for  the 
veterinary  obstetrist,  and  thanks  also  to  the  flexibility  of  the  cords  which, 
in  his  practice,  take  the  place  of  the  forceps,  offers  no  serious  difficulty. 
At  page  243,  it  has  been  shown  that  this  direction  may  vary,  and  may  be 
modified  according  to  the  presentation — and  more  particularly  the  position 
— of  the  foetus,  and  also  according  to  the  period  of  labor. 


Fig.  182. 
Diagram  of  the  Pelvic  Axis. 

Degree  of  Traction. 
When  passing  through  the  pelvic  cavity,  the  foetus  undergoes  a  certain 
amount  of  compression,  proportionate  to  the  uterine  contractions  or  the 
external  traction  which  determines  its  progression  outwards  ;  at  the  same 
time,  this  compression  produces  a  kind  of  reaction  in  the  body  of  the 
foetus,  and  gives  rise  to  an  eccentric  pressure  against  the  walls  of  the 
passage,  related  to  that  which  itself  experiences.  The  question  is,  there- 
fore, limited  to  the  amount  of  force  necessary  to  overcome  the  resistance 
that  prevents  the  onward  progress  of  the  foetus,  without  injuring  either 
the  latter  or  the  parent.  In  veterinary  obstetrics  we  have  no  fixed  data 
to  rely  upon  ;  but  the  experiments  of  Joulin,  Delore,  and  Poullet,  alluded 
to  by  Saint-Cyr,  may  afford  some  idea  of  the  resistance  offered  by  the 
pelvic  girdle  to  the  eccentric  pressure.  These  authorities  found  that  if  a 
rounded  body — a  ball  for  instance,  to  represent  the  head  of  a  foetus — is 
attempted  to  be  pulled  through  the  pelvis  of  a  woman,  it  requires  a  force 
represented  by  375  to  441,  and  even  as  much  as  635  pounds  (estimated 
by  the  dynamometer),  to  produce  such  serious  lesions  as  fracture  in  the 
bones  or  disunion  of  the  symphyses.  But  it  must  not  be  concluded  from 
this  result,  that  such  powerful  traction  can  be  practised  with  impunity  in 
woman.  In  the  first  place,  the  child  could  not  be  extracted  alive,  for  its 
existence  appears  to  be  compromised  if  the  degree  of  traction  by  the 
forceps  exceeds  from  132  to  154  pounds  ;  and  in  order  that  the  pelvis  of 
woman  could  resist  such  pressure,  certain  conditions  are  required  which 
we   never   meet  with   in   ordinary  practice:    for  instance,  the  pressure 


MECHANICAL  EXTRACTION  OF  THE  FCETUS.  525 

should  be  equally  applied  to  every  part  of  the  bony  girdle  in  contact  with 
the  head  of  the  foetus.  But  this  does  not  take  place  with  the  ordinary 
forceps,  which,  even  in  the  hands  of  the  most  expert  accoucheur,  not  only 
acts  as  a  traction  agent,  but  at  a  given  moment  is  unfortunately  trans- 
formed into  a  lever  of  the  first  or  second  kind,  whose  power  is  incalcula- 
ble, and  which,  resting  on  two  opposite  points  of  the  pelvic  circumference, 
may  burst  it,  without  the  dynamometer  showing  any  thing  more  than  a 
relatively  feeble  degree  of  traction. 

Otherwise,  it  is  not  only  the  bones  which  have  to  be  considered,  but 
also  the  soft  parts,  which,  pressed  between  the  foetal  head  and  the  hard 
pelvic  circumference,  may  be  bruised,  contused,  or  lacerated  to  a  variable 
degree,  if  the  comparison  exceeds  a  certain  limit.  This  pressure,  how- 
ever, is  always  considerable  ;  for,  according  to  Chassagny,  when  a  trac- 
tile force  of  fifty  kilogrammes  is  exercised  on  the  head  of  a  foetus  seized 
by  the  ordinary  forceps,  we  may  calculate  that  each  square  centimetre  of 
surface  of  the  pelvic  walls  sustains  a  pressure  of  1800  grammes,  even  in 
the  most  favorable  conditions ;  though  it  may  be  as  much  as  six  kilo- 
grammes or  more,  according  to  circumstances. 

These  observations,  though  doubtless  valuable  and  significant  for  the  ac- 
coucheur of  woman,  are  only  very  indirectly  applicable  to  veterinary  ob- 
stetricy.  Without  taking  into  account  the  strength  of  the  pelvic  osseous 
girdle,  which  is  so  much  greater  in  the  Mare  and  Cow  than  in  woman, 
several  other  circumstances  allow  us  to  understand  why  this  bony  circle 
may,  in  these  animals,  resist  an  amount  of  strain  which  would  appear  to 
be  altogether  unreasonable,  if  judged  according  to  the  principles  which 
should  guide  the  practice  of  the  human  obstetrist.  But  the  veterinarian 
is  in  possession  of  means  of  traction  which  give  him  a  great  advantage 
in  this  respect — an  advantage  which  the  accoucheur  has  not  yet  been 
able  to  avail  himself  of  :  we  allude  to  the  cords  the  former  so  frequently 
employs  as  traction  instruments,  and  which  can  never  be  transformed  into 
levers,  like  the  forceps. 

In  woman,  as  with  animals,  the  foetus,  in  passing  through  the  pelvic 
cavity,  is  pressed  upon  by  its  walls,  and  in  return  it  presses  upon  them, 
in  the  manner  of  a  wedge,  which  tends  to  tear  them  asunder.  But  there 
is  a  great  difference  in  woman  and  animals.  On  the  one  hand,  it  is  a 
hard,  bony,  and  little  reducible  region — the  head — which  presses  against 
the  pelvic  walls,  to  which  it  transmits,  almost  undiminished,  the  pressure 
itself  receives  ;  on  the  other  hand,  it  is  a  bony  cage — the  chest — formed 
of  numerous  very  movable  parts,  and  which  can  submit  without  injury  to 
much  distortion,  in  addition  to  its  being  covered  by  soft  and  readily  com- 
pressible tissues :  consequently,  we  can  easily  comprehend  how  much  in 
the  latter  case — that  of  animals — the  eccentric  pressure  produced  by  the 
passage  of  the  foetus  should  be  attenuated.  Besides  all  this,  the  head  of 
the  infant  is  spherical,  and  therefore  comes  in  contact  with  the  interior  of 
the  mother's  pelvis  by  a  circle  or  narrow  zone  ;  the  surface  of  the  pelvis 
in  contact  with  the  foetal  head  has  been  estimated  at  sixty  square  centi-  ^ 
metres,  and  it  is  to  this  limited  space  that  the  head  transmits  the  pressure 
it  sustains.  Chassagny,  from  a  series  of  experiments,  estimates  that,  for 
a  traction  of  sixty  kilogrammes — exerted  under  the  most  favorable  cir- 
cumstances by  his  forceps  on  the  head  of  the  human  foetus — each  square 
centimetre  of  the  surface  of  the  pelvis  in  contact  with  it  should  support 
a  pressure  of  about  500  grammes  ;  in  less  favorable  conditions  it  may 
even  be  much  more. 


526  OBSTETRIC  OPERATIONS. 

From  some  measurements  made  by  Saint-Cyr,  the  pelvis  of  the  Mare 
and  Cow,  and  which  is  nearly  cylindrical,  maybe  reckoned  at  1600  square 
centimetres  (248  inches)  of  internal  surface  ;  and  it  is  on  this  expanse 
that  is  distributed,  in  a  nearly  uniform  manner,  the  eccentric  pressure 
which  the  chest  of  the  foetus  transmits  to  the  walls  of  the  genital  canal, 
to  which  it  is  very  closely  applied  during  its  passage  outwards.  If,  then,  it 
be  admitted  that  the  total  of  this  eccentric  pressure  measures  about  one- 
half  the  tractile  force  expended  on  the  foetus,  it  will  be  easy  to  find,  by  a 
simple  calculation,  the  pressure  on  each  square  inch.  Supposing  the 
traction  to  be  equal  to  1540  pounds — the  estimated  strength  of  seven  or 
eight  men  pulling  with  all  their  force  at  the  cords — the  pressure  on  each 
square  inch  would  be  about  73^  ounces  ;  or  one  half  that  exerted  on  the 
same  extent  of  surface  with  a  tractile  force  of  132  pounds,  in  woman  ! 

Saint-Cyr  does  not  pretend  that  these  calculations  give  a  rigorously 
exact  measure  of  what  really  takes  place  during  parturition  ;  but  he  be- 
lieves th^  may  assist,  up  to  a  certain  point,  in  explaining  certain  facts  in 
comparative  obstetrics  which  otherwise  would  remain  obscure  :  how,  for 
instance,  natural  birth,  which  is  always  so  painful  in  woman,  is  compar- 
atively painless  in  the  larger  animals  ;  and  why  traction,  the  very  idea  of 
which  frightens  the  accoucheur  of  woman,  is,  in  the  majority  of  instances, 
so  well  sustained  by  the  veterinary  surgeon's  patients. 

It  must  be  confessed,  however,  that  we  have  as  yet  no  certain  data  by 
which  we  can  estimate  the  exact  amount  of  force  necessary,  or  which 
may  be  employed  without  danger ;  and  on  this  point  the  opinions  of  the 
best  authorities  are  widely  divergent.  Some  declare  for  moderate  trac- 
tion— two,  three,  or  four  men  at  the  most,  pulling  simultaneously  at  the 
cords  with  all  their  force,  are,  in  their  opinion,  quite  sufficient  in  all 
cases,  if  well  managed  ;  and  they  assert  that  it  is  rash  and  dangerous 
to  employ  more.  Others  do  not  hesitate  to  have  recourse  to  more  ener- 
getic traction,,  and  are  not  afraid  of  employing  the  combined  strength  of 
six,  eight,  or  ten  strong  men  ;  being  convinced  that  the  parent  suffers 
more  from  protracted  labor  than  powerful  traction  :  and  not  unfrequently 
their  success  justifies  their  boldness. 

Donnarieix  admits  that  three  assistants  are  usually  sufficient  with  the 
Cow :  one  at  the  head,  another  at  the  tail,  and  the  third  to  aid  the  opera- 
tor ;  while  ten  are  needed  for  the  Mare  :  one  at  the  head,  another  hold- 
ing the  rope  which  confines  the  limbs  of  the  animal,  and  prevents  its  do- 
ing damage,  a  third  to  hold  the  tail,  a  fourth  to  assist  the  operator,  and 
the  other  five  or  six  to  pull  at  the  foetus  when  necessary.  Zundel,  how- 
ever, is  of  opiniori  that  these  numbers  are  somewhat  exaggerated  ;  very 
often  more  than  three  assistants  are  required  for  the  Cow,  and  if  more 
than  six  are  needed  for  the  Mare,  it  is  better  to  have  recourse  to  mechan- 
ical means  ;  as  too  many  assistants  hamper  the  operator,  and  are  often 
in  each  other's  way,  while  their  united  strength  cannot  be  usefully  ap- 
plied. 

The  assistants  should  be  strong,  and  have  had  some  experience  in 
handling  animals  ;  some  of  them  are  to  maintain  the  creature  in  a  favor- 
able position,  while  the  others  aid  the  attempts  at  extraction,  under  the 
orders  of  the  operator.  The  tractile  efforts  should  be  made  simultane- 
ously, without  jerking,  but  in  a  continued  and  energetic  manner,  and 
always  in  the  direction  of  the  axis  of  the  pelvis — in  a  straight  line  behind 
the  animal.  The  direction  of  the  traction  may,  however,  be  a  little  down- 
ward in  the  anterior  presentation,  lumbo-sacral  position,  until  the  withers 


MECHANICAL  EXTRACTION  OF  THE  F^^TC/S.  527 

have  passed  through  the  inlet ;  as  by  this  means  the  top  of  the  withers  is 
depressed,  and  this  part  enters  the  pelvis  before  the  sternum.  The 
operator  stands  behind  the  parent,  his  hands  on  the  sides  of  the  vulva, 
v.hich  he  depresses  with  the  cubital  border  of  one  hand,  while,  with  the 
back  of  it  he  separates  the  lips,  and  prevents  their  being  abraded  by  the 
cords.  It  is  better  to  engage  only  one  shoulder  of  the  foetus  *at  a  time, 
if  possible ;  and  when  the  sternum  and  one  shoulder  have  been  carried 
into  the  passage,  then  the  other  shoulder  is  brought  forward  by  directing 
the  assistants  to  pull  a  trifle  towards  the  opposite  side.  By  acting  in  this 
way,  with  care,  and  by  slow  though  continued  efforts  while  the  parent  is 
straining,  delivery  will  be  effected,  if  this  be  possible  by  traction.  The 
operator  must  not  act  hurriedly  or  brusquely,  and  his  hand  should  care- 
fully attend  the  advance  of  the  foetus  :  facilitating  its  passage,  and  aiding 
the  progress  of  the  haunches  by  passing  his  open  hand  between  them 
and  the  maternal  pelvis. 

In  the  posterior  presentation,  when  at  least  one  assistant  must  be  told 
off  to  each  cord,  the  traction  should  be  moderate,  or  even  gentle  at  first, 
until  the  operator's  hand  has  adjusted  the  foetus  as  much  as  possible.  In 
addition,  the  latter,  besides  directing  his  assistants,  must  frequently  him- 
self guide  the  traction  by  the  disengaged  hand,  and  personally  exert  him- 
self in  the  extraction  of  the  young  creature  :  separating  the  lips  of  the 
vulva,  and  pressing  them  towards  the  pelvis  when  they  are  pushed  out- 
wards by  the  advancing  foetus  ;  lubricating  the  latter  and  the  genital  canal 
when  necessary,  etc. 

Means  of  Developing  the  Necessary  Force. 

Hitherto  we  have  only  been  alluding  to  the  employment  of  human  or 
manual  force  in  the  extraction  of  the  foetus  ;  and  this,  of  course,  is  that 
which  is  generally  resorted  to  at  first.  But  it  is  not  the  only  force  w^e 
may  employ,  and  especially  if  it  is  desirable  to  exercise  very  powerful 
traction.  It  is  true  that  empirics  and  amateurs  have  often  adopted  the 
barbarous  expedient  of  attaching  the  cords  fixed  on  the  foetus  to  a  horse 
or  ox,  and  by  making  the  latter  exert  its  strength,  to  tear  the  young  crea- 
ture through  the  maternal  passage.  Rainard  mentions  that  in  the  Ca- 
margue,  those  who  have  the  charge  of  droves  of  Mares,  not  having  the 
services  of  a  veterinary  surgeon,  yoke  another  Mare  to  the  cords  they 
fasten  on  the  foetus,  and  deliver  the  parturient  animal  in  this  cruel  fash- 
ion. Being  destitute  of  anatomical  knowledge,  they  act  blindly  ;  and 
not  understanding  how  to  adjust  a  malposition,  the  foal  is  nearly  always 
extracted  dead,  and  only  too  frequently  the  mother  perishes. 

With  the  object  of  extracting  the  foetus  by  force  when  manual  traction 
is  not  sufficient,  the  windlass,  capstan,  wheel,  cart,  and  pulleys,  have  fre- 
quently been  used,  and  with  great  benefit.  Many  veterinarians  consider 
the  employment  of  machines  as  equally  barbarous  with  the  ox  or  horse 
traction,  but  this  opinion  is  scarcely  just.  They  say  such  machines  are 
blind  instruments  which  cannot  be  directed  at  will,  and  they  prefer  in- 
creasing the  number  of  men  indefinitely  rather  than  resort  to  them. 

But  some  of  the  most  intelligent  and  experienced  veterinary  obstetrists 
— Lecoq,Gunther,  Binz,  Leconte,  Rainard,  Baumeister,  Saint-Cyr,  Franck, 
etc. — speak  in  the  highest  terms  of  the  utility  of  these  machines  ;  and 
some  of  them  state  that  whenever  the  combined  strength  of  six  men  is 
not  sufficient  to  extract  the  foetus  from  the  larger  animals,  they  do  not 
hesitate  to  employ  one  of  these  articles.     Not  only  can  a  greater  tractile 


528 


OBSTETRIC  OPERATIONS. 


force  be  developed  by  them,  but  this  force  maybe  diminished  or  increased 
at  will,  and  as  gradually  as  the  circumstances  may  require.  In  this 
direction,  though  the  windlass,  capstan,  or  wheel  may  be  utilized,  yet, 
for  convenience  in  application,  portability,  and  steady  graduated  traction, 
nothing  can  approach  the  light  obstetric  pulley,  the  manner  of  using 
which  is  shown  in  the  annexed  drawing  (Fig.  183). 

When  very  powerful  traction  is  required,  whether  manual  or  machine, 
there  is  the  risk — particularly  if  the  animal  is  standing — of  dragging  it 
backwards  until  it  falls,  or  doing  it  some  injury,  unless  the  precaution  is 
adopted  of  fixing  it  in  some  way.  It  is  obvious  that  there  is  great  danger 
— indeed  cruelty — in  attaching  it  merely  by  the  head  or  neck,  and  allow- 
ing these  to  bear  all  the  strain.  It  is  necessary  to  render  the  creature 
immovable,  by  passing  cords,  bands,  or  a  sack  behind  the  thighs  and 
above  the  hocks,  bringing  the  ends  towards  the  animal's  shoulders,  and 
maintaining  them  there  either  by  assistants,  or  to  the  manger  or  any 
other  part  sufficiently  strong,  in  the  direction  of  the  creature's  head.     A 


Fig.  183. 
Obstetric  Pulleys. 

wooden  bar,  placed  behind  the  thighs,  and  secured  to  the  stall-posts,  is 
also  serviceable  ;  as  is  also  an  ordinary  harness  breeching,  the  front 
parts  being  secured  to  rings  in  the  wall  or  manger.  In  some  cases, 
vigorous  assistants,  placing  their  back  against  the  haunches  of  the  animal, 
will  offer  sufficient  resistance  to  its  displacement.  Many  practitioners 
prefer  throwing  the  animal  down,  if  it  is  standing,  in  order  to  avoid  the 
dangers  of  being  dragged  ;  Schaack  even  asserts  that  the  body  lying  on 
the  ground  increases  the  expulsive  efforts,  and  keeps  the  foetus  in  the 
plane  of  the  pelvis.  Donnarieix  is  not  afraid  of  seeing  the  animal  dragged 
a  little,  and  recommends  that  the  traction  should  not  cease  in  conse- 
quence. Nevertheless,  during  the  decubitus,  the  operator  is  more  quickly 
fatigued,  besides  being  restrained  in  his  movements ;  the  necessary 
manoeuvres  are  more  difficult  to  perform,  and  the  weight  of  the  fcetus 
is  often  an  additional  obstacle.  And  even  when  the  creature  is  lying,  if 
the  traction  is  very  strong,  it  is  often  necessary  to  prevent  the  body  being 
drawn  backwards. 

All  these  inconveniences  being  recognized  by  Baron,  in  1858  he  intro- 
duced an  obstetrical  machine — an  apparatus  for  producing  sustained 
traction  {appareil  d  tradmi  soutenue)  in  the  extraction  of  the  foetus.  This 
apparatus  presses  against  the  hind-quarters  of  the  parturient  animal,  and 
owing  to  its  construction  it  cannot  only  develop  a  very  energetic  extrac- 
tive force  in  the  gentlest  and  most  inoffensive  way  possible,  but  itself 
produces  the  counter-extension  in  an  exacdy  proportionate  degree. 


MECHANICAL  EXTRACTION  OF  THE  FCETUS. 


529 


The  principal  parts  of  the  machine  are:  a  kind  of  horse-collar  (Fig. 
184,  A)  with  three  stalks  (B,  C,  D)  intermediate  between  this  collar 
and  a  broad,  fixed,  female  screw  (E),  which  receives  a  movable  screw 
rod  (H)  that  bears  a  revolving  hook  and  chain  (K)  at  one  end;  the 
other  end  of  the  chain  has  also  a  hook  to  which  the  cord  or  cords  fixed 
on  the  foetus  are  attached.  The  collar  is  made  of  several  pieces  of  light 
wood  superposed  an^  bound  together  by  an  iron  band  applied  to  its  pos- 
terior surface.  This  band  is  perforated  by  three  screwed  holes  placed  in 
a  triangular  position,  and  which  receive  the  iron  stalks.  The  anterior 
face  of  the  collar  is  so  fashioned  as  to  fit  closely  on  the  hind  parts  of  the 
animal,  the  space  for  the  passage  of  the  fcetus  being  about  twenty  inches 
in  diameter.  The  intermediate  stalks  (B,  C,  D)  serve  to  transmit  to  the 
collar  the  pressure  exercised  by  the  female  screw  ;  they  are   about  forty 


Fig.  1S4. 
Bakon's  Obstetric  Machine. 


inches  long,  and  each  is  composed  of  two  pieces,  one  of  these  being 
hollow  (4,  5,  6),  the  other  solid  (i,  2,  3)  :  consequently,  one  fits  into  the 
other,  and  the  end  opposite  the  collar  enters  one  of  the  openings  in  the 
flange  of  the  female  screw  (E)  ;  a  small  thumb-screw  (7,  8,  9)  secures  the 
two  portions  of  the  stalk.  The  female  screw  is  of  iron  or  copper,  the  flange 
being  of  wood,  and  its  circumference  provided  with  two  handles  to  hold  it 
firmly  when  the  machine  is  in  use.  The  male  screw  (H)  is  of  iron,  and 
screwed  to  the  right  ;  one  extremity  articulates  with  the  turning-hook(I)  : 
it  is  screwed  in  the  contrary  direction  to  the  principal  portion,  so  as  not 
to  become  unscrewed  during  the  operation  ;  the  other  end  has  a  four- 
branched  windlass  which  can  be  removed  at  will. 

To  use  the  machine,  the  animal  is  made  to  lie  ;  the  cords  are  attached 
to  the  foetus  in  the  usual  manner ;  the  windlass  handle  is  put  on  its  place  ; 
the  screwed  stalk  (H)  is  introduced  into  the  female  screw  to  about  as  far 
as  J  ;  the  collar  is  applied  to  the  animal's  croup,  and  the  three  long  stalks 
are  fixed — one  end  in  the  collar,  the    other  in   th.e  flange.     An   assistant 

34 


530  OBSTETRIC  OPERATIONS. 

keeps  the  machine  in  equilibrium  by  placing  one  of  his  hands  on  one  of 
the  forked  handles  of  the  flange,  while  the  other  handle  rests  firmly  on, 
the  ground.  Another  assistant,  the  cords  attached  to  the  foetus  being 
fixed  in  the  hook  at  the  end  of  the  chain  (K),  slowly  turns  the  windlass 
in  such  a  direction  as  will  bring  the  extremity  of  the  stalk  (I)  towards  the 
flange,  while  the  operator  superintends  the  extraction.  It  will  thus  be 
seen  that  a  strong  traction  is  exerted  on  the  foetus,  while  a  proportionate 
pressure  is  transmitted  to  the  croup  of  the  parent  through  the  three  long 
rods — the  machine  producing  extension  and  counter-extension  at  the 
same  time,  while  it  also  allows  a  sustained  traction  to  be  obtained — 
without  jerks  or  checks,  and  as  powerful  as  may  be  desired. 

This  machine  has  been  well  tested  in  France,  and  has  received  the 
highest  praise. 

Comparison  between  Ma7iual  and  Mechanical  Force. 

The  employment  of  machines  which  multiply  force,  for  artificial  ex- 
traction of  the  foetus,  can  be  traced  to  a  somewhat  distant  period  ;  and 
the  use  of  the  windlass,  the  wheel,  and  the  cart,  by  rude  Empirics  is  of 
ancient  date. 

Resorted  to  byignor.ant  people  destitute  of  that  knowledge  which  alone 
can  ensure  safety  and  success,  these  appliances  must  have  been  produc- 
tive of  great  injury  and  loss.  It  "was  probably  from  witnessing  these  re- 
sults that  the  early  French  veterinarians  were  almost  unanimous  in  their 
condemnation  of  their  use,  and  designated  them  as  "  ciliel  "  and  "mur- 
derous." "It  is  cruel,"  says  Fromage  de  Feugre,  "  to  tie  a  cord  to  a 
calf,  and  pull  at  it  by  the  windlass  or  capstan,  or  by  horses  attached  to  it. 
It  is  much  better,  the  Cow  being  tied  by  its  horns,  to  make  men  pull  at 
the  cord,  so  that  force  may  be  employed  with  more  precaution  and  man- 
agement." Hurtrel  d'Arboval  remarks  :  "  There  are  people  who  would 
go  so  far  as  to  pull  at  the  cord  wWch  is  attached  to  the  foal  or  the  calf 
by  the  windlass,  the  capstan,  or  pulleys  ;  this  procedure  is  not  only  cruel, 
but  its  violence  usually  kills  the  foetus,  and  often  causes  lacerations, 
serious  injury,  and  displacement  of  the  uterus."  Other  writers  have 
written  in  equally  strong  terms  against  the  use  of  traction  machines,  and 
in  favor  of  manual  force — which,  they  argue,  is  an  intelligent  force,  may 
be  graduated  at  will,  and  its  direction  modified  according  to  circumstances, 
so  as  always  to  act  in  the  most  favorable  way — i.e.,  in  the  axis  of  the 
pelvis. 

Nevertheless,  since  1838,  when  Lecoq  spoke  out  in  favor  of  mechanical 
appliances,  many  of  the  most  experienced  practitioners  have  expressed  them- 
selves in  their  favor.  "  I  propose  the  pully,"  says  Lecoq,  "  because  it 
afifords  much  more  gentle  and  steady  traction  than  that  obtained  by  strength 
of  arm.  .  .  .  This  opinion  is  shared  by  the  majority  of  the  veterinarian  sur- 
geons in  our  part  of  the  world."  "  The  employment  of  the  moulinet,'"  writes 
Darreau  in  1852,  "gives  a  more  regular  and  sustained  traction  than  that 
of  assistants,  no  matter  how  vigorous  and  intelligent  these  may  be  ;  in 
turning  it  slowly,  we  obtain  a  gradual  and  continuous  traction  ;  the 
shoulders  and  the  body  of  the  foetus  are  elongated,  the  sides  are  flattened 
by  the  pressure,  and  delivery  is  effected  in  the  majority  of  cases  without  an 
accident.  ...  By  this  procedure,  we  succeed  in  eight  cases  out  of  ten." 
Ayrault  writes  {Recueil  de  Med  Veterinaire,  1857)  :  "I  have  decided  to 
employ  a  means  which  \  have  often  very  severely  qualified  when  in  the 


MECHANICAL  EXTRACTION  OF  THE  FCETUS.  531 

hnndsof  empirics,  and  which  can  be  only  barbarous  and  brutal  by  reason  of 
the  ignorance  of  those  who  apply  it :  I  speak  of  the  windlass,  and  wheel 
and  axle.  ...  It  is  now  amply  demonstrated  to  me  that  this  obstetrical 
means,  so  little  enticing  at  first  sight,  is  the  first  among  all  the  means  for 
producing  traction  which  the  veterinary  surgeon  has  at  his  disposal — pro- 
vided always  that  he  watches  its  operation  with  much  attention  ....  so 
that  no  part  of  the  foetus  wedges  against  the  sides  of  the  pelvis  ;  for  the 
windlass  does  not  know  of  any  obstacle  which  it  cannot  overcome."  And 
Garreau,  commenting  on  Baron's  obstetric  machine  just  described,  re- 
marks {Report  a  la  Soc.  Centrale  de  Med  Veterinaire,  1858)  :  "  From 
what  has  been  said,  it  results  from  an  examination  of  every  part  of  this 
apparatus  :  that  the  mechanism  is  simple,  and  works  well  and  easily ;  that 
its  power  is  at  least  equal  to  that  of  the  pulleys,  windlass,  or  capstan  ; 
that  its  action  is  based  on  mechanical  laws  ;  that  the  traction  it  produces 
is  so  gentle,  slow,  and  regular,  that  it  is  without  danger  for  the  mother  ; 
that  its  employment  altogether  leaves  behind  all  the  other  means  used  for 
the  production  of  the  necessary  counter-extension  in  foetal  extraction  ; 
that  the  collar  transmits,  in  a  regular  manner,  and  to  the  whole  of  the 
inferior  and  posterior  parts  of  the  maternal  pelvis,  the  pressure  it  receives 
from  the  female  screw  ;  that  this  pressure,  disseminated  over  the  entire 
hind-quarters  of  the  female,  is  proportionally  less  severe  and  painful 
during  traction  of  a  given  intensity." 

Many  more  references  could  be  given  to  other  very  competent  author- 
ities in  favor  of  mechanical  over  manual  traction  ;  but  we  will  sum  the 
evidence  by  stating  that  mechanical  traction  is  preferable  to  that  pro- 
duced by  manual  power,  inasmuch  as  it  is  slower,  more  regular,  its  ac- 
tion is  more  sustained,  and  it  is  more  powerful  and  efficacious,  without 
imposing  increased  strain  on  the  parent  or  foetus.  Manual  traction  is 
unsteady  and  jerking,  especially  when  several  men  are  pulling  ;  all  the  men 
do  not  pull  alike  or  at  the  same  time,  therefore  even  during  traction, 
however  steady  it  may  aim  to  be,  the  strain  varies  ;  men  soon  become 
fatigued,  whereas  the  machine  can  maintain  the  traction  for  any  length 
of  time  without  increasing  or  diminishing  it. 

One  of  the  objections  urged  against  machine  traction,  is  that  its  direc- 
tion cannot  be  so  easily  varied  upwards,  downwards,  or  to  one  side  or  the 
other,  as  manual  traction.  But  this  is  a  very  trifling  objection,  and  it 
may  be  nearly,  if  not  altogether,  overcome  by  making  assistants  press 
against  the  cord  or  cords,  so  as  to  give  them  the  necessary  direction. 

When  powerful  traction  is  required,  whether  it  be  manual  or  mechan- 
ical, great  attention  is  necessary  in  guiding  the  foetus  through  the  genital 
canal,  so  as  to  prevent  injury  to  the  parent.  The  traction  should  cease 
in  the  intervals  between  the  labor-pains,  and  the  efforts  ought  not  to  be 
continuous  ;  the  animal  should  bs  allowed  intervals  of  rest,  and  time  be 
given  for  the  genital  canal  to  dilate  and  adapt  itself  to  the  passage  of  the 
foetus.  Severe  and  injudicious  traction  may  be  productive  of  the  most 
serious  results.  Even  when  tiae  operation  is  nearly  terminated,  care  will 
be  requisite  in  order  to  prevent  inversion  of  the  uterus.  This  accident 
may  be  obviated  by  careful  manipulation,  and  abundant  injection  of 
emollient  fluids.* 

*  While  on  the  subject  of  mechanical  traction  in  veterinary  obstetrics,  we  may  note  that  two  distinguished 
French  accoucheurs — MM.  Chassagny  and  Joulin — have  recently  introduced  an  apparatus  intended  to 
replace  mechanical  for  manual  traction  in  the  human  female,  botlj  being  unanimous  with  regard  to  the 


#    • 


532  OBSTETRIC  OPERATIONS. 

CHAPTER  II. 

Embryotomy. 

Embryotomy,  or  embryuicia,  is  the  name  given  to  ever}'  operation  which 
has  for  its  object  the  reduction  in  volume  of  the  foetus  at  parturition,  by 
mutilating  or  dividing  it  ;  so  as  to  allow  it  to  be  extracted  by  portions, 
when  it  cannot  be  delivered  whole.  It  is  a  generic  term  for  a  number  of 
operations  very  different  in  their  character,  and  performed  on  the  foetus 
either  while  it  is  wholly  retained  in  the  uterus,  or  more  or  less  engaged 
in  the  genital  passage. 

These  operations  may  be  practised  on  various  parts  of  the  young 
creature  :  head,  limbs,  or  body,  and  faciliate  the  removal  of  one  or  more 
parts,  so  that  the  remainder  can  be  removed  from  the  uterine  cavity.  Of 
course,  the  life  of  the  foetus,  if  it  be  alive,  is  sacrificed  in  every  case  ;  and 
this  sacrifice  is  only  made  to  prevent  a  greater  loss — the  death  of  the 
parent.  But  in  resorting  to  embryotomy,  the  veterinary  obstetrist  is  not 
hampered  by  those  gr^ve  considerations  which,  in  a  legal,  moral,  and  re- 
ligious point  of  view,  have  so  long  embarrassed  the  action  of  the  accou- 
cheur of  woman. 

The  question  with  the  veterinary  surgeon,  should  the  foetus  be  living,  is 
as  to  the  respective  value  of  parent  and  offspring,  and  which  of  these 
should  be  preserved  in  the  interest  of  the  owner. 

In  nearly  every  instance  the  response  is  entirely  in  favor  of  the  parent,  this 
being  of  most  commercial  value ;  and  this  fact^  together  with  the  absence 
of  legal  and  moral  objections,  will  account  for  embryotomy  being  much 
more  frequently  practised  in  veterinary  than  in  human  obstetrics.  Never- 
theless, the  destruction  of  the  living  foetus  in  the  case  of  domesticated 
animals  should  not  be  lightly  entertained  ;  it  is  the  duty  of  the  veterina- 
rian, in  the  interest  of  his  client,  to  preserve  the  life  of  the  young  creature 
as  well  as  that  of  the  parent,  by  every  means  in  his  power ;  and  it  is  not 
until  these  means  have  been  fairly  tried,  or  are  deemed  insufficient  after 
due  deliberation  and  without  trial,  that  the  necessary  mutilation  shquldbe 
undertaken.  And  it  must  not  be  forgotten  that  embryotomy  is  not  always 
without  danger  for  the  parent ;  on  the  contrary,  it  is  nearly  always 
serious,  and  its  consequences  have  often  to  be  dreaded,  while  to  the 
operator  it  is  in  the  great  majority  of  cases  a  heavy  and  fatiguing  task. 

When  the  foetus  is  not  dead,  then  it  is  only  the  most  urgent  necessity 
that  should  impel  the  obstetrist  to  resort  to  embryotomy  ;  though  when 
the  creature  has  perished  there  is  no  need  for  hesitation,  and  the  opera- 
tion maybe  undertaken  at  once,  if  the  operator  is  satisfied  that  extraction 
cannot  be  readily  effected  otherwise. 

We  have  already  indicated  the  conditions  which  generally  require  re- 
course to  embryotomy.  These  are  deformities  of  the  maternal  pelvis — 
either  congenital  or  acquired,  constitutional  or  accidental — which  prevent 
extraction  of  the  intact  foetus,  this  condition  being,  however,  very  rare 
in  animals;  hysterocele ;  disproportion  between  the  size  of  the  foetus  and  the 
genital  canal ;  certain  kinds  of  monstrosity ;  particular  malprese?itatio?is  and 
malpositions^  as  well  as   irreducible  distortions  of  the   foetus  ;  death  of  the 

superiority  of  the  former  over  the  latter.  Chassagny  gives  his  reasons  for  preferring  the  one  to  the  other- 
(thev  are  the  same  as  those  which  have  been  expresse'd  by  veterinary  obstetrists  for  many  years),  in  a  well 
written  article  in  the  Gazette  Medicale  d^  Lyon  for  1861  ;  while  Joulin,  a  year  afterwards,  in  his  work  on 
midwifery  {Traiti  comf>let  d' Accouchements,  Paris,  1862),  points  out  in  the  clearest  manner  the  great 
advantages  of  his  means  of  extraction. 


EMBRYOTOMY.  533 

/(etiis,  when  its  retention  in  the  uterus  has  given  rise  to  intense  emphy- 
sema which  hinders  delivery  ;  certain  diseases  of  the  foetus^  as  hydroceph- 
alus, ascitis,  oedema,  etc.  Indeed,  embryotomy  is  indicated  in  every 
case  when  parturition  cannot  be  accomplished  by  the  other  measures 
already  mentioned,  without  seriously  compromising  the  life  or  future 
usefulness  of  the  parent. 

We  have  stated  that  division  of  the  foetus  is  a  heavy  and  fatiguing  task  ; 
and  we  have  only  now  to  remark  that,  however  easy  it  may  be  to  lay 
down  rules  and  give  directions  as  to  how  the  manuel  of  the  operation 
should  be  conducted,  those  only  who  have  had  experience  in  this  direc- 
tion can  testify  that  it  is  much  easier  to  write  and  to  speak  than  to  act, 
and  that  some  of  the  manoeuvres  so  complacently  recommended  by  those 
who  have  but  little  knowledge  of  the  practical  part  of  veterinary  obstet- 
rics, cannot  be  carried  out. 

The  fact  is,  that  embryotomy  cannot  be  restricted  to  definite  rules 
which  shall  be  applicable  to  every  case  ;  the  operation  must  vary  ac- 
cording to  circumstances,  and  these  are  often  of  the  most  diverse  kind. 
In  very  many  instances,  before  the  veterinarian  is  called  in,  rude  and 
misguided  hands  have  greatly  complicated  the  case, 'and  caused  so  much 
injury  and  swelling  to  the  maternal  organs  that  the  difficulties  of  the 
operation  are  increased  manifold. 

But,  as  in  every  thing  else,  there  is  a  right  way  and  a  wrong  way  of 
operating — apart  from  the  collateral  difficulties  of  the  operation  ;  and 
though  no  fixed  rules  can  be  laid  down  for  every  case  which  requires  em- 
bryotomy, yet  there  are  directions,  based  on  the  results  of  practical  ex- 
perience, which  afford  a  general  and  trustworthy  summary  of  the  most 
important  points  to  be  observed — by  the  young  practitioner  more  particu- 
larly. These  directions  we  will  now  allude  to,  in  treating  of  the  inci- 
sion, excision,  or  ablation  of  those  parts  of  the  foetus  which  are  selected  for 
operation — these  being  the  head,  limbs,  and  body.  But  we  must  first 
notice  the  instruments  in  actual  use,  or  whxh  are  recommended  for  per- 
forming embryotomy. 

Embryotomy  Instruments. 

The  performance  of  embryotomy  necessitates  the  use  of  surgical  ap- 
pliances for  the  division,  puncture,  or  removal  of  certain  parts  ;  and  as 
these  operations  have  to  be  effected  either  in  the  genital  canal  or  in  the 
cavity  of  the  uterus,  the  manipulation  of  cutting  instruments  in  such  a 
confined  space,  under  all  the  disadvantages  of  distance  from  the  opera- 
tor, the  struggles  and  paralyzing  straining  of  the  mother,  and  the  fact 
that  only  one  hand  can  be  employed,  and  that  without  the  aid  of  vision 
to  guide  and  direct  it,  renders  the  operations  peculiarly  difficult  and  dan- 
gerous. These  difficulties  and  dangers  have  stimulated  the  inventive 
faculties  of  veterinarians  for  a  long  time,  in  devising  instruments  by 
which  they  might  operate  quickly  and  safely,  and  so  obviate  fatigue  and 
danger  to  themselves,  and  exhaustion  and  risk  to  the  parturient  animal. 

It  is  needless  to  remark  that  many  of  these  instruments  have  never 
come  into  general  use,  either  because  they  did  not  fulfil  the  requirements 
claimed  from  them,  or  because  they  were  too  complicated  or  expensive. 
Sometimes,  also,  prejudice  rather  conflicts  with  the  introduction  of  any 
novelty  in  this  direction  ;  while  long  experience  often  enables  the  prac- 
titioner to  achieve  the  desired  end  with  instruments  which  would  be 
useless,  if  not  dangerous,  in  the  hand  of  a  less  expert  obstetrist. 


534  OBSTETRIC  OPERATIONS. 

So  it  is  that,  for  nearly  all  the  cutting  operations,  an  ordinary  pocket 
knife  or  bistoury  is  sometimes  the  only  instrument  employed  ;  the  ope- 
rator being  satisfied  if  the  spring  is  sufficiently  strong  to  prevent  the 
blade  shutting  up  in  the  handle  when  it  is  used  in  the  uterus.  Rainard 
preferred  an  ordinary  knife  with  a  blunt  point  and  a  convex  cutting  edge  ; 
others  use  a  bistoury  cache.  Even  small  pocket-knives  of  various  sizes 
are  utilized  for  this  purpose,  and  one  of  Mr.  Cartwright's  embryotomy 
knives  is  not  unlike  a  gardener's  large  pruning  knife.  In  the  use  and 
preference  for  knives,  much  must  depend  upon  custom  and  the  expertness 
of  the  operator. 

Nevertheless,  convenience,  safety,  and  the  absence  of  long  experience, 
demand  that  proper  instruments  be  devised  for  this  operation ;  and  this 
requirement  has  long  been  present  to  the  minds  of  veterinary  obstetrists. 
One  of  the  earliest  to  introduce  a  convenient  and  efficient  embryotom 
was  Giinther,  who,  in  his  work,  published  in  1830,  figures  an  instrument 
which  is  fixed  on  the  finger  by  a  ring  ;  the  cutting  edge  of  the  blade, 
about  two  inches  long,  being  somewhat  concave.  This  embryotom  has 
been  slightly  modified  in  various  ways  by  different  practitioners — some- 
times having  two  narrow  rings,  so  as  to  grasp  more  of  the  finger  ;  at 
other  times  having,  in  addition,  a  small  button  on  the  back  of  the  blade 


Fig.  185.  Fig.  i86. 

Straight  Embryotom.  Curved  Embryotom. 

for  the  finger  to  press  upon  ;  while  the  blade  itself  has  been  made  more 
curved,  straighten  longer,  or  like  the  blade  of  a  fleam.  This  instrument 
is  the  prototype  of  the  ring  scalpel  invented  by  Dr.  Simpson,  of  St.  An- 
drews, for  opening  the  skull  of  the  human  foetus.  Two  of  these  embry- 
otoms  which  have  been  used  in  England,  are  shown  in  the  annexed 
figures  (185,  186).  An  improvement  in  this  instrument  is  the  having  a 
hole  at  the  opposite  end  of  the  blade  (Fig.  186),  through  which  a  piece 
of  cord  or  tape  can  be  passed  and  tied  round  the  wrist,  to  prevent  the 
knife  slipping  from  the  finger  and  falling  into  the  cavity  of  the  uterus. 
Indeed,  this  is  a  wise  precaution  with  all  the  short  instruments  introduced 
into  the  genital  organs,  as  the  contractions  of  the  uterus,  struggles  of  the 
animal,  and  the  position  of  the  hand,  as  well  as  the  slipperiness  caused 
by  the  presence  of  mucus,  etc.,  only  too  often  render  the  hold  of  the  in- 
strument very  insecure.  The  middle-finger  of  the  operating  hand  is  passed 
through  the  ring  and  the  other  fingers  enclose  the  blade,  which  is  in  this 
way  safely  conveyed  to  the  part  of  the  foetus  which  is  to  be  incised.  The 
finger-knife  is  the  most  useful  instrument  in  embryotomy. 

Giinther  also  at  this  time  introduced  another  form  of  embryotom, 
which  has  likewise  continued  in  use,  and  has  been  more  or  less  altered 
or  improved  in  shape.  This  consists  of  a  blade,  which  can  be  made  to 
slide  out  of  or  into  a  handle,  by  the  thumb  of  the  hand  holding  it.  It 
can  therefore  be  introduced  into  or  withdrawn  from  the  genital  passage, 
without  risk  of  injury  to  the  maternal  organs.     The  annexed  figure  (187) 


EMBRYOTOMY.  .535 

exhibits  an  improved  model  of  Gunther's  second  embryotom  ;  the  original 
pattern  had  double  cutting  edges.  We  may  remark  that  Zundel  and  Saint- 
Cyr  give  Thibeaudeau  the  credit  of  inveniing  this  sliding  bistoury  ;  but 
the  instrument  is  only  described  by  the  latter  in  183 1  {Rec.  de  Med.  Vet- 
h'inaire,  1831,  p.  152);  where  as  an  exactly  similar  knife  is  figured  in 
Giinther's  work  {Lehrbuch  der  Practischen  Veterindr-Gebiirtshiilfe),  pub- 
lished at  Hanover  in  1830. 

Another  kind  of  embryotom  is  one  not  unlike  an  ordinary  large  scal- 
pel, along  one  side  of  which  glides  a  blade-guard,  which  can  also  be 
moved  backwards  or  forwards  by  the  thumb  of  the  hand  that  holds  it. 
This  is  a  very  convenient  knife  (Fig.  188). 


Fig.  187. 
GuNrHER's  Embryotom:    Improved  Pattern. 

Embryotoms  have  also  been  proposed  by  Brogniez,  Hubert,  Contamin, 
Obermayer,  and  others,  but  they  all  are  more  or  less  imitations  of  the 
foregoing  models. 

Giinther  figures  an  embryotom  fixed  on  a  handle,  and  which  may  be  of 
any  convenient  length — about  thirty  inches  is  recommended  (Fig.  189)  ; 
the  blade  is  semicircular,  the  concave  border  and  point  being  very  sharp. 
This  instrument  is  extolled  foi"  its  usefulness  in  cutting  through  the  mus- 
cles subcutaneously,  and  especially  in  separating  the  limbs  from  the  trunk. 
The  same  authority  gives  the  figure  of  a  "  Scheerenmesser,"  or  "  secator," 
as  it  has  been  termed.  This  is  an  instrument  about  thirty-six  inches  in 
length,  composed  of  two  branches,  held   together  by  two  short  sheaths, 


Fig.  188. 
Colin's  Scalpel  Embryotom. 

through  which  the  one  glides  on  the  other.  Each  of  the  branches  has  a 
blade  placed  at  a  right  angle  to  the  stalk  ;  these  blades  are  opposite  each 
other,  the  opposing  edges  being  sharp,  and  they  are  brought  in  contact 
by  a  ratchet  arrangement  and  screw  moved  by  a  handle  at  the  other 
extremity.  This  instrument  is  very  powerful,  and  can  divide  bones  as 
well  as  soft  tissues. 

Subcutaneous  embryotomy  is  at  times  very  necessary,  but  after  the 
skin  has  been  incised  great  difficulty  is  often  experienced  in  separating 
it  from  the  textures  beneath,  by  tearing  through  the  connective  tissue. 
This  is  found  to  be  the  case  more  particularly  in  amputating  the  shoulder, 
when  the  fingers  become  fatigued  in  trying  to  pass  them  beneath  the  skin. 
To  facilitate  this  part  of  the  operation,  different-shaped  spatulas  have 
been  devised,  which  do  the  work  of  the  fingers  in  liberating  the  skin  from 
the  parts  it  covers.  One  of  these  spatulas  has  been  used  by  Cartwright  ; 
it  is  merely  a  thin  but  rigid  blade  of  iron,  about  seven  inches  long  and 


536 


OBSTETRIC  OPERATIONS. 


one  or  one  and  a  quarter  inch  wide,  the  edges  being  smooth  and  rounded, 
and  one  end  fixed  in  a  wooden  handle  (Fig.  190). 

Carsten-Harms  employs  a  double  spatula  about  three  feet  in  length  ; 
the  blade  at  each  end  is  about  an  inch  wide  and  two  inches  long,  the 
intermediate  portion  being  simply  a  round  rod  about  half-inch  thick  j  one 
end  is  a  little  bent  to  one  side  (Fig.  191).  This  instrument  can  be  used 
with  both  hands,  and  is  more  firmly  held  than  a  one-handed  spatula. 


0 


Fig.  r8q. 

Gunther's  Long-hakdled 
Embryotom. 


Fig.  190. 

Cartwright's  Subcutaneous 
Spatula. 


ll 


Fig.  191 


Carsten-Harms's 
Spatula. 


Ungefrohrn  proposes  another,  but  somewhat  differently-shaped,  spatula. 
This  measures  about  twenty-five  inches,  the  stalk  being  about  three-eighths 
of  an  inch  thick,  and  the  blade  two  inches  long  and  somewhat  crescent- 
shaped  ;  the  convex  border  is  most  useful  in  raising  the  skin,  particularly 
in  parts  where  the  connective  tissue  is  close  and  resisting.  The  blade 
must  be  pretty  strong  and  slightly  convex  on  one  side,  concave  on  the 
other.     The  other  end  has  a  wide  eyelet  as  a  handle. 

The  section  of  bones,  though  not  often  necessary,  is  nevertheless  some- 


EMBRYOTOMY. 


537 


times  required  to  be  made,  and  it  is  found  to  be  no  easy  matter — wiiii 
the  larger  bones  especially.  For  this  purpose  chisels,  saws,  and  forceps 
have  been  proposed  and  employed.  Cartwright  has  a  model  of  an  instru- 
ment for  slitting  up  the  skin  of  a  limb,  which  may,  on  occasions,  be  made 
useful    as    a  bone-chisel.     Including  the   handle,  it  is    about    thirty-two 


« 


Fig.  192. 

Fig.  193. 

Fig.  194. 

Fig.  195. 

Jngefrohrn's 
Spatula. 

Cartwright's 
Bone-chisel. 

Cartwright's 
Bone-saw. 

Swedish 
Chain-saw 

inches  in  length  ;  the  chisel  portion  is  a  little  more  than  two  inches  long, 
and  one  or  one  and  a  half  inch  broad  ;  only  the  middle  portion  at  the  end 
is  sharp,  the  two  corners,  which  project  a  little,  being  blunt  and  rounded, 
as  are  also  the  sides  (Fig.  193). 


538  OBSTETRIC  OPERATIONS. 

Margraff's  "  Stemmeisen,"  or  chisel,  is  not  unlike  a  joiner's  chisel  in 
shape  \  the  instrument  itself  is  seven  or  eight  inches  long,  and  at  its  cut- 
ting edge  (end),  which  is  very  sharp,  is  an  inch  to  inch-and-quarter  broad. 
The  sides  are  well  rounded,  and  the  instrument  gradualy  tapers  as  it 
reaches  the  handle,  into  which  it  is  fixed.  This  handle  is  a  round  piece 
of  hard  wood  about  three  feet  long  and  about  two  inches  in  diameter, 
with  a  ferule  at  the  end  into  which  the  chisel  is  fixed,  as  in  the  ordinary 
carpenter's  chisel.  The  cutting  end  of  the  instrument  is  carried  by  the 
right  or  left  hand  to  the  part  of  the  foetus  to  be  incised,  while  the  handle 
is  held  by  the  other  hand.  The  two  hands  can  in  this  way  be  employed  : 
that  in  the  uterus  guiding  the  movements  of  the  chisel,  while  that  holding 
the  handle  applies  the  necessary  force.  This  simple  instrument  has  been 
found  most  serviceable  in  dividing  the  vertebrae  when  the  body  of  the 
foetus  had  to  be  bisected,  dividing  the  head  or,  in  double-headed  mon- 
strosities, the  two  heads  ;  as  well  as  slitting  up  the  skin.  It  has  been 
well  suggested  that  if  the  cutting  edge  was  made  slightly  concave  the 
chisel  would  be  more  useful. 

For  the  same  purpose  a  saw  has  been  proposed.  Such  an  article  has 
been  successfully  employed  when  the  occasion  demanded  it.  Cartwright's 
saw  is  shown  in  the  annexed  figure  (194).  The  stalk  (of  iron)  is  sixteen 
inches  in  length,  the  saw  four  inches  long,  and  the  handle  six  inches. 
The  saw-blade  should  be  of  the  same  thick,ness  throughout,  the  end  and 
back  being  well-rounded  and  smooth. 

Sjostedt  {Handbok  i  Forlossnings  Konsten  for  och  uppfodare  af  Husdjur) 
draws  attention  to  the  value  of  the  ordinary  surgical  chain-saw,  which  a 
veterinary  surgeon  at  Stromsholm  had  successfully  employed.  That  which 
was  recommended  is  about  a  foot  in  length,  and  an  inch  wide.  Each  end 
has  a  ring  to  which  a  cord  is  ^.ttached,  and  to  the  cord  may  be  fixed  a 
short,  transverse  wooden  handle.  The  chain-saw  has  the  advantage  of 
being  perfectly  flexible,  and  can  therefore  be  passed  around  bones,  joints, 
etc.,  and  the  necessary  movements  performed  in  cutting  through  these — 
by  pulling  alternately  at  each  cord — without  endangering  the  organs  of 
the  mother.  One  hand  of  the  operator  must,  of  necessity,  guide  the  saw 
and  ascertain  its  progress.* 

Bone-forceps  might  be  used  advantageously,  but  we  are  not  aware  that 
they  have  been  employed  in  veterinary  obstetrics.  They  should  be  made 
with  the  jaws  bent,  so  that  the  cutting  edge  would  be  concave,  and  they 
could  be  made  sufficiently  strong  in  jaws  and  handles  to  cut  through  the 
largest  bones.  A  screw  at  the  end  of  the  handles  would  bring  these 
together  with  sufficient  force  to  divide  the  strongest  pieces  of  bone. 

In  the  foregoing  we  have  only  alluded  to  the  instruments  which  are 
generally  approved  of ;  many  more  might  have  been  described  ;  but  no 
particular  advantage  could  have  been  derived  by  doing  so.  A  multitude 
of  instruments  can  only  be  embarrassing  to  the  veterinary  obstetrist.  Be- 
sides, it  must  be  confessed  that  too  little  attention  has  been  devoted  to  the 
perfecting  of  those  already  in  use,  or  to  devising  others  more  simple  and 
efficient  to  supplant  them.  There  is  here  a  wide  field  still  open  for  those 
who  desire  to  cultivate  a  most  important  department  of  veterinary  surgery. 

Instruments  necessary  for  particular  operations  will  be  referred  to  as 
these  are  described. 

*  All  the  obstetrical  instruments  to  which  reference  has  been  made  in  this  work,  are  supplied  by  Mackey, 
Sellers  &  Co.,  Bouverie  Street,  Fleet  Street,  London. 


i 


EM  BR  YO  TOM  Y  539 

Preliminary  Arrangements  for  Embryotomy. 

There  is  not  much  to  arrange  before  commencing  embryotomy.  The 
operator  is  supposed  to  have  made  an  exploration  of  the  genital  passage, 
and  to  have  ascertained  the  state  of  affairs  ;  he  may  even  have  attemp'ed 
every  thing  possible  in  the  way  of  extraction,  and  failed.  Being  satisfied 
that  nothing  remains  to  be  done  to  preserve  the  life  of  the  parent,  save 
removing  the  fcetus  piecemeal,  he  has  to  decide,  from  the  nature  of  the 
case,  how  this  is  to  be  effected.  The  necessary  instruments  he  may  have 
with  him,  or  they  may  be  devised  on  the  spot ;  if  the  case  is  more  diffi- 
cult than  usual,  they  may  have  to  be  sent  for.  But,  as  a  rule,  the  opera- 
tor must  utilize  to  the  best  of  his  ability  whatever  is  to  hand  ;  as  he  usu- 
ally finds  his  patient  greatly  exhausted,  either  from  protracted  labor  or 
the  mischievous  meddling  of  untutored  hands. 

The  animal  must  be  detached  from  the  manger  or  rack,  and  kept,  if 
possible,  in  a  standing  attitude  :  this  position  being  the  one  best  suited 
for  such  an  operation,  or  it  may  be  tied  by  the  head  to  a  stake,  by  a 
rather  long  head-rope.  A  rope,  or,  better  still,  a  rug  or  blanket,  should 
be  passed  round  the  hind-quarters,  a  little  above  the  hocks,  the  ends 
being  held  by  assistants  standing  towards  the  shoulders  of  the  animal. 
This  precaution  is  required  to  steady  the  creature,  to  keep  it  in  a  stand- 
ing position,  and  to  assist  it  in  resisting  the  traction  generally  employed 
in  removing  the  foetus.  It  may  be  necessary,  if  the  animal  is  much  ex- 
hausted or  suffering  much  pain,  to  administer  a  stimulant,  meal  or  flour 
gruel,  or  an  anodyne  draught. 

Cephalotomy. 

Every  operation  which  has  for  its  object  the  diminution  in  size  of  the 
head,  or  rather  cranium,  when  this  part  offers  an  obstacle  to  the  passage 
of  the  fcetus,  is  designated  by  this  name.  Hydrocephalus  is  the  condi- 
tion which  most  frequently  calls  for  the  operation  in  the  larger  animals  ; 
though  certain  malformations  and  monstrosities,  and  even^an  exaggerated 
volume  of  the  head  of  the  fcetus  in  the  Bitch  or  Cat,  may  also  require  it. 

Cephalotomy  comprises  several  distinct  operations,  which  may  be  per- 
formed independently  or  simultaneously.  These  are  simple  puncture,  in- 
cision, or  crushijig  of  the  cranial  parietes. 

Puncture  of  the  Cranium. 

In  order  to  allow  the  escape  of  fluid  from  the  cranium,  as  in  hydro- 
cephalus, and  thus  permit  the  birth  of  the  foetus,  a  simple  puncture  is  often 
all  that  is  necessary.  The  fluid  having  escaped,  the  thin  fragile  bones  of 
the  cranium  readily  collapse  from  the  pressure  they  undergo  in  the  pelvic 
cavity  ;  so  that  the  head  and  body  can  be  removed  by  traction. 

Supposing  the  presentation  to  be  anterior,  it  is  first  necessary  to  fix 
the  head,  unless  it  is  firmly  wedged  in  the  passage  ;  this  fixation  may  be 
effected  by  using  a  head-stall,  Schaack's  head-stall  forceps,  or  even  a 
cord  on  the  lower  jaw :  exercising  sufficient  traction  on  the  cord  to  pre- 
vent the  head  from  slipping  from  under  the  hand  of  the  obstetrist  during 
the  operation. 

The  head  may  be  punctured  by  a  scalpel,  straight  bistoury,  finger-knife, 
or  even  the  finger  in  certain  cases.     If  a  long-bladed  instrument  is  used, 


540 


OBSTETRIC  OPERA  TIONS. 


there  is  sometimes  a  good  deal  of  risk,  so  far  as  the  maternal  organs  are 
concerned  ;  and  it  is  advisable  to  wrap  twine,  tow,  or  tape,  around  a 
good  portion  of  the  blade  towards  the  handle. 

The  best  instrument,  if  it  is  at  hand,  is  a  long,  medium-sized  trocar  and 
cannula,  the  end  of  the  latter  fitting  closely  on  the  stalk  of  the  trocar, 
which  should  be  very  sharp.  It  is  introduced  safely  into  the  genital 
canal  by  drawing  the  point  sufficiently  far  back  into  the  cannula  as  to  be 
entirely  concealed.  This  end  is  then  seized  between  the  fingers  and 
thumb  in  such  a  way  that  the  index-finger  extends  a  little  beyond  the  ex- 
tremity of  the  cannula ;  the  other  three  fingers  holding  it  in  the  palm  of 
the  hand,  while  the  right  hand  sustains  and  guides  the  instrument. 
Should  the  trocar  not  fit  the  cannula  tightly,  the  play  between  the  two 
renders  their  indroduction  somewhat  difficult,  and  the  point  may  glide 
through  and  wound  the  operator.  The  trocar  may,  in  such  a  case,  be 
pushed  quite  through  the  cannula,  and  the  point  fixed  in  a  cork  which 
can  readily  be  knocked  off  by  one  of  the  fingers  when  the  instrument  has 
reached  the  head  of  the  foetus.  Having  arrived  at  this  part,  the  proper 
spot  for  puncture  is  selected,  and  then  the  instrument  is  applied  to  it — 
perpendicular  to  its  surface  if  possible,  to  prevent  slipping.  The  trocar 
is  made  to  penetrate  slowly  by  a  slight  rotatory  motion  from  side  to  side, 
and  when  all  resistance  ceases  the  cranium  is  perforated.  This  perfora- 
tion should  not  be  made  at  the  sutures,  if  they  can  be  avoided,  as  they 
overlap  and  close  the  opening.  The  cannula  is  now  held  firmly  in  its 
place  by  the  left  hand,  the  trocar  is  withdrawn  by  the  right,  and  the  fluid 
escapes.  The  instrument  should  be  sufficiently  long  for  the  end  to  be 
near,  or  even  outside,  the  vulva,  when  the  point  is  on  the  cranium  of  the 
foetus. 

There  is  no  difficulty  in  performing  this  operation  when  the  head  pre- 
sents first,  even  though  it  should  not  have  entered  the  inlet,  so  long  as  it 
is  easily  accessible  to  the  hand.  With  the  posterior  presentation,  how- 
ever, the  operation  is  troublesome  ;  as  owing  to  the  body  of  the  foetus 
occupying  the  passage,  it  is  extremely  difficult  to  pass  the  hand  armed 
with  the  trocar  so  far  as  the  head.  Nevertheless,  it  maybe  accomplished 
in  many  cases  by  patience  and  tact.  There  is  no  reason  why  the  trocar 
and  cannula  should  not  be  passed  through  the  mouth  of  the  foetus  in  some 
cases,  and  made  to  penetrate  the  cranium  at  the  base  of  the  skull,  when 
the  frontal  region  cannot  be  attained.  If  the  head  cannot  be  reached  in 
this  presentation,  then  exsection  of  the  body  of  the  young  creature  must 
be  practised,  and  the  parts  removed  until  the  head  can  be  manipulated. 

Craniotomy. 

Craniotomy  or  incisioJi  of  the  cranium,  is  resorted  to  when  puncture  has 
not  sufficiently  reduced  the  size  of  the  head.  It  is  an  operation  of  great 
antiquity  in  human  obstetrics,  and  various  instruments  have  been  intro- 
duced to  facilitate  its  performance  ;  but  very  few  of  them  have  been  util- 
ized in  veterinary  obstetrics,  and  indeed  for  the  larger  domesticated  an- 
imals they  are  of  no  use.  A  simple  straight  or  curved  bistoury.  Gunthers 
sliding  embryotom  (Fig.  187),  finger-scalpel  (Figs.  185,  186).  the  long- 
handled  embryotom  (Fig.  189),  scalpel  embryotom  (Fig.  188),  bone-chisel 
(Fig.  193),  or  saw  (Fig.  194),  may  one  or  all  be  employed,  according  to 
circumstances.  It  cannot  be  denied,  however,  that  the  operation  is  very 
difficult  to  execute,  and  not  without  serious  danger  for  the  parent.     Even 


EMBRYOTOMY.  541 

in  woman,  with  all  those  advantages  and  appliances  of  which  the  veter- 
inary obstetrist  cannot  avail  himself,  craniotomy  is  always  a  formidable 
undertaking.  The  cephalotribe  and  craniodast,  so  useful  in  human  obstet- 
ricy,  cannot  be  employed  with  our  animals,  it  would  appear  ;  but  there  is 
no  reason  why  modifications  of  these  instruments  might  not  be  devised 
to  answer  the  same  end. 

Hurtrel  d'Arboval  recommends  that  craniotomy  be  performed  with  a 
convex  probe-pointed  bistoury  (sharp  on  the  convex  border),  the  middle 
of  the  cranium  being  incised  ;  then  the  fingers  compress  the  bones,  and 
so  effect  delivery. 

Rainard  advises  two  incisions  on  each  side  of  the  head,  in  the  parietal 
region.  Giinther  mentions  that  if,  after  puncture,  the  operator  cannot 
crush  the  bones  of  the  cranium  with  the  hand,  they  should  be  cut  by 
his  secator,  and  removed  picemeal.  Carsten  Harms  states  that  when 
the  head  is  an  obstacle,  it  should  always  be  crushed,  if  possible,  the 
bones  being  broken  beneath  the  skin.  Sometimes  it  is  sufficient  to  re- 
move the  lower  jaw  ;  and  in  order  to  effect  this,  the  jaw  is  first  fixed  by 
a  cord,  the  skin  is  then  cut  through  on  each  side — from  the  commissure 
of  the  mouth  to  the  temporo-maxillary  articulation,  the  masseter  muscles 
and  the  ligaments  being  divided  ;  a  transverse  section  of  the  skin  is  now 
made  between  the  two  joints,  the  finger  separating  it,  and  two  or  three 
assistants  pulling  at  the  cord,  the  jaw  is  removed.  If  it  is  the  trans- 
verse diameter  of  the  head  which  forms  the  obstacle,  the  division  must 
be  longitudinal,  and  great  service  may  be  derived  from  the  use  of  the 
bone-chisel — either  Cartwright's  or  Margraff's  pattern.  As  much  of  the 
skin  should  be  left  as  possible,  in  order  to  cover  the  jagged  ends  of  the 
bones. 

With  the  smaller  animals,  puncture  and  craniotomy  are  not  at  all  diffi- 
cult operations,  the  bones  being  fragile  and  easily  perforated  or  crushed. 

Decapitation. 

Decapitation,  an  operation  which  consists  in  separating  the  head  com- 
pletely from  the  body,  so  as  to  allow  these  parts  to  be  removed  one  after 
the  other,  is  not  very  often  required  ;  and  fortunately  so,  as  it  is  not  with- 
out great  danger  to  the  parent.  More  frequently  the  head  is  partially  re- 
moved, the  fore-limbs  amputated,  or  evisceration  of  the  chest  or  abdo- 
men, or  both,  practised,  rather  than  resort  to  decapitation. 

Nevertheless,  it  is  indicated  when  a  double-headed  monstrosity — mon- 
osomian  or  sysooiian — is  presented,  and  in  certain  irreducible  malposi- 
tions of  the  head  or  limbs — especially  in  heifers,  when  the  head  of  the 
calf  is  in  the  genital  canal,  and  can  neither  be  advanced  nor  pushed 
into  the  uterus. 

The  operation  is  more  or  less  difficult,  according  to  the  situation  of 
the  head :  if  entirely  in  the  uterus  or  fixed  in  the  passage,  or  if  it  is  or 
can  be  brought  near  or  beyond  the  vulva.  In  the  latter  instance,  it  is 
easily  accomplished ;  although,  except  in  the  case  of  double  monstrosi- 
ties, it  is  rarely  very  useful,  as  when  the  head  is  in  this  situation  it  is 
not  an  obstacle  to  birth,  and  its  removal  deprives  the  operator  of  a  most 
powerful  means  of  exercising  traction  on  the  parts  which  are  firmly  re- 
tained in  the  maternal  organs.  When  wedged  in  the  canal,  however, 
the  head  may  prove  a  troublesome  obstacle  to  the  performance  of  those 
manoeuvres  necessary  for  the  reduction  of  other  parts  ;  as  it  may  not  be 
possible  either  to  advance  or  repel  it,  nor  yet  to  pass  the   hand  between 


542  OBSTETRIC  OPERATIONS. 

it  and  the  pelvic  walls  to  search  for  a  deviated  limb,  for  example,  or  to 
bring  this  limb  into  a  proper  position. 

The  passage  must,  therefore,  be  freed  from  the  obstacle,  and  this  can 
be  accomplished  in  various  ways,  the  most  common  of  which  is  as  fol- 
lows :  The  fore-limbs,  if  present,  are  corded  and  pushed  as  far  towards 
the  uterus  as  possible  ;  then  the  head  is  secured  by  cording  the  lower 
jaw,  a  pointed  hook  fixed  in  each  orbit,  or  a  head-collar  over  the  head  if 
it  can  be  placed.  Four  or  five  assistants  now  pull  at  the  head  by  these 
appliances,  so  as  to  bring  it  as  near  the  vulva  as  circumstances  will  per- 
mit ;  while  another  assistant  keeps  the  labia  apart,  in  order  to  expose  as 
much  of  the  head  as  he  can,  and  prevent  injury  to  the  organs  of  the 
parent.  The  operator,  with  a  convenient  knife  (the  curved  finger-scalpel 
is  very  useful),  incises  the  skin  around  the  neck — first  one  side,  then  the 
other — close  to  the  occiput,  passes  his  fingers  between  it  and  the  muscles 
beneath,  and  pushes  it  well  back  on  the  neck — the  assistants  pulling  at  the 
head  at  the  same  time  facilitate  this  separation.  A  few  cuts  now  divide 
the  soft  tissues  down  to  the  vertebrae,  and  nothing  more  remains  to  be 
done  than  to  produce  disarticulation  by  vigorous  traction,  and  a  twisting 
movement  of  the  head  at  the  same  time  ;  the  ligaments  gradually  yield 
and  tear,  the  head  extends  and  at  last  comes  away,  and  the  body  of  the 
foetus  recedes  more  or  less  suddenly  into  the  abdominal  cavity.  If  the 
limbs  have  been  previously  secured,  they  are  brought  into  the  passage  by 
the  cords  attached  to  them  \  or  if  they  are  not  so  accessible,  they  must 
be  sought  for  in  the  way  already  indicated,  and  delivery  completed :  care 
being  taken  to  cover  the  exposed  bones  of  the  neck  by  the  surplus  skin, 
while  the  foetus  is  being  brought  through  the  passage. 

Another  method  is  to  make  an  incision  through  the  skin  across  the 
forehead,  in  front  of  the  ears,  and  to  separate  it  by  means  of  the  fingers 
or  spatula  as  far  as  the  occipital  articulation.  The  knife  divides  this 
joint,  as  well  as  the  soft  tissues  around  it,  and  particularly  the  ligaments  ; 
traction  will  bring  away  the  head.  The  upper  part  of  the  neck  is  covered 
by  the  loose  skin — which  may  be  fixed  there  by  ligature — and  directed 
into  the  middle  of  the  passage.  Crotchets  should  now  be  placed  on  the 
bodies  of  the  vertebrae,  or  even  on  the  ribs  if  they  can  be  reached  ;  as  the 
limbs  do  not  offer  sufficient  resistance  if  they  alone  are  pulled  at,  neither 
do  they  bring  the  body  fairly  into  the  passage.  Traction  should  be  made 
on  the  sternum,  not  the  withers,  as  the  latter  ought  first  to  enter  the  inlet. 

A  third  method  consists  in  removing  the  lower  jaw,  and  excising  the 
head  from  below.  Or  this  excision  may  be  practise<^  from  the  mouth, 
the  chisel  being  used  to  divide  the  vertebrae,  after  the  cheeks,  masseter 
muscles,  and  soft  tissues  behind  the  lower  jaw  have  been  cut  through. 

Decapitation,  under  the  most  favorable  circumstances,  is  often  a  long 
and  fatiguing  operation,  as  the  greatest  care  has  to  be  observed  in  order 
to  avoid  injuring  the  parent.  But  this  fatigue  and  anxiety  are  vastly  in- 
creased, when  the  head  is  deeply  buried  in  the  passage  or  the  uterus. 
Then,  as  Saint-Cyr  truthfully  says,  the  hand,  moist  with  the  fluids  of  the 
genital  organs,  embarrassed  by  shreds  of  the  foetal  envelopes,  ham- 
pered by  the  presence  of  the  limbs,  compressed  and  paralyzed  by  the 
uterine  contractions — the  hand  can  then  scarcely  hold  and  guide  the 
cutting  instrument,  or  distinguish  what  belongs  to  the  foetus  and  what  to 
mother,  and  has  no  longer  any  strength  to  divide  the  tissues,  which 
are  all  the  more  difficult  to  cut  by  reason  of  their  softness  and  flaccidity. 
It  will  readily  be  understood  how  such  an  operation  must  be  difficult  for 


EMBRYOTOMY.  543 

the  operator  and  dangerous  for  the  mother.  It  would  almost  be  deemed 
impossible,  if  veterinarians  had  not  attempted  it  and  succeeded  ;  though 
the  majority  of  them  have  said  but  little  as  to  their  mode   of  procedure. 

It  is  always  preferable,  if  possible,  to  remove  one  of  the  fore-limbs,  as 
this  is  easier,  quicker,  and  less  dangerous. 

But  decapitation  must  sometimes  be  performed,  and  then   the   above 
instructions  will  be  found  useful. 

•  In  the  case  of  double-headed  monstrosities,  the  saw  and  bone-chisel, 
or  a  pair  of  strong  bone-forceps,  will  be  valuable.  When  the  head  of 
the  foetus  is  retained  in  the  uterus,  and  bent  back  towards  the  shoulder 
or  flank,  then  it  may  be  decided  to  amputate  the  head  should  it  and  the 
neck  be  distorted.  Disarticulation  may  be  commenced  at  the  most  con- 
venient part  of  the  convexity  made  by  the  bend  of  the  neck,  cutting 
through  the  soft  tissues  down  to  the  vertebra  on  that  side,  then  on  the 
other  ;  then  sawing  or  chiselling  through  the  bones,  and  afterwards  using 
the  crotchets  carefully. 

Amputation  of  the  Limbs. 

When  the  limbs  are  so  deviated  that  they  cannot  be  straightened,  or 
when  by  their  presence  in  the  genital  passage  they  prevent  the  necessary 
manoeuvres  for  the  adjustment  of  other  parts  of  the  foetus,  then  it  may 
be  necessary  to  amputate  or  disarticulate  one  or  more  of  the  extremities. 
Some  of  the  indications  for  the  operation  have  been  referred  to  on  vari- 
ous occasions  :  they  include  all  those  foetal  monstrosities  which  have  su- 
pernumerary limbs  that  require  removal  before  delivery  can  be  effected  ; 
those  cases  in  which  the  foetus  is  exaggerated  in  volume,  either  normally, 
or  through  having  become  emphysematous  after  death  in  utero ;  those 
complicated  malpresentations,  such  as  the  abdominal,  hock,  thigh,  etc., 
and  certain  deviations  of  the  head  and  neck  in  the  anterior  presentation. 
Saint-Cyr  points  out  that,  in  the  latter,  it  is  well  to  hesitate  before  de- 
cidiug  to  remove  the  limbs  ;  for  if  it  is  true  that  their  ablation  allows 
more  space  for  manoeuvres,  and  more  facility  for  adjusting  the  head,  it  is 
not  less  true  that,  should  these  manoeuvres  fail,  by  the  loss  of  the  limbs 
we  are  deprived  of  a  powerful  means  of  traction  when  we  are  compelled, 
as  a  derniere  ressource,  to  adopt  forced  extraction.  Besides,  it  must  not  be 
forgotten  that  embryotomy  is  itself  an  extreme  measure,  to  which  we 
should  only  have  recourse  when  every  other  fails  or  seems  to  be  really 
hopeless. 

One  or  both  of  the  fore  or  hind-limbs  may  be  required  to  be  ampu- 
tated, according  to  circumstances.  In  the  earlier  days  of  veterinary 
science,  the  obstetrist  was  content  to  pull  at  the  limb  of  the  foetus  which 
he  wished  to  remove,  either  by  mechanical  or  manual  power,  until  it  was 
torn  off  by  brute-force.  Fromage  de  Feugre  mentions  that  Texier  had  in 
this  manner  torn  away  the  limbs  of  many  foals  which  he  could  not  ex- 
tract— the  separation  of  the  limb  always  taking  place  between  the  chest 
and  scapula,  by  rupture  of  the  muscles  uniting  these  two  parts  ;  and  he 
asserts  that  by  this  procedure  he  was  able  to  save  many  Mares — though 
he  says  nothing  as  to  the  suffering  of  these  before  the  limbs  could  be 
torn  from  the  body. 

Subsequently,  it  was  discovered  that  the  skin  offered  most  resistance 
to  this  kind  of  avulsion — the  muscles  and  ligaments  being  much  more 
easily  torn.  Then  the  knife  was  employed  to  incise  the  skin,  and  thus 
get  rid  of  the  chief  difficulty.     On  the  Continent,  in  amputating  a  fore 


544  OBSTETRIC  OPERATIONS. 

limb,  for  instance,  the  skin  and  muscles  were  divided  as  near  the  shoul- 
der as  possible,  and  the  bones,  united  by  their  ligaments  and  covered 
by  the  skin,  separated  by  traction.  Skellet,  in  his  crude  and  imperfect 
work  {A  Practical  Treatise  on  the  Parturition  of  the  Cow),  published  in 
1807,  writes:  "Take  a  sharp  knife,  and  cut  from  the  point  of  each 
shoulder  of  the  calf  to  the  muscular  or  thick  part  of  the  fore-leg ;  then 
cut  round  it,  so  as  to  enable  the  operator  to  skin  the  upper  part  of  the 
shoulder.  A  knife  is  then  to  be  conveyed  betw^een  the  shoulder  and 
brisket,  so  as  to  cut  the  muscles  which  unite  them.  When  so  done,  the 
leg  and  shoulder  may  be  easily  pulled  off  from  its  body.  The  other 
fore-leg,  etc.,  is  to  be  taken  off  in  the  same  way."  But  the  subcutaneous 
method  of  excision  was  greatly  facilitated  by  the  directions  published  in 
Gilnther's  work  in  1830,  and  also  by  the  publication  of  the  procedure  of 
Huvellier  in  the  same  year  {Recueil  de  Med.  Vet^rinaire,  1830,  p.  449); 
while  the  parent  was  protected  from  some  of  the  dangers  and  pain  which 
attended  the  old  plan.  Since  the  introduction  of  this  method,  it  has 
been  adopted  by  every  obstetrist  of  note,  who  has  either  kept  to  the 
original  manuel  operatoire,  or  modified  it  to  suit  his  own  fancy  or  con- 
venience. 

Amputation  of  the  Fore-Limbs. 

In  order  to  amputate  a  fore-limb,  it  must  be  more  or  less  advanced  in 
the  vagina,  or  even  beyond  the  vulva.  So  that,  if  it  is  still  in  the  uterus, 
it  must  first  be  removed  therefrom  and  brought  into  the  canal.  If  both 
limbs  are  to  be  removed,  they  must  be  secured  by  cords  around  the 
pastern  in  the  ordinary  manner,  the  cord  of  the  one  which  is  to  be  first 
excised  being  pulled  at  by  two,  three,  or  four  assistants,  so  as  to  draw  it 
as  near,  or  as  much  beyond,  the  vulva  as  possible.  Another  assistant 
then  keeps  the  lips  of  the  vulva  wide  apart,  in  order  to  allow  the  opera- 
tor more  room.  The  latter  makes  a  circular  incision  above  the  fetlock 
— or,  better  still,  the  knee,  taking  care  not  to  go  deeper  than  the  ^in. 
From  this  incision,  gliding  his  hand  into  the  vagina,  along  the  limb,  he 
gradually  makes  a  longitudinal  one,  extending  higher  up  as  the  leg  be- 
comes elongated  by  the  traction. 

Bome  practitioners  make  this  incision  on  the  inner  aspect  of  the  limb, 
others  on  the  outer  side.  On  the  latter  there  is  perhaps  less  danger  of 
wounding  the  maternal  organs,  and  it  may  be  more  convenient  for  the 
operator.  But  this  is  a  matter  of  minor  importance  ;  it  is  more  neces- 
sary to  be  careful  in  incising  the  skin  over  the  articulations,  so  as  not  to 
divide  the  ligaments  of  these,  as  this  might  lead  to  the  limb  being  torn 
away  at  the  wrong  place ;  no  such  precaution  is  necessary  with  the 
muscles. 

This  longitudinal  incision  having  being  made,  the  skin  is  separated 
from  the  structures  beneath,  either  by  means  of  the  fingers  or  spatula  : 
pushing  it  up  towards  the  shoulder  as  it  is  detached,  until  at  length,  as 
the  leg  becomes  stretched,  the  incision  and  the  detached  skin  are  as 
high  as  the  shoulder.  The  dissection  being  then  deemed  sufficient,  and 
the  limb  being  only  retained  by  the  muscles  which  attach  it  to  the 
thorax,  the  operator,  either  by  his  hand  or  the  crutch,  makes  pressure  on 
the  foetus,  while  the  assistants  are  ordered  to  pull  energetically  at  the  ^ 
cord  on  the  pastern,  and  in  a  kind  of  jerking  manner.  Soon  slight  crack-  ' 
ing  sounds  are  heard,  the  muscles  are  rupturing  and  giving  way,  and  in  a 
very  short  time  the  entire  limb — scapula  and  all — is  removed. 


EM  BR  yq  TOM  V.  5  43 

The  removal  of  one  limb  usually  leaves  a  considerable  space  in  the 
genital  canal,  and  this  allows  delivery  to  be  completed.  Sometimes, 
however,  and  particularly  when  the  head  is  deviated  towards  the  flank, 
it  is  necessary  to  remove  the  other  limb  ;  and  this,  when  effected,  per- 
mits the  head  to  be  sought  for  and  rectified,  version  accomplished,  etc., 
according  to  the  requirements  of  the  case. 

Some  practitioners  operate  in  a  somewhat  different  manner  to  the  fore- 
going. Lecoq,  for  instance,  commences  his  incision  at  the  upper  part  of 
the  shoulder,  brings  it  down  over  the  head  of  the  humerus,  on  the  side 
of  the  fore-arm,  and  as  far  as  the  middle  of  the  cannon,  where  he  makes 
his  circular  incision  ;  the  skin  is  separated  from  this  part  upwards.  In 
some  cases  this  procedure  may  be  preferable  to  the  other,  and  it  cer- 
tainly is  less  dangerous  for  the  parent ;  but  it  may  sometimes  happen 
that  the  shoulder  cannot  be  reached. 

Giinther  pushed  back  the  foetus  as  far  as  possible  by  means  of  the 
crutch,  then  with  the  finger-scalpel  divided  the  skin  before  and  behind 
the  scapula,  then  across — below  and  above  ;  cutting  through  the  pectoral 
muscles,  and  then  extracting  the  limb.  Cartwright  operates  in  a  similar 
manner  to  Lecoq.  He  first  has  a  leg  drawn  out,  and  divides  the  skin  as 
far  as  possible  ;  or  he  introduces  his  hand,  containing  a  knife,  as  high  as 
he  can  on  the  side  of  the  scapula,  and  makes  an  incision  thence  down  the 
whole  length  of  the  limb  to  the  pastern  bones  ;  the  skin  is  separated  by 
the  fingers  or  spatula  as  far  as  possible  from  the  entire  leg,  and  the  trans- 
verse pectoral  muscles  cut  through.  The  limb  is  then  disjointed,  either 
at  the  pastern  or  fetlock ;  the  foot  being  left  attached  to  the  skin,  as  it  is 
afterwards  found  to  be  useful  in  the  extraction  of  the  body.  Cords  are 
fastened  around  the  limb  above  the  fetlock-joint  and  knee,  and  the  Cow 
being  firmly  tied  by  the  head,  the  necessary  force  is  applied,  and  the 
whole  limb  drawn  away.  He  writes,  "  I  have  known,  in  some  of  these 
cases,  the  limbs  to  separate  at  the  shoulder  joints,  and  yei;  the  foetus  has 
been  extracted — both  from  the  Mare  and  Cow — with  the  shoulders 
attached,  the  points  of  the  latter  having,  fortunately,  not  caught  the  edge 
of  the  pelvis.  The  great  danger  in  these  cases  is,  that  the  shoulder  joints 
may  catch  against  the  pelvis  and  thus  prevent  extraction." 

Meyer  recommends  that  the  circular  incision  on  the  cannon  be  not 
made  until  the  skin  is  detached  above,  as  this  facilitates  avulsion. 

It  is  well  to  divide  as  many  of  the  muscles  uniting  the  limb  to  the  chest 
as  possible,  and  also  to  apply  counter-extension  by  means  of  the  arm 
or  crutch  placed  against  the  chest  or  opposite  shoulder  of  the  foetus  ; 
this  also  spares  the  mother  much  of  the  pain  and  exhaustion  attending 
extraction.- 

Amputation  of  the  entire  fore-limb,  including  the  scapula,  is  a  very 
useful  operation  in  the  most  serious  cases  of  dystokia  ;  but  there  some- 
times occur  instances  in  which  the  whole  leg  need  not  be  excised — as 
when  the  legs  are  an  obstacle  rather  from  their  length  than  their  volume. 
This  happens,  as  has  been  described,  in  the  abdominal  presentation  of  the 
foetus,  when  the  limbs  so  often  render  version  difficult — all  of  them  being 
perhaps  in  the  genital  canal,  from  which  they  cannot  be  advanced  or 
pushed  back.  In  these  circumstances,  disarticulation  of  the  limbs  at  the 
knee  or  elbow  joints  is  often  practised — the  latter  being  generally  pre- 
ferred ;  though  it  must  be  remembered  that  excision  at  this  part  can  be 
but  of  limited  value,  and,  in  fact,  is  only  useful  in  the  presentation  just 
alluded  to,  because  it  does  not  give  so  much  room  as  removal  of  the 
scapula  and  humerus.  35 


I 


546  ■    OBSTETRIC  OPERATIONS. 

In  the  abdominal  presentation  with  four  legs  in  the  vagina,  Donnarieix 
lays  down  the  following  procedure  :  Three  pieces  of  supple  twine  are  got 
ready,  as  well  as  a  strong  cord.  With  the  twine  the  pasterns  of  three  of 
the  limbs  are  firmly  bound,  while  the  cord  is  fixed  on  the  limb  which  is  to 
be  detached,  and  confided  to  five  assistants,  who  pull  at  the  cord  while  the 
other  limbs  are  pushed  towards  the  uterus.  The  knee,  then  the  fore-arm 
appear,  and  the  lips  of  the  vulva  being  kept  widely  separated,  the  ope- 
rator makes  a  circular  incision  through  the  skin  at  this  part ;  traction  is 
again  applied,  the  muscles  tear,  and  gradually  the  joint  is  reached.  The 
tendons  and  ligaments  are  cut,  and  the  leg  being  twisted  as  it  is  pulled 
at,  another  cut  of  the  knife  finally  removes  it. 

With  the  Sheep  or  Goat,  amputation  of  the  fore-limbs  of  the  fcetus  is 
very  rarely  indeed  required,  though,  if  necessary,  it  can  be  effected.  The 
same  remark  applies  to  the  Bitch  and  Cat. 

Amputation  of  the  Hind-Limbs. 

When  the  foetus  makes  a  posterior  presentation,  with  the  hind-limbs 
flexed  at  the  hocks,  and  so  firmly  wedged  in  the  canal  that  they  cannot 
be  extended  backwards,  nor  yet  sufficiently  bent  to  permit  delivery — 
which  is  far  from  being  rare  in  the  Mare — these  joints  are  disarticulated. 

This  is  accomplished  by  passing  a  running  noose  round  each  leg,  above 
the  hock,  and  tying  it  firmly  there.  Powerful  traction  being  made  on  one 
of  the  cords  by  four  or  five  assistants,  will  bring  the  point  of  one  of  the 
hocks  to  the  vulva,  the  lips  of  which  are  separated,  while  the  operator 
divides  the  gastrocnemii  tendons  and  the  lateral  ligaments  of  the  joint,  so 
as  to  produce  complete  disarticulation.  The  tibia  is  then  pushed  into 
the  vagina,  the  other  limb  is  amputated  in  the  same  way,  and  birth  is 
accomplished  by  pulling  at  both  cords,  which  remain  attached  to  the  lower 
end  of  the  leg-bone. 

When  the  limbs  are  completely  retained  in  the  uterus  in  this  presenta- 
tion, the  procedure  recommended  at  pages  486  and  515  must  be  adopted. 
We  may  remark  that  Carsten  Harms  recommends  symphysiotomy  to  be 
practised  on  the  fcetus,  when  the  buttocks  present  at  the  inlet — the  sym- 
physis pubis  being  cut  through.  By  this  means,  the  two  borders  of  the 
symphysis  can  be  made  to  overlap,  and  the  transverse  diameter  of  the 
pelvis  thereby  diminished.  The  finger-scalpel  and  spatula  are  the  instru- 
ments he  prefers.     The  saw  might  be  advantageously  used. 

In  certain  kinds  of  monstrosity  in  which  the  posterior  parts  of  the  foetus 
are  double,  or  when  the  hind-limbs  are  in  the  vagina,  and  in  consequence 
of  the  narrowness  of  the  maternal  pelvis,  or  width  of  the  croup,  or 
haunches  of  the  young  creature,  birth  cannot  take  place,  them  amputation 
of  the  legs  at  the  trunk  may  be  necessary.  Such  an  operation  can  be 
rarely  required,  however.  It  is  performed  in  a  similar  manner  to  that 
for  removal  of  the  fore-limbs — subcutaneously.  A  cord  is  fastened  to 
each  pastern,  and,  one  after  another,  the  limbs  are  drawn  towards  the 
vulva ;  a  circular  incision  is  made  through  the  skin  above  the  hock ;  then 
a  longitudinal  incision  is  carried  as  high  as  possible  on  the  thigh,  and  the 
skin  separated  in  the  ordinary  way  by  means  of  the  spatula — always  as- 
cending towards  the  croup  ;  the  gluteal  and  other  muscles  attaching  the 
thigh  to  the  pelvis  are  cut  across,  and  the  limb  is  at  last  torn  away  by 
strong  and  sustained  traction. 

Amputation  of  the  hind-limb  is  a  much  more  onerous  and  fatiguing 


EMBRYOTOMY. 


547 


operation  than  the  removal  of  the  fore-extremity.  The  skin  adheres  very 
closely  to  the  subjacent  textures,  and  more  labor  is  needed  to  separate  it ; 
the  muscles  attaching  the  limb  to  the  trunk  are  more  numerous  and 
powerful,  and  when  they  are  cut  through  there  remains  the  resistance  of 
the  pubio  and  coxo-femoral  ligaments  (in  the  foal — the  pubio-femoral 
ligament  is  not  present  in  the  calf).  Harms  estimates  that  if  three  assist- 
ants can  pull  away  a  fore-limb,  four  men  will  not  in  every  instance  remove 
a  hind  one.  However,  the  difficulties  are  not  always  insuperable,  and 
many  cases  are  on  record  in  which  the  operation  has  been  successfully 
performed. 

After  avulsion  of  the  limbs,  crotchets  should  be  fixed  in  the  cotyloid 
cavities  or  oval  foramina,  and  delivery  completed  according  to  the  direc- 
tions already  laid  down. 

Division  or  Detruncation  of  the  Fcetus. 

When  one-half  of  the  body  of  the  foetus  has  more  or  less  passed 
through  the  pelvic  canal,  and  the  other  half  is  retained,  so  that  it  is  impos- 
sible to  extract  or  return  it,  it  is  recommended  to  cut  the  trunk  in  two — 
division  or  detruncation.  We  have  shown  that  this  retention  may  be  due 
to  malposition  or  malpresentation,  excessive  development  of,  or  deformity 
in  the  hind-quarters  of  the  fcetus,.  as  well  as  ascites,  anasarca,  or  emphy- 
sema {physometrd). 

If  the  hind-parts  are  retained,  and  the  head  and  fore-limbs  are  not 
much  beyond  the  vulva — if  so  far — cords  should  be  placed  on  each 
pastern,  and  a  head-stall  on  the  head,  and  slow,  gradual,  but  strong 
traction  exerted  on  them,  so  as  to  expose  as  much  of  the  body  of  the 
young  creature  as  possible.  This  done,  the  operator,  with  a  sharp 
bistoury,  incises  the  body  in  a  circular  manner  as  close  to  the  vulva  as  is 
convenient  (the  labia  being  kept  well  out  of  the  way  by  an  assistant) — 
the  incision  commencing  below,  which  allows  the  elongation  of  the 
vertebral  stalk  ;  then  the  skin  and  muscles  on  the  sides  are  divided. 
When  the  vertebrae  are  reached,  the  bistoury  is  passed  between  them, 
and  as  close  to  the  loins  as  possible  ;  slight  pulling  and  twisting  will 
then  complete  the  bisection. 

It  is  a  good  plan  to  incise  the  skin  at  some  distance  in  front  of  the 
place  where  it  is  intended  to  divide  the  spine,  and  to  separate  and  push 
it  back  over  the  portion  of  trunk  in  the  genital  canal.  When  the  divis- 
ion of  the  body  is  effected,  this  superfluous  skin  is  pulled  forward  over  the 
mutilated  remaining  part  of  the  trunk  and  sewn  together,  so  as  to  en- 
close the  latter  completely,  and  prevent  injury  to  the  parent  during  the 
subsequent  manoeuvres. 

Should  the  hind-limbs  be  doubled  under  the  croup  in  the  passage,  or 
should  they  still  be  in  the  uterus,  they  ought  to  be  sought  for  and  corded  at 
the  pasterns,  the  cords  being  given  to  assistants.  Then  vigorous  pres- 
sure is  applied  to  the  divided  end  of  the  spine  in  the  remaining  part  of 
the  trunk,  while  the  assistants  pull  until  version  is  effected  ;  extraction  is 
afterwards  easy.  In  some  cases  it  is  not  necessary,  nor  is  it  always 
possible,  to  secure  the  hind-limbs  before  the  trunk  is  pushed  into  the 
uterus,  version  taking  place  merely  by  the  retropulsion  ;  and  sometimes, 
when  one  limb  has  been  found,  there  is  much  difficulty  in  discovering 
the  other.  In  such  a  case,  and  when  version  cannot  be  effected,  Rain- 
iard  recommends  that  the  limb  which  has  been  secured  be  drawn  towards 


548  OBSTETRIC  OPERATIONS. 

the  vulva,  and  disarticulated ;  this  will   enable  the  operator  to  find  the 
other  leg. 

The  foetus,  when  wholly  retained  in  the  uterus,  has  been  divided,  ac- 
cording to  the  reports  of  several  veterinarians,  successfully  ;  but  they 
have  not,  it  would  appear,  furnished  us  with  any  details  as  to  the  pro- 
cedure they  adopted.  In  particular  circumstances  it  might  certainly  be 
accomplished,  but  we  scarcely  see  the  necessity  for  it. 

Evisceration. 

When  it  is  desired  to  reduce  the  volume  of  the  thorax  or  abdomen,  or 
both,  the  organs  they  contain  are  removed. 

This  procedure  is  generally  adopted  when,  after  removal  of  one  or 
more  of  the  limbs,  the  body  of  the  fcetus  still  remains  fixed  in  the  genital 
canal ;  by  it  we  obtain  a  considerable  diminution  in  the  dimensions  of 
these  regions,  and  perhaps  next  to  the  removal  of  the  limbs  it  is  the  most 
useful  operation  in  embryotomy,  and  is  to  be  highly  recommended. 

As  we  have  said,  evisceration  of  either  of  the  cavities  may  be  practised, 
according  to  circumstances.  We  shall,  therefore,  describe  the  mode  of 
reducing  the  volume  of  both — thorax  and  abdomen. 

Thoracic  Evisceration. 

The  chest  is  emptied  of  its  contents  first,  when  the  anterior  part  of  the 
foetus  is  in  the  passage.  The  head  and  limbs  should  be  corded — if  one 
of  the  latter  is  removed  all  the  better ;  if  not,  the  cords  should  be  pulled 
well  upwards,  in  order  to  make  more  room.  Should  the  head  be  an 
obstacle  to  the  performance  of  the  operation,  it  may  be  amputated  ;  but 
if  it  is  back  in  the  uterus,  then  it  may  be  left  there.  A  strong  scalpel 
with  a  long  handle,  the  finger-scalpel,  or  either  of  the  two  embryotoms 
shown  in  Figs.  187,  188,  is  the  best  instrument.  It  is  passed  carefully 
into  the  vagina  until  the  hand  reaches  the  breast  of  the  foetus,  when  the 
blade  is  thrust  deeply  into  the  chest,  between  the  two  front  ribs,  and  as 
close  to  the  spine  as  possible,  cutting  down  towards  the  sternum. 

The  knife  is  now  dispensed  with,  and  the  hand  being  re-introduced, 
the  fingers  are  pushed  into  the  foetal  chest  and  the  two  first  ribs  removed, 
thereby  allowing  sufficient  room  for  the  whole  hand  to  enter  the  cavity. 
The  lungs  and  heart  are  torn  away  from  beneath  the  spine,  and,  with  the 
thymus  gland,  removed  from  the  uterus.  The  chest  collapses  a  good 
deal,  but  if  the  foetus  cannot  yet  be  extracted,  the  hand  may  be  pushed 
through  the  diaphragm,  and  the  contents  of  the  abdomen  carried  away 
through  the  chest. 

Some  operators,  instead  of  opening  the  thorax  in  front,  incise  from  two 
to  five  of  the  ribs  close  to  the  sternum,  and  pass  the  hand  into  the  chest 
by  the  aperture  so  made.  Others  divide  the  ribs  on  both  sides,  and 
remove  the  sternum  as  well  as  the  viscera.  It  will  often  be  found  that 
the  contents  of  the  chest  and  abdomen  can  be  removed  without  cutting 
the  ribs. 

Abdominal  Evisceration. 

Evisceration  of  the  abdomen  may  be  effected,  as  just  stated,  through 
the  thorax,  by  tearing  away  the  diaphragm. 

But  in  the  posterior  or  abdominal  presentations,  and  indeed  in  any 
presentation  or  position  in  which  this  region  is  accessible  to  the  hand. 


VAGINAL  HYSTEROTOMY. 


549 


eventration  can  be  performed.  Nevertheless,  it  is  not  always  easy  ;  on 
the  contrary,  it  is  sometimes  most  difficult  and  dangerous. 

Either  of  the  embryotoms  used  for  evisceration  of  the  chest  may  be 
employed  for  the  abdomen. 

The  edge  of  the  instrument  is  applied  to  the  wall  of  the  cavity,  which 
is  incised  by  drawing  the  hand  towards  the  operator.  Then  the  whole 
of  the  viscera  are  torn  away,  and,  if  need  be,  that  of  the  chest  also, 
through  the  diaphragm. 

This  terminates  what  we  have  to  state  with  regard  to  embryotomy ; 
and  it  will  be  remarked  that  nearly  all  the  operations  connected  with  it 
require  much  time,  are  fatiguing  for  the  operator,  and  only  too  often 
very  exhausting  and  serious  for  the  parent.  During  the  operations,  the 
latter  should  receive  the  greatest  consideration  ;  from  time  to  time,  an 
interval  ought  to  be  allowed  for  it  to  rest  or  to  rally  from  the  exhaustion 
which  is  always  evident  to  the  attentive  obstetrist.  It  may  even  be 
necessary  to  give  it  a  stimulant  in  the  form  of  brandy,  beer,  etc.,  or 
nourishing  drinks — warm  or  tepid  if  convenient. 

The  greatest  care  should  be  observed  in  preventing  injury  to  the 
maternal  organs  from  the  cutting  instruments  employed,  or  from  the 
ends  of  divided  bones 


CHAPTER   III. 

Vaginal  Hysterotomy. 

At  page  349  we  alluded  to  induration  of  the  cervix  uteri  as  a  cause  of 
dystokia,  and  described  more  or  less  fully  the  indications  for  overcoming 
the  obstacle ;  we  also  alluded  to  the  manner  in  which  these  indications 
should  be  carried  out.  As  we  are  now  treating  of  obstetric  operations 
for  the  extraction  of  the  foetus,  it  is  necessary  that  we  describe  more  fully 
the  operation  and  its  consequences,  as  these  are  of  much  importance. 

Vaginal  hysterotomy  consists  in  incising  the  indurated  and  inextensi- 
ble  neck  of  the  uterus,  in  such  a  manner,  and  to  such  an  extent,  that  it 
will  allow  the  foetus  to  pass  through  its  canal. 

For  this  purpose,  the  only  instrument  necessary  is  a  strong  probe- 
pointed  bistoury,  a  bistoury  cache,  or  one  of  the  finger-scalpels  or  other 
embryotoms.  When  the  straining  of  the  animal  has  propelled  the  cervix 
uteri  towards  the  vulva,  with  partial  prolapsus  of  the  vagina,  the  opera- 
tion is  simple,  as  the  eye  can  then  aid  the  hand.  All  that  has  to  be  done 
is  to  glide  the  instrument  into  the  os,  and  make  the  necessary  number  of 
incisions  through  the  tissues  composing  the  cervix :  the  situation  and 
depth  of  the  incisions  depending  upon  the  extent  of  the  induration  and 
the  atresia. 

In  other  cases  there  is  no  prolapsus  of  the  vagina,  which  is  quite  soft 
and  elastic.  Then  the  left  hand  may  be  passed  into  it,  and  the  index- 
finger  being  introduced  into  the  os,  draws  the  cervix  towards  the  vulva  ; 
tlie  labia  of  the  latter  are  separated  by  an  assistant,  and  the  operator 
passes  the  blade  of  the  instrument — guiding  it  by  the  index-finger  of  the 
other  hand — into  the  os,  where  he  gradually  and  steadily  incises  the 
tissues. 


550 


OBSTETRIC  OPERATIONS. 


When,  however,  the  walls  of  the  vagina  are  involved  in  the  induration, 
this  retraction  of  the  cervix  cannot  be  effected,  and  the  part  must  be  op- 
erated upon  in  its  ordinary  situation  :  the  knife  being  carried  carefully 
into  the  vagina,  passed  to  the  necessary  depth  in  the  os,  and  the  incision 
made.     Perhaps  the  bistoury  cache  is  the  best  instrument  for  such  cases. 

It  is  rare  indeed  that  one  incision  is  sufficient;  generally  from  two  to 
four  are  required,  and  it  is  better  to  have  a  larger  number  than  make 
them  too  deep  ;  they  certainly  must  not  pass  through  the  entire  thickness 
of  the  cervix. 

The  situation  of  the  incisions  is  a  matter  of  some  moment.  The  lower 
portion  of  the  cervix  should  be  avoided,  in  consequence  of  its  proximity 
to  the  floor  of  the  vagina,  which  is  in  immediate  contact  with  the  bladder 
and  urethra  ;  should  these  be  wounded,  the  results  might  be  serious,  if  not 
fatal ;  and  if  the  peritoneum  is  cut  or  torn  during  the  passage  of  the 
foetus,  fluids  and  discharges  will  escape  into  the  abdominal  cavity,  and 
give  rise  to  peritonitis.  There  is  less  danger  in  incising  the  upper  part 
of  the  cervix,  as  the  rectum  is  not  so  near  ;  nevertheless,  in  induration 
there  may  be  adhesions  between  them,  and  an  accident  is  therefore  pos- 
sible— though  it  must  be  rare. 

So  that,  if  only  two  incisions  are  required,  it  is  advisable  to  make  one 
on  each  side  of  the  cervix  ;  and  if  four  are  necessary,  to  have  them  at 
each  corner. 

Horsburgh  {^Veterinarian,  vol.  xviii.,  p.  215)  recommends,  if  the  atresia 
is  complete,  to  pass  the  finger  or  a  blunt  instrument  into  the  os,  then  in- 
troduce a  stout,  sharp-pointed,  curved  bistoury  about  four  inches  long — 
dividing  the  stricture  laterally  by  two  incisions — always  drawing  the  bis- 
toury towards  the  operator ;  after  which  he  is  to  introduce  both  hands, 
with  the  palms  towards  each  other,  and  press  them  apart.  "  He  will 
find  the  part  immediately  dilate  to  the  proper  size,  and  labor  may  go  on 
naturally ;  or  he  may  then  proceed  to  extract  the  calf  if  labor  has  been 
protracted." 

The  object  in  making  the  incisions  only  to  a  comparatively  slight  depth, 
and  not  through  the  entire  thickness  of  the  os,  is  to  prevent  extensive 
lacerations  of  the  organ  during  the  passage  of  the  fcetus.  It  will  gen- 
erally be  found  that  these  partial  incisions  will,  with  a  little  patience, 
admit  the  hand  ;  this  being  passed  into  the  uterus,  seizes  the  presenting 
part  of  the  young  creature,  places  it  in  a  favorable  position  if  necessary, 
and  then  begins  to  draw  it  gently  into  the  os. 

Sometimes  with  primiparae  in  good  health  and  strong,  delivery  is  after- 
wards effected  spontaneously,  and  this  is  the  most  favorable  result ;  but 
in  the  majority  of  cases  labor  has  been  going  on  for  a  long  time — per- 
haps two  days  or  more,  the  parent  is  exhausted,  and  the  uterine  contrac- 
tions are  either  suspended,  or  so  feeble  as  to  preclude  all  hope  of  their 
expelling  the  foetus.  The  head  and  fore-feet  must  then  be  corded,  and 
delivery  accomplished  in  the  ordinary  way. 

It  is  well  to  remember,  however,  that  the  traction  resorted  to  must  be 
judiciously  employed.  It  should  be  moderate,  gradual,  and  sustained,  in 
order  to  allow  the  tissues  of  the  cervix  time  to  accommodate  themselves 
to  the  eccentric  pressure  imposed  on  them  by  the  advancing  foetus.  To 
act  otherwise,  is  to  incur  the  grave  risk  of  lacerating  the  uterus  beyond 
the  possibility  of  repair,  and  is  quite  as  reprehensible  as  making  deep 
incisions. 


J 


VAGliVAL  HYSTEROTOMY.  551 

With  regard  to  the  consequences  of  vaginal  hysterotomy,  it  must  be 
admitted  that  it  is  not  without  danger,  and  that  death  not  unfrequently 
results.  We  have  no  reliable  statistics  to  guide  us  in  estimating  the 
amount  of  success  or  non-success  following  its  performance,  as  not  all — 
or  perhaps  not  many — of  the  cases  are  published.  Saint-Cyr  has  col- 
lected thirty-four  cases — all  those  published  in  France  and  Belgium  since 
the  commencement  of  the  century,  an  analysis  of  these  gives  the  follow- 
ing results  : 

Mother  and  progeny  saved  in 14  instances. 

Mother  saved — fate  of  the  progeny  not  mentioned — in  -     9         " 
Mother  alone  saved  in  ------5  " 

Progeny  saved,  mother  died,  in      -         -         -         -         -     6         " 

Mother  succumbed — fate  of  progeny  not  mentioned — in     5         " 
Mother  and  progeny  perished  in  -         -        -         -         -     i         " 

So  that  of  40  Cows  operated  upon,  28  survived,  and  12 — or  30  per 
cent. — succumbed;  while,  with  regard  to  the  progeny,  14  calves  were  de- 
livered alive  and  continued  to  live,  and  6  were  dead ;  nothing  is  said  as 
to  the  other  14. 

In  other  words,  of  80  lives  more  or  less  compromised,  18  at  least — or 
22^  per  cent. — were  not  saved  by  the  operation. 

And  Saint-Cyr  is  inclined  to  think  that  if  all  the  successful  cases  have 
been  published,  there  is  reason  to  believe  that  all  the  unsuccessful  ones 
have  not  ;  and  he  is  apparently  confirmed  in  this  view  by  Bugniet  {lie- 
cueil de  Med.  Veterinaire,  1873),  who  writes:  "Distinguished  veterina- 
rians have  published  very  interesting  observations  on  this  important 
question  in  obstetrics^  but  I  am  bound  to  say  that  these  experienced 
practitioners  have  been  more  fortunate  than  myself,  for  I  have  had  noth- 
ing but  misfortune,  and  in  the  interest  of  science  I  do  not  hesitate  to  say 
so."  Bugniet,  after  describing  three  cases  in  which  he  operated,  and  in 
which  death  of  the  mother  followed,  as  evidence  that  his  procedure  was 
not  at  fault,  remarks  :  '•  Nevertheless,  I  acted  with  extreme  prudence  ; 
when  the  incisions  were  made,  I  proceeded  to  complete  delivery  with 
great  care  and  deliberation.  Incision,  dilatation,  birth,  removal  of  the 
placenta — all  conducted  with  knowledge  and  circumspection;  and  yet 
this  did  not  prevent  a  fatal  issue."  But  in  opposition  to  this  experience, 
we  have  that  of  other  practitioners  who  have  had  a  fair — indeed,  a  large 
— share  of  success.  Donnarieix,  for  instance  {Ibid.,  1874,  p.  511),  com- 
menting on  Bugniet's  report,  blames  the  latter  for  adopting  expectant  in- 
stead of  active  treatment,  and  asserts  that  he  has  taken  the  exception  for 
the  rule.  From  his  own  experience,  extending  over  thirty  years,  during 
which  he  had  performed  vaginal  hysterotomy  in  sixty  cases  with  only 
one  death  (the  cause  of  which  was  not  apparent),  he  concludes  (i)  that 
incision  of  the  cervix  uteri  is  generally  curable,  and  (2)  that  palliative 
measures  are  more  injurious  than  beneficial,  when  their  uselessness  is 
demonstrated. 

Many  instances  of  successful  treatment  by  incision  might  be  given,  in 
addition  to  those  already  enumerated,  but  a  few  will  suffice. 

I.  Of  several  cases  given  by  Donnarieix  {Op.cit.,  1874,  pp.  512,  514)  we  will  select  two. 
In  one  case,  atresia  was  so  complete  that  the  index-finger  could  not  be  introduced  into 
the  OS.  and  it  was  impossible  to  discover  if  there  was  a  calf.  The  vagina  was  prolapsed 
beyond  the  vulva,  and  formed  a  tumor  as  large  as  a  man's  head.     After  evacuating  the 


552  OBSTETRIC  OPERATIONS. 

bladder  by  replacing  the  vagina,  hysterotomy  was  practised,  and  the  fore-limbs  of  the 
foetus  were  seized  and  brought  through  the  os,  but  the  head  was  deviated ;  so  it  was 
necessary  to  cord  thefeet,  return  them  to  the  uterus,  and  adjust  the  head.  The  opera- 
tion lasted  for  six  hours,  but  the  calf  was  extracted  alive.  In  about  half  an  hour,  inver- 
sion of  the  uterus  took  place,  with  the  membranes  adherent.  The  latter  were  detached, 
reposition  of  the  uterus  was  effected,  and  the  organ  retained  by  Renault's  bandage — all 
in  a  few  minutes.  The  Cow  did  not  die,  but  lived,  and  subsequently  produced  more 
calves. 

The  second  case  was  one  of  occlusion  of  the  os  uteri.  Vaginal  hysterotomy  occupied 
about  ten  minutes ;  a  bull-calf  was  born  alive,  and  the  Cow  did  not  appear  to  suffer. 
The  animal,  of  the  Charolaise  breed,  was  of  great  value,  and  was  subsequently  sold  for 
a  thousand  francs  ;  after  producing  several  calves  without  any  difficulty,  it  was  again 
sold,  when  aged  twelve  years,  for  six  hundred  francs. 

2.  Binz  {Zeitschrift  filr  Wissenschaftliche  Thierheilktinde,  1846,  p.  365)  describes  the  case 
of  a  Cow  which  for  three  years  was  unprolific ;  but  during  oestrum,  at  the  end  of  this 
period,  the  os  was  artificially  dilated  by  the  finger  half  an  hour  before  the  animal  was 
put  to  the  Bull.  Impregnation  resulted,  but  at  the  termination  of  pregnancy  delivery 
could  not  take  place.  Binz,  on  exploration,  found  the  cervix  in  a  cartilaginous  condi- 
tion, and  the  os  completely  and  firmly  occluded.  With  difficulty  one  of  the  fingers 
was  passed  half  through  the  canal.  The  labor-pains  were  so  extremely  powerful, 
that  it  seemed  as  if  the  foetus  would  be  expelled  through  the  walls  of  the  uterus  or  the 
rectum  before  the  os  would  dilate.  An  incision  in  the  cervix  was  then  made  by  means 
of  a  probe-pointed  bistoury,  from  the  os,  and  upwards.  The  labor-pains  continuing 
strong,  the  "  water-bag  "  soon  appeared;  but  the  os  did  not  dilate  sufficiently  to  allow  it 
or  the  fcetus  to  enter  ;  a  second  incision — also  upwards — was  therefore  made  in  the 
cartilaginous  cervix,  which  permitted  the  "  water-bag  "  to  pass  through.  This  was  opened, 
and  it  was  found  that  the  calf  presented  in  the  proper  position  in  front  of  the  opening. 
The  incisions  gradually  widened,  and  in  a  few  minutes  a  fine  Cow-calf,  weighing  forty 
ffund,  was  born  ;  in  half  an  hour  afterwards  the  foetal  membranes  came  away.  Three 
or  four  times  a  day  lukewarm  water,  with  a  decoction  of  chamomile  flowers  and  tincture 
of  myrrh,  was  injected  ;  the  animal  ate  and  drank  well,  and  soon  quite  recovered  ;  it 
yielded  a  good  quantity  of  milk,  and  in  a  year  afterwards  was  sold  to  the  butcher  in  fine 
condition. 

3.  The  same  excellent  authority  [Ibid.,  p.  368)  performed  the  operation  on  a  Cow,  the 
cervix  of  whose  uterus  was  so  indurated  that  it  was  impossible  to  bring  the  calf  through 
it.  Birth  then  took  place  without  assistance,  and  no  ill  consequences  resulted.  When 
oestrum  again  occurred,  the  worst  fears  of  the  owner  were  realized,  in  that  the  Cow, 
when  put  to  the  Bull,  was  not  impregnated.  Binz  was  consulted,  and  on  examination  he 
found  that,  at  the  part  where  the  incisions  had  been  made  during  the  last  calving,  a  hard 
cicatrix  as  thick  as  the  finger  had  developed,  but  that  the  other  parts  of  the  cervix  were 
sufficiently  dilatable  to  allow  him  to  introduce  the  finger  into  the  os.  The  latter  being 
rendered  permeable  in  this  way,  the  Cow  was  once  more  put  to  the  Bull,  conceived,  and 
at  the  termination  of  gestation,  with  very  little  help,  brought  forth  a  fine  calf. 

4.  Pflug  [Wochenschrift  fiir  Thierheilkunde  tend  Viehzucht,  1863)  was  called  upon  to 
assist  a  heifer  in  calving.  The  labor-pains  were  strong,  and  the  vagina,  together  with 
the  cervix — behind  which  were  the  head  and  feet  of  the  calf — protruded  beyond  the  vulva. 
The  calf  was  alive.  Reposition  of  the  vagina  was  effected,  the  upper  part  of  the  cervix 
was  incised  in  one  place,  and  the  young  creature  extracted.  The  haemorrhage  was  not 
serious.  The  afterbirth  was  removed  piecemeal,  and  in  a  few  days  the  Cow  regained 
its  appetite.  Suddenly  it  became  unwell,  and  on  examination  it  was  found  that  the 
upper  margin  of  the  cervix  was  greatly  swollen  ;  in  a  short  time  an  abscess  formed,  pus 
was  discharged,  and  the  heifer  soon  recovered  permanently. 

5.  Foglar  {Oesterreichische  Vlerteljahresschrift  fiir  Wissenschaftliche  Veterincirhinde, 
1876,  p.  30),  in  referring  to  this  "  Scheidengebarmutterschnitt,"  as  the  Germans  desig- 
nate the  operation,  makes  some  interesting  observations.  In  the  course  of  five  years' 
practice  he  had  performed  vaginal  hysterotomy  on  six  occasions — partly  on  primiparae, 
partly  on  pluriparae.  The  incisions  in  the  cervix  were  made,  in  two  of  the  cases,  in  the 
outer  margin  of  the  dense  cartilaginous  ring,  so  as  to  allow  the  inner  ring  to  be  incised.* 
In  the  other  four  cases,  the  occlusion  of  the  os  was  so  complete  that  at  most,  only  the 
tip  of  the  little  finger  could  be  introduced.  A  passage  to  the  interior  of  the  uterus  had 
to  be  gradually  cut  by  means  of  the  knife.  The  operation  took  from  one  and  a  quarter 
to  one  and  a  half  hour,  during  which  the  animals  were  kept  standing  :  two  or  three  men 
were  placed  at  the  head  and  tail,  and  the  left  hind-leg  was  secured.  The  animals 
remained  perfectly  quiet.     Foglar  used   the   probe-pointed  or  button  bistoury  for  the 

*  Foglar,  following  the  example  of  human  anatomists,  recognizes  in  the  canal  of  the  cervix  an  os  uteri 
externum,  and  internum  or  "rings"  iringen). 


VAGINAL  HYSTEROTOMY.  553 

operation,  the  blade  being  covered  for  one-half  its  length  by  a  bandage.  The  instrument 
is  carried  in  the  hand,  so  that  the  forefinger  covers  the  back  of  the  blade,  while  the 
remaining  four  fingers  firmly  grasp  the  handle.  The  hand — well  oiled — is  passed 
into  the  vagina,  and  after  the  external  ring  of  the  cervix  has  been  incised — right  and 
left — to  the  depth  of  one-third  to  half  an  inch,  towards  the  top,  attempts  are  made,  by 
careful  manipulation,  to  further  dilate  the  passage.  This  procedure  has,  as  a  rule, 
been  attended  with  success.  The  iimer  ring  is  reached,  after  this  manipulation  has 
been  continued  for  some  time  ;  and  this  is  dilated,  partly  by  incision,  and  partly  by 
pressure  or  distention — though  care  is  taken  to  avoid  contact  with  the  incisions  already 
made.  This  happened,  however,  in  his  first  case,  in  which  the  textures  between  the  rings 
had  to  be  divided.  Sometimes  the  knife  is  dispensed  with  in  the  course  of  the  operation, 
and  the  hand  alone  is  made  to  trace  the  channel,  which  has  often  a  devious  course. 
During  the  '"  pains  "  the  knife  is  very  liable  to  slip  from  the  hand  and  injure  the  uterus 
— thereby  causing  unnecessary  haemorrhage.  In  four  cases,  in  which,  after  the  widen- 
ing of  the  incisions,  birth  took  place  in  a  normal  manner,  the  result  was  most  satisfactory ; 
the  animals  operated  upon  recovered  completely,  and  after  only  a  brief  indisposition. 
Two  afterwards  became  pregnant,  and  calved  without  any  difficulty. 

In  the  other  two  cases  the  results  were  not  so  favorable  :  the  calves  being  too  large  to 
pass  through  the  vagina,  and  the  Caesarean  section  was  objected  to  by  the  owners,  and 
was  certainly  not  deemed  very,  likely  to  be  attended  with  success  by  Foglar. 

After  parturition,  the  foetal  membranes  were  either  removed  artificially,  or  left  to 
nature ;  and  in  no  instance  were  any  ill  consequences  noted.  In  the  first  case  the 
"afterbirth  "  came  away  on  the  ninth  day  ;  and  in  all  the  cases  the  subsequent  treat- 
ment chiefly  consisted,  for  the  first  two  or  three  days,  of  cold  applications  to  the  loins, 
cold  water  pessaries  in  the  vagina,  gruel,  and  Glauber's  salts,  with,  in  particular  instances, 
injection  of  cold  water  into  the  genital  canal. 

6.  Macgillivray  {Veterinary journal,  1S77,  p.  149),. referring  to  the  instances  alluded 
to  at  p.  352,  adds :  "  In  the  first  case  the  subject  was  a  seven-year-old  Cow,  on  which  I 
operated  by  incision  (making  two  side  cuts  up  and  down),  and  extracted  two  living 
calves.  Both  calves  and  the  Cow  did  well.  Having  made  a  speedy,  good,  and  perfect 
recovery,  the  said  Cow  was  in  due  course  again  served  with  the  Bull,  and  the  following 
season  produced  (without  any  uncommon  disturbance)  a  living  calf  !  Thus  showing  that 
incision  of  indurated  cervix  uteri  is  no  bar  to  future  productiveness  of  a  perfectly  normal 
character." 

There  is  no  doubt  that,  in  the  majority  of  instances,  and  in  the  hands 
of  careful  obstetrists,  vaginal  hysterotomy  will  be  successful,  and  will 
prove  a  useful  operation. 

As  a  rule,  after  the  operation,  and  for  a  period  of  eight  or  ten  days, 
there  is  a  muco-purulent  discharge  from  the  vulva  ;  but  the  Cow  eats, 
ruminates,  gives  the  usual  quantity  of  milk,  and  does  not  appear  to  be 
any  more  inconvenienced  than  after  normal  parturition. 

The  unfavorable  results,  however,  must  not  be  overlooked.  Serious 
injury  to  the  neighboring  organs  by  the  knife,  or  by  the  extension  of  the 
laceration,  is  within  the  range  of  possibility.  When  the  cervix  is  com- 
pletely divided,  either  by  incision,  or  by  subsequent  laceration  during  the 
passage  of  the  foetus,  we  may  have  intense  peritonitis  arising  from  escape 
of  the  liquor  amnii  or  other  fluids  into  the  abdomen,  and  speedy  death. 
Or  excessive  haemorrhage  may  lead  to  serious  consequences. 

In  every  case,  of  course,  there  must  be  more  or  less  bleeding  from  the 
incisions ;  but,  as  a  rule,  this  is  of  no  importance,  and  it  ceases  after  a 
time.  In  less  frequent  cases,  however,  it  persists,  and  either  brings 
on  great  debility,  or,  if  excessive,  will  lead  to  a  rapidly  fatal  termination. 
This  result  is  most  to  be  apprehended  when  the  cervix  is  greatly  degen- 
erated, and  its  tissue  extremely  vascular — as  in  carcinoma  and  sarcoma. 
It  may  also  occur  from  rupture  of  blood-vessels,  in  laceration  of  the  cer- 
vix or  body  of  the  uterus,  during  the  passage  of  the  calf  through  the 
incised  os. 

When  serious  haemorrhage  occurs,  cloths  or  sponges  steeped  in  cold 
water,  astringent  lotions,  and   styptics — as   the   perchloride   of   iron — 


554  OBSTETRIC  OPERATIONS. 

should  De  applied  as  close  to  the  part  as  possible  ;  while  cold  water 
irrigation  should  be  maintained  on  the  loins. 

Another  result  is  metritis,  or  metro-vaginitis,  which  is  rapidly  fatal,  and 
in  which  we  find  the  usual  local  lesions  on  making  an  autopsy.  Sep- 
tikaemia  is  also  to  be  apprehended  ;  and  to  prevent  it,  it  is  well  to 
remove  every  source  of  putridity,  or  any  thing  likely  to  become  putrid, 
and  to  use  plentifully  a  weak  solution  of  carbolic  acid  (i  to  loo)  or  the 
permanganate  of  potass  in  the  interior  of  the  uterus,  and  particularly 
about  the  incisions  in  the  cervix — even  for  some  days  after  the  operation. 


CHAPTER  IV. 

Gastro-Hysterotomy,  or  the  Csesarean  Section. 

Gastro-hysterotomy,  the  Ccesarean  Section^  or  abdommal  hysterotomy,  is 
an  operation  which  has  for  its  object  the  removal  of  the  fcetus  or  foetuses 
from  the  uterus  of  the  parent,  when  they  cannot  be  doWvered  per  vias 
naticrales,  by  making  an  opening  in  that  organ  through  the  abdominal 
walls,  and  thereby  extracting  them. 

This  is  a  formidable  and  a  serious  operation,  whether  it  is  practised 
on  the  human  female  or  on  animals.  In  the  obstetricy  of  woman,  it  has 
been  resorted  to  from  a  very  early  period ;  the  Greeks  knew  it  as 
vffTspoToiJMToxiYj  or  i,ai3piosXxrj,  though  it  is  supposed  that  they  only  performed 
it  after  the  mother  was  dead,  and  to  save  the  child.  Persons  thus  born 
were  sacred  to  Apollo,  and  yEsculapius  was  designated  the  son  of  that 
god,  because  it  was  believed  he  had  been  delivered  by  gastro-hysterot- 
omy. Some  strange  notion  appears  to  have  been  attached  to  this 
method  of  delivery  ;  as  among  these  old-world  people,  the  person  who 
had  been  born  by  means  of  the  operation  was  esteemed  remarkable  and 
fortunate.  Hence  Claudius  Caesar,  Scipio  Africanus,  Ca^so  Fabius, 
Julius  Caesar,  and  other  more  or  less  illustrious  personages  of  old  Rome, 
received  the  surname  of  "  Caesones  "  from  being  extracted  by  abdominal 
incision  from  their  mother's  womb  :  "  Quia  caeso  matris  uteru  in  lucem 
prodiscunt."  At  a  later  period  these  persons  were  designated  "  Caesares," 
— a  noble  title  ;  though,  as  has  been  demonstrated,  it  is  a  mistake  to 
assert  that  it  owes  its  origin  to  Julius  Ceesar — this  being  merely  his 
patronym. 

Since  these  early  times,  abdominal  hysterotomy  has  been  often  prac- 
tised on  woman  ;  but  when  it  was  first  attempted  on  animals  we  cannot 
yet  be  quite  certain.  Haller  was  led  to  believe  that  the  Greek  veterinari- 
ans— Apsyrtus  and  Hierocles — knew  and  performed  the  operation  on  the 
domesticated  animals ;  but  this  has  been  shown  to  be  a  mistake.  Until 
we  arrive  at  the  time  of  Bourgelat — the  illustrious  founder  of  veterinary 
schools — in  the  latter  half  of  the  last  century,  we  appear  to  have  no  evi- 
dence that  such  an  operation  was  ever  proposed  for  animals.  And  even 
Bourgelat  only  suggests  it  in  cases  in  which  the  dam  is  attacked  by 
a  dangerous  disease  when  the  period  of  gestation  has  nearly  or  quite 
expired,  and  its  life  may  be  beneficially  sacrificed  in  favor  of  its  prog- 
eny, which  is  to  be  quickly  removed  from  the  uterus.  {Traite  de  la 
Conformation  Exterieure  du  Cheval,  1768.)  In  1781,  Brugnone  {Trattaio 
della  Razzi  di  Cavalli,  p.  406)  intimates  that  this  operation  may  be  per- 


GASTRO-HYSTEROTOMY,  OR  THE  CESAREAN  SECTION.    555 

formed  on  Mares  and  other  animals  which  could  not  bring  forth  ;  but, 
like  Bourgelat,  he  does  not  state  whether  he  ever  practised  it. 

It  was  not  apparently  until  1813,  that  Morange,  and  in  1816  Gohier 
{Mem.  sur  la  Chirurgie  et  la  Med.  Veterinaire^  vol.  ii.,  p.  40),  attempted  it 
on  the  living  animal,  though  unsuccessfully.  Morange  operated  on 
a  Cow,  and  it  was  to  all  appearance  in  a  fair  way  to  recovery,  when  it  suc- 
cumbed to  an  attack  of  indigestion  caused  by  improper  feeding.  About 
the  same  period,  Rohlwes  {Das  Gauze  der  Thierheilkunde,  1822,  p.  143) 
operated  on  a  Mare. 

Since  that  time  gastro-hysterotomy  has  been  practised  comparatively 
often,  both  in  England  and  on  the  Continent ;  and  there  can  scarcely 
be  a  doubt  that  it  was  mainly  indebted  to  its  general  introduction,  as  an 
obstetric  operation,  to  the  fact  that  the  abdomen  of  animals  could  be 
opened  with  impunity  in  such  operations  as  ovariotomy  (spaying)  in 
swine  and  other  creatures ;  as  well  as  from  the  experience  that,  in 
abdominal  hernia  in  the  pregnant  animal,  the  foetus  had  been  often 
extracted  in  this  way,  and  the  mother  did  not  succumb. 

Gastro-hysterotomy  has  been  practised  both  on  the  large  and  small 
domesticated  animals,  but  perhaps  with  most  success  on  the  latter.  In 
48  cases  of  this  operation,  Franck  finds  that  25 — or.  52  per  cent. — had  a 
fatal  termination.  Saint-Cyr,  from  a  smaller  number,  makes  the  mortal- 
ity 71  per  cent.  Franck  can  only  note  three  instances  in  the  Mare,  and 
they  were  all  fatal,  though  the  foals  were  saved.  For  the  Cow  he  has  17 
instances  ;  6  of  these  recovered  (one  of  them,  however,  was  Morange's, 
which  died  from  over-feeding  fifteen  days  after  the  operation,  and 
another  was  Sacchero's,  which  was  sent  to  the  butcher  in  six  days).  This 
gives  35  per  cent,  saved,  and  65  percent,  lost.  In  three  Sheep  there  were 
no  recoveries,  and  in  two  Goats,  only  one.  With  the  Pig  the  operation  ap- 
pears to  have  been  wonderfully  successful.  In  8  instances  all  recovered  : 
a  result  Franck  is  inclined  to  attribute  to  the  different  arrangement — or 
rather  attachment — of  the  placenta,  which  renders  this  animal  less  liable 
to  septic  infection  through  injury  to  the  uterus.  With  the  Bitch,  the  mortal- 
ity is  about  the  same  as  in  the  bovine  species  ;  in  15  cases,  6 — 40  per 
cent. — lived.  Franck  thinks  this  percentage  might  be  much  increased  if 
the  operation  was  performed  on  the  right  side,  and  antiseptic  treatment 
adopted,  or,  if  necessary,  even  extirpation  of  the  uterus ;  as  putrid  infec- 
tion readily  occurs  in  the  Dog. 

With  regard  to  saving  the  young,  the  operation  is  not  very  favorable. 
In  nearly  all  the  instances  in  which  the  parent  recovered,  the  progeny 
has  been  dead,  or  died  ;  and  in  only  4  of  Franck's  list  of  cases  were  the 
parents,  and  one  or  more  of  the  young  creatures,  preserved  alive.  Three 
of  these  cases  were  Bitches,  and  the  other  was  a  Sow. 

With  the  Cow,  the  Calf  is  often  saved,  while  the  parent  dies.  Of  7  in- 
stances, the  calves  were  extracted  alive  in  6. 

With  the  Mare,  the  operation  must  be  resorted  to  early  in  order  to  save 
the  foal,  as,  for  the  reasons  already  given,  it  perishes  quickly. 

It  is  only  on  a  knowledge  of  the  length  of  time  the  foetus  may  live 
during  parturition,  or  after  the  death  of  the  parent,  that  the  operation 
can  be  undertaken  with  any  prospect  of  success — so  far  as  obtaining  it 
alive  is  concerned  ;  and  this  is  an  important  consideration  with  regard  to 
the  bovine  species.  Kehrers,  in  his  observations  on  the  Bitch,  found 
that  three  minutes  after  death  the  foetus  began  to  show  symptoms  of 
asphyxia,  and  in  thirty-six   minutes  it  was  dead.     In  pregnant  Cows  and 


556  OBSTETRIC  OPERATIONS. 

Sheep  which  were  slaughtered,  the  foetus  moved  about  in  a  very  lively 
manner  for  eight  to  ten  minutes,  but  death  ensued  soon  after. 

Sauer  observed  an  unusual  instance  of  fcetal  vitality  in  a  Bitch  which 
could  not  be  delivered,  and  was  poisoned  by  cyanide  of  potassium. 
Eight  minutes  after  death  the  foituses  were  observed  to  move  in  the 
abdomen,  and  this  and  the  uterus  being  opened,  they  were  extracted 
alive. 

After  fifteen  minutes,  Franck  has  found  in  slaughtered  Sheep  that  the 
foetus  was  usually  asphyxiated ;  and  he  concludes  that  during  the  first 
eight  minutes  after  the  death  of  the  parent,  the  foetus  can  be  extracted 
alive  (if  alive  before  the  parent  died)  ;  even  towards  fifteen  minutes  there 
is  a  chance  of  preserving  it,  but  by  that  time  it  is  usually  dead.  When 
extracted  late,  and  in  the  first  stage  of  asphyxia,  though  it  may  rally  for 
a  short  time,  yet  it  usually  succumbs  to  inflammation  of  the  lungs — 
through  the  amniotic  fluid  having  penetrated  into  the  air-passages  during 
the  convulsive  gasps  the  young  creature  makes. 

There  can  be  no  doubt  that  much  of  the  great  mortality  which  follows 
the  operation,  is  due  to  the  circumstances  amid  which  it  is  undertaken. 
It  is,  as  a  rule,  never  resorted  to  until  every  other  means  to  deliver  the 
animal  has  failed,  and  the  creature,  worn  out  by  suffering,  is  already 
almost  dead.  In  addition  to  this,  the  foetus  itself — subjected  to  long- 
continued  and  severe  manipulation — is  either  dying  or  dead  ;  indeed,  it 
may  have  perished  days  before,  and,  becoming  putrid,  has  already  in- 
fected the  parent." 

Death  is  usually  due,  when  not  immediate,  to  putrid  infection — to  peri- 
tonitis or  metro-peritonitis.  This  is  more  particularly  the  case  with  the 
Bitch,  in  which,  when  the  operation  is  performed  early,  and  the  young  are 
extracted  alive,  recovery  generally  takes  place  ;  though  Franck  remarks, 
that  wherever  the  green  coloring  matter  of  the  placenta  imparts  a  simi- 
lar tint  to  the  textures  it  comes  in  contact  with,  very  often  septic  inflam- 
mation begins  there.  The  same  authority  points  out  that  there  is  no 
great  reason  otherwise  why  death  should  be  a  frequent  result  of  the  ope- 
ration, when  we  consider  the  hundreds  of  similar  operations  performed 
in  the  study  of  embryology,  by  Bischoff  and  others,  on  Bitches,  Guinea- 
pigs,  and  Rabbits,  the  majority  of  which  did  not  have  a  fatal  termination. 
He  also  alludes  to  the  success  of  Nature's  Caesarean  section,  when  we 
have  mummification  and  maceration  of  the  foetus,  consequent  on  occlu- 
sion of  the  OS  uteri,  and  the  remains  of  the  creature  find  their  way  out 
by  another  channel  without  much  disturbance  to  the  mother. 

The  most  dangerous  cases  for  operation  are  those  in  which  the  foetus 
is  dead,  and  more  or  less  decomposed. 

Indications. 

The  operation  should  only  be  resorted  to  in  those  cases  in  which  de- 
livery by  the  natural  passages — the  foetus  being  alive — is  altogether  im- 
possible, or  so  difficult  and  dangerous  that  the  mother  incurs  nearly  as 
much  risk  as  from  gastro-hysterotomy  itself,  while  the  young  creature 
must  be  sacrificed  ;  or  when  the  owner  prefers  having  the  latter  alive,  in- 
stead of  incurring  the  risk  of  losing  both — the  progeny  being  the  most 
valuable.  The  operation  is  therefore  likely  to  be  demanded  in  those 
deformities  of  the  pelvis  produced  by  fractures,  exostoses,  etc.^  which 
considerably  diminish  its  canal,  intra-pelvic  tumors,  hernia  of  the  uterus, 


GASTRO-HVSTEROTOMY,  OR  THE  CESAREAN  SECTION.     557 

extra-uterine  foetation,  certain  cases  of  uterine  torsion  irreducible  by  the 
methods  we  have  described.  Atresia  of  the  os  should  be  more  advan- 
tageously overcome  by  vaginal  hysterotomy,  unless  the  owner  is  desirous 
of  saving  the  foetus  and  sacrificing  the  mother. 

The  operation  is  also  indicated  when  an  animal,  near  the  termination 
of  pregnancy,  is  so  seriously  ill  or  injured  that  it  cannot  live  until,  birth 
takes  place.  It  may  then  be  most  judicious,  if  the  progeny  is  valuable, 
to  kill  the  parent  and  extract  the  foetus  at  once.  If  the  parent  has  just 
died,  or  is  dying,  the  operation  may  also  be  practised. 

In  considering  the  adoption  of  the  Caesarean  section,  the  species  of 
animal  will,  of  course,  weigh  a  good  deal.  Those  which  can  be  utilized 
as  food,  there  need  be  no  hesitation  in  operating  upon,  and  sacrificing 
immediately  afterwards  ;  the  value  of  the  carcase  and  the  living  calf  or 
lamb  diminishing  very  considerably  the  loss  which  would  otherwise  be 
sustained.  With  the  Mare,  as  we  have  said,  the  foal  may  be  very  much 
more  valuable  than  the  parent. 

With  the  Bitch  and  Sow,  there  is  much  more  prospect  of  a  favorable 
result  of  the  operation  ;  and,  as  difficult  parturition  in  them  is  often  so 
serious,  it  is  advisable  to  operate  in  good  time.  Indeed,  in  all  cases 
when  the  operation  is  once  decided  upon,  no  time  should  be  lost  in  prac- 
tising it,  if  w^e  desire  to  preserve  the  progeny,  and  guve  the  parent  a 
chance. 

We  have  seen  that  the  foal  soon  perishes  when  it  cannot  be  born,  and 
though  the  foetus  of  other  animals  retains  its  vitality  longer,  yet  there  is 
also  a  limit  here.  Besides,  it  must  be  remembered  that  the  strength  of 
the  parent  is  an  important  factor  in  the  case,  and  the  longer  the  delay, 
so  the  less  chance  is  there  of  a  successful  result. 

It  is,  therefore,  most  important  that  the  obstetrist  loses  no  time  in 
making  his  diagnosis,  and  coming  to  a  conclusion  as  to  the  course  he 
must  pursue.  Embryotomy  will,  of  course,  present  itself  to  his  mind 
before  gastro-hysterotomy,  which  is,  after  all,  only  to  be  an  ultimate 
means  of  saving  either  mother  or  progeny,  or  both,  in  very  exceptional 
cases.  It  need  scarcely  be  pointed  out  that  in  irreducible  uterine  hernia, 
there  need  be  no  delay  in  deciding,  and  that  this  condition  gives  good 
hope  of  success — especially  in  the  smaller  animals. 

Operation. 

Looking  at  the  Caesarean  Section  from  a  purely  surgical  point  of  view, 
there  can  be  no  doubt  that,  so  far  as  the  larger  domesticated  animals  are 
concerned,  it  is  one  of  the  longest,  most  fatiguing,  and  most  difficult,  in 
veterinary  surgery. 

There  is  also  the  great  extent  of  the  wound,  as  well  as  the  opening  of 
the  peritoneum,  haemorrhage,  and  escape  of  blood  or  liquor  amnii  into 
the  peritoneal  cavity,  to  be  considered.  Besides,  the  animal  is,  as  a  rule, 
in  a  state  of  extreme  prostration,  and  the  results  of  mischievous  interfer- 
ence may  be  already  apparent  before  the  operation  is  commenced,  or  even 
before  the  veterinary  surgeon  is  called  in. 

The  after  treatment  of  the  mother,  too,  often  requires  much  attention, 
and  is  expensive  ;  and  recovery  requires  a  considerable  period,  as  conva- 
lescence is  only  too  often  protracted. 

What,  however,  makes  the  operation  so  formidable,  if  the  mother  is  to 
be  saved,  is  the  quadrupedal  position  of  animals  ;  for,  after  section  of  the 


558  OBSTETRIC  OPERATIONS. 

abdominal  parietes,  the  mass  of  intestines  presses  heavily  on  the  part 
which  has  to  be  incised  ;  so  that  it  needs  much  careful  management  and 
supervision  to  effect  cicatrization,  and  to  procure  such  a  solid  adhesion 
of  the  margins  of  the  wound  that  hernia  may  not  result. 

If  the  mother  is  alive,  the  operation  is  a  painful  one,  and  one  of  long 
duration  in  some  cases,  and  the  pain  inflicted  causes  the  animal  to 
struggle  ;  this  inconveniences  the  operator  more  or  less,  and — not  to 
speak  of  the  humane  feelings  which  should  ever  be  predominant  on  such 
occasions — induces  him  to  avail  himself  of  the  advantages  of  anaesthesia, 
if  they  can  be  obtained.  Perhaps  no  agent  is  so  useful  in  this  respect  as 
the  hydrate  of  chloral,  though  chloroform  or  aether  may  be  administered 
in  the  usual  way — by  inhalation — and  produce  their  effect.  The  objection 
to  the  two  latter  substances,  however,  is  very  great,  so  far  as  cattle  are 
concerned ;  as  they  taint  the  flesh,  should  it  be  necessary  to  kill  the  ani- 
mals, and  utilize  their  flesh  as  food;  whereas  the  chloral  dydrate  has  not 
this  objectionable  action.  The  latter  is  perhaps  best  administered  in 
enema  ;  for  horses  and  cattle,  the  dose  may  be  from  fourteen  to  twenty- 
two  drams  ;  about  two  or  three  drams  for  dogs  (depending  on  the  size), 
and  three  to  six  drams  for  pigs.  It  is  best  given  in  mucilage  or  bland 
syrup  of  any  kind.  In  a  quarter  of  an  hour  or  so  the  animal  is  in  a  state 
of  narcosis,  and  the  operation  may  be  commenced.  Unfortunately,  the 
drug  only  too  frequently  causes  the  death  of  the  foetus — a  matter  of  some 
importance  when  this  is  of  more  value  than  the  parent ;  but  not  to  be 
considered  when  the  life  of  the  latter  is  to  be  preserved. 

When  the  parent  is  doomed  to  be  killed — as  in  the  case  of  a  worthless 
Mare,  or  one  suffering  from  an  incurable  disease  or  accident — and  the 
young  animal  is  to  be  rescued,  the  best  course  to  follow  is  to  pierce  the 
medulla  oblongata,  and  operate  at  once,  as  Vollmar  has  done  with  suc- 
cess. By  this  means  insensibility  has  been  produced,  and  the  young 
creature  extracted  alive.  Gtlnther  recommends  dividing  the  posterior 
aorta  after  removal  of  the  foetus,  as  it  is  close  to  hand  in  the  abdominal 
cavity,  and  death  quickly  ensues. 

For  the  operation  but  few  instruments  are  needed.  They  consist 
chiefly  of  a  scalpel,  probe-pointed  bistoury,  scissors,  forceps,  muscle-hooks, 
and  some  common  suture  needles,  pins,  and  sutures — silk  or  catgut.  For 
the  larger  animals  a  strong  suture  needle,  suture  wire,  and  waxed  carbol- 
ized  thread  or  twine,  teased  oakum,  tow,  small  pieces  of  wood  or  whale- 
bone for  the  sutures,  and  large  pieces  of  linen  are  required  in  addition, 
as  well  as  a  body-bandage  made  by  folding  a  linen  or  cotton  sheet.  If 
the  parent  is  not  to  be  preserved,  or  is  already  dead  or  dying,  of  course 
no  such  preparations  need  be  made ;  as  a  scalpel  and  probe-pointed  bis- 
toury, or  even  and  ordinary  pocket-knife,  on  an  emergency,  and  used  with 
care,  will  suffice. 

The  operation  might,  and  should  if  possible,  be  performed  under  the 
carbolic-acid  spray ;  with  the  smaller  animals  at  least,  this  antiseptic 
treatment  can  be  adopted. 

The  incision  in  the  abdomen  may  be  made  in  either  of  two  regions — at 
the  linea  alba,  or  the  right  flank.  If  it  is  desired  to  preserve  the  parent, 
the  flank  operation  is  certainly  to  be  preferred,  with  the  larger  animals  and 
the  Sow,  as  no  sutures  can  resist  the  weight  of  the  mtestines  when  the 
incision  is  at  the  inferior  part  of  the  abdomen.  Even  with  the  Bitch  the 
flank  operation  should  be  adopted  for  the  same  reason,  and  also  because 
wounding  the  mammae  is  avoided — an  important  consideration  in  more 


GASTRO-HYSTEROTOMY,  OR  THE  CESAREAN  SECTION. 


559 


respects  than  one.  It  is  true  that  Bourgelat,  describing  how  gastro-hys- 
terotomy  ought  to  be  performed  in  the  Mare  in  order  to  obtain  the  living 
foetus,  says  that  the  animal  should  be  carefully  thrown,  placed  on  its 
back,  and  there  secured.  "  Then  a  crucial  incision  is  to  be  made  at  the 
middle  of  the  lower  part  of  the  abdomen,  and  it  should  be  about  a  foot- 
and-a-half  in  length — terminating  at  the  pubis.  If  the  large  intestine, 
forced  outwards  by  the  struggles  of  the  animal,  appears,  it  should  be 
carried  to  one  side,  when  the  uterus  will  soon  be  seen  ;  then  an  opening, 
corresponding  to  the  other,  must  be  made  with  the  greatest  circumspec- 
tion, so  as  not  to  wound  the  foal ;  the  membranes  are  to  be  opened, 
the  *  waters  '  they  contain  escape,  and  the  young  creature  is  to  be  im- 
mediately removed.  The  success  of  the  enterprise  depends  upon  the 
attention  paid  in  order  to  prevent  the  death  of  the  Mare  j  the  more 
time  lost,  so  the  more  is  the  foetus  weakened  ;  the  less  time  is  there  to 
spare  if  the  Mare  is  dead,  for  then  it  is  certain  that  the  foal  will  not 
live  longer  than  a  few  moments."  The  umbilical  cord  was  to  be  liga- 
tured at  four  or  five  inches  from  the  body  of  the  foal  ^  *'  after  which  it  is 
only  a  question  of  providing  means  for  rearing  the  young  animal,  until 
it  can  attend  to  itself." 

But  Rainard  points  out  that  nothing  is  said  as  to  closing  and  bandag- 
ing the  incision,  or  the  after-treatment  of  the  mare — thus  indicating  that 
preserving  the  foal  only  was  in  view. 

With  the  Mare  or  Cow,  the  operation  is  sometimes  attempted  in  the 
standing  attitude  ;  but  it  is  obvious  that  there  must  be  great  inconvenience 
and  danger  in  this.  It  is  much  better,  therefore,  to  place  the  Mare,  Cow, 
Sheep,  or  Goat,  on  the  left  side — right  side  uppermost ;  either  side  suffices 
for  the  Bitch  or  Sow. 

If  the  animal  is  narcotized  and  insensible,  then  it  is  not  necessary  to 
secure  the  limbs  ;  but  if  it  is  only  partially,  or  not  at  all  unconscious,  then 
means  of  contention  must  be  adopted,  for  the  safety  of  the  animal  as 
well  as  the  operator.  The  right  hind  leg  should  be  firmly  fixed  back- 
wards, so  as  fully  to  expose  the  region  to  be  operated  upon  ;  the  other 
three  limbs  are  secured  together  in  the  ordinary  manner.  A  small  animal 
can  be  held  by  one  or  two  assistants. 

The  incision,  as  has  been  said,  is  made  in  the  right  flank,  rather 
below  and  in  front  of  the  anterior  spinous  process  of  the  ilium,  so  as  to 
avoid  wounding  the  circumflex  artery — an  accident  which  might  embar- 
rass the  operator ;  if  this  or  any  other  artery  is  wounded,  it  must  be  tied 
immediately.  If  there  is  no  great  hurry,  and  the  hair  is  long,  this  had 
better  be  clipped  off.  The  incision  should  pass  downwards  and  forwards, 
in  the  direction  of  the  fibres  of  the  small  oblique  muscle  of  the  abdomen 
(no  muscle  should  be  cut  across)  ;  it  should  extend  through  the  skin  to 
the  muscles,  and  even  if  it  passes  into  these,  there  is  no  danger  to  be 
apprehended. 

The  length  of  the  wound  will,  of  course,  depend  upon  the  size  of  the 
animal :  for  the  Mare  or  Cow,  it  may  be  from  twelve. to  fourteen  inches. 
The  layers  of  muscles  are  to  be  gently  cut  through  until  the  peritoneum 
is  reached,  and  into  it  a  small  opening  is  to  be  made,  but  in  doing  this 
the  greatest  care  is  to  be  exercised,  so  as  not  to  wound  the  viscera.  The 
two  first  fingers  of  the  left  hand  are  passed  through  this  opening,  the 
back  of  the  hand  downwards  ;  the  blade  of  the  probe-pointed  bistoury  is 
placed  between  these  fingers,  and  carried  along — cutting  through  the 
peritoneum  and  muscles  until  the  opening  is  of  the  same  length  as  that 


560  OBSTETRIC  OPERATIONS. 

in  the  skin.  An  intelligent  assistant  should  be  at  hand  to  prevent  the 
escape  of  the  intestines  through  this  large  aperture. 

The  arm  of  the  operator  is  now  pushed  into  the  abdominal  cavity  in 
search  of  the  uterus,  which,  when  found,  is  brought  opposite  the  incision, 
should  it  not  be  there  at  first.  Two  assistants  compress  the  sides  of  the 
wound,  so  as  to  maintain  them  closely  against  the  uterus ;  this  the 
operator  cuts  through  slowly,  layer  after  layer,  using  all  diligence  so  as 
to  escape  wounding  the  fcetal  membranes. 

Two  fingers  are  insinuated  between  the  walls  of  the  organ  and  these 
membranes,  and  the  bistoury  is  again  employed  to  dilate  the  opening,  as 
in  the  peritoneal  incision,  so  as  to  give  it  nearly  the  same  direction  and 
extent  of  that  in  the  abdominal  wall.  Should  the  membranes  be  still 
intact,  they  are  to  be  torn,  and  the  "  waters  "  allowed  to  flow — but  only  ^7//- 
j"/V/(?the  abdomen,  if  possible.  The  operator  now,  plunging  his  arm  at  once 
into  the  cavity  of  the  uterus,  seizes  the  first  parts  of  the  foetus  that  come 
to  hand — fore-legs,  head,  or  hind  quarters,  if  possible — and  removes  it 
quickly  ;  the  umjjilical  cord  is  torn  or  tied,  and  the  young  creature  given 
to  those  who  will  dry  and  rub  it,  wrap  it  in  a  warm  blanket,  and  otherwise 
attend  to  it. 

The  obstetrist  immediately,  if  the  parent  is  to  be  preserved,  removes 
the  fcetal  membranes — an  easy  task  comparatively  in  the  Mare,  much 
more  tedious  and  difficult  in  the  Cow,  as  all  the  adhering  cotyledons 
must  be  separated  one  by  one.  Then,  by  means  of  a  sponge,  all  the 
fluid  remaining  in  the  organ  is  to  be  cleared  out,  as  well  as  any  that  may 
have  escaped  into  the  abdomen.  It  might  be  well  to  damp  the  interior 
of  the  uterus  with  a  very  weak  solution  of  carbolic  acid.  .  This  accom- 
plished, the  great  wound  is  to  be  closed. 

Nothing  is  done  to  the  uterus,  as  a  rule ;  the  organ  soon  diminishes 
very  considerably  in  volume,  and  it  would  appear  that  the  wound  in  it  is 
not  long  in  cicatrizing.  The  borders  of  the  wound  in  the  abdomen,  how- 
ever, must  be  speedily  and  solidly  united.  The  best  means  of  union  is 
undoubtedly  the  quilled  suture,  which  is  to  be  applied  according  to  the 
ordinary  rules  of  surgery  ;  care  must  be  taken  to  make  the  sutures  enter 
at  a  good  distance  from  the  border  of  the  wound,  and  to  include  the 
muscles  as  well  as  the  skin.  If  the  cord  fixing  the  outstretched  hind 
limb  is  slackened  a  little,  it  will  facilitate  closing  the  wound.  A  small 
corner  should  be  left  open  at  the  lower  end  of  the  wound,  to  allow  the 
products  of  inflammation  and  suppuration  to  escape.  External  to  the 
wound,  either  a  layer  of  fine  tow  or  lint,  slightly  carbolized,  or  oakum, 
may  be  placed.  Over  this,  long  narrow  strips  of  canvas  covered  with 
melted  glue  may  be  fixed,  to  support  the  sutures  and  retain  the  dressing ; 
then  on  these  another  thin  layer  of  carbolized  tow  or  oakum,  and  lastly, 
the  wide  body-bandage  around  the  abdomen  and  loins  of  the  creature. 
Though  it  is  somewhat  difficult  to  apply,  yet  it  is  essential  that  this 
bandage  or  compress  be  put  on  before  the  animal  is  allowed  to  rise. 
Afterwards,  the  bandage  may  be  adjusted  and  tightened  if  necessary. 

When  the  incision  is  made  at  the  lima  alba  the  procedure  is  somewhat 
similar  ;  but,  as  we  do  not  recommend  it  for  the  reasons  above  stated,  we 
need  not  allude  to  it  further. 

The  after-treatment  of  the  wound  is  that  followed  for  all  such  serious 
traumatisms.  Cold  water,  or  ice,  or  very  dilute  carbolic  acid,  may  be 
applied  to  the  wound,  if  necessary ;  but  very  often  this  requires  only 
ordinary  surgical  management.  The  patient  must  not  be  allowed  to  lie  down 
until  the  wound  is  united. 


GASTRO-HYSTEROTOMY,  OR  THE  CESAREAN  SECTION.     561 

The  diet  should  be  light  and  sloppy  for  a  short  time,  unless  the  animal 
is  very  feeble,  when  nourishing  food  must  be  given. 

With  the  smaller  animals  the  treatment  will  be  the  same.  For  enlarg- 
ing the  abdominal  and  peritoneal  incisions,  small  sharp  scissors  will  be 
found  very  useful  and  safe,  the  blade  with  the  blunt  point  being  intro- 
duced. 

The  bad  results  to  be  apprehended  from  the  operation  are  septic 
metritis,  or  peritonitis,  or  both  ;  abscess  at  the  seat  of  the  incision,  or 
adhesion  of  the  abdominal  organs  to  this  part. 

As  the  subject  is  particularly  interesting  and  important,  we  shall  en- 
deavor to  give  the  first  complete  list  of  cases  of  gastro-hysterotomy  which 
has  yet  been  published. 

1.  Youatt  [Cattle,  1834)  states  that  he  had  twice  attempted  the  operation,  but  in 
neither  instance  did  he  save  either  the  Cow  or  Calf. 

2.  Berry  {Veteriiiarian,  vol.  xii.,  p.  709)  records  a  case  of  extra-uterine  foetation,  in 
which  the  operation  was  performed  by  a  medical  man,  but  the  Heifer  died. 

3.  Ellis  [Ibid.,  loc.  cit.)  :  Operation  on  a  Sow  which  could  not  farrow  because  of  the 
immense  size  of  the  foetuses,  which  were  in  a  state  of  decomposition.  The  operation 
had  been  delayed  too  long,  however,  and  the  animal  died.  Ellis  rnentions  -that  he 
had  twice  successfully  performed  the  Caesarean  Section  on  the  Bitch. 

.  4,  5.  Carlisle  [Ibid.,  vol.  xiii.,  p.  121)  operated  on  a  Sow  (flank)  which  had  been  in 
labor  for  six  days,  and  had  gone  ten  days  beyond  the  ordinary  period  of  pregnancy. 
The  foetuses,  seven  in  number,  were  dead,  but  the  Sow  recovered.  He  states  that, 
sixteen  years  previously  (he  writes  in  1839),  a  farrier  residing  near  Carlisle  had  per- 
formed the  operation  on  a  Mare,  and  with  success.  "  The  poor  animal  was  sadly 
mutilated."' 

6,  7,  8,  9,  10,  II,  12,  13,  14.  Hayes,  in  1824  [Ibid.,  loc.  cit.,  p.  267),  had  a  kind  of  ex- 
perimental operation  upon  a  Bitch,  removing  six  puppies  alive,  but  one  died  on  the 
following  day.     The  remainder,  with  the  Bitch,  did  well.   ' 

In  1825,  he  tried  to  remove  a  Calf  by  embryotomy  (head  very  large,  and  deviated  to- 
wards the  flank),  but  could  not  succeed  :  gastro-hysterotomy  was  resorted  to,  and  the 
Cow  was  doing  well  until  the  twelfth  day,  when  it  suddenly  died.  The  diaphragm  was 
found  to  be  ruptured  and  gangrenous. 

A  third  case  occurred  in  a  very  old  Cow,  that  had  'exceeded  the  usual  period  of  ges- 
tation about  seventeen  days.  The  foetus,  could  not  be  extracted  by  embryotomy ;  the 
pelvis  being  too  small.  After  the  Caesarean  section,  no  untoward  symptoms  appeared, 
and  the  animal  was  quite  recovered  in  nine  weeks. 

The  same  practitioner  states  :  "  Since  that  time  I  have  operated  successfully  on  two 
Cows  and  one  Sow.  Three  other  Cows  on  which  I  operated  died,  in  three,  six  and 
eight  days  afterwards  ;  two  of  these  were  affected  with  severe  peritonitis. 

15.  Carlisle  [Ibid.,  loc.  cit.,  1^.  spi)  performed  the  flank  operation  for  torsion  of  the 
uterus.     The  Cow  died  from  strangulation  of  the  intestines. 

16.  Bowles  [Proc.  of  the  Veterinary  Medical  Association,  1839 — 40)  describes  a  case  in 
which  the  parent  was  killed,  and  the  foetus  extracted  by  the  Caesarean  Section. 

17.  Younghusband  [Ibid.)  records  the  case  of  a  Cow  which  had  been  in  labor  for 
some  time,  and  the  os  uteri  of  which  was  completely  occluded.  The  animal  was  extremely 
exhausted,  and  the  foetus  seemed  to  be  dead.  As  the  case  appeared  to  be  a  hopeless 
one,  it  was  resolved  to  spare  the  Cow  further  pain  by  killing  it.  This  was  done  by 
blowing  into  the  jugular  vein,  and  at  the  moment  the  animal  expired  the  foetus  was 
seen  to  move  strongly.  The  abdomen  was  at  once  opened  by  a  long  knife,  the  uterus 
incised,  and  a  living'Calf  extracted.  This  being  well  attended  to,  in  two  days  it  was 
able  to  drink  milk  wdthout  assistance,  and  was  afterwards  reared  successfully. 

i3.  Morgan  (  Veterinarian,  vol.  xxix.,  p.  698)  attended  a  Sow  which  could  not  farrow 
[all  her  pigs — only  two  having  been  born.  One  was  extracted /^r  vaginam  by  the  crotch- 
iCt,  but  as  the  animal  was  sinking,  it  was  decided  to  resort  to  gastro-hysterotomy.  The 
[■operation  was  performed  in  the  right  flank ;  only  one  foetus  remained,  and  this  was 
■taken  away.  The  Sow  recovered  in  a  short  time.  The  incision  in  the  uterus  was  su- 
;  tared.  When  the  animal  was  fatted  and  killed,  two  months  afterwards,  it  was  found  that 
[adhesion  had  taken  place  between  the  organ  and  contiguous  intestine,  and  that  an 
[abscess  had  formed,  from  which  a  sinus  could  be  traced  into  the  intestinal  canal.  The 
fright  ovary  was  destroyed. 

19.  Brooks  and  "Whitworth  [Ibid.,  vol.  xxxix.,  p.  33)  relate  the  history  of  a  Bitch, 

36 


562  OBSTETRIC  OPERATIONS. 

which,  while  pregnant,  had  its  pelvis  injured  by  being  run  over  by  a  carriage.  When 
parturition  had  been  going  on  fruitlessly  for  some  time,  an  examination  was  made,  and 
it  was  discovered  that,  owing  to  the  fracture  of  the  pelvis,  'just  above  the  symphysis 
pubis,  the  dimensions  of  the  canal  were  greatly  reduced  and  altered  in  form,  so  that  the 
finger  could  scarcely  be  passed.  Chloroform  was  administered,  the  hair  removed  from 
the  skin  in  the  right  iliac  region,  where  the  incision  was  made.  Two  puppies  were  re- 
moved, the  wound  in  the  uterus  closed*by  silver  wire  suture.  In  three  weeks  the  Bitch 
was  well.     The  puppies,  put  to  another  bitch,  also  lived. 

20.  ?>zcc\\&ro  [Giornale  di  Med.  Veterinaria,  1858)  alludes  to  the  case  of  a  four-years  old 
Cow,  which  had  been  in  labor  for  tliree  days,  and  every  attempt  to  remove  the  Calf  per 
vaginani  had  failed.  The  os  uteri  could  not  be  dilated.  So  it  was  proposed  to  extract 
the  foetus  by  the  Cassarean  section.  The  animal  was  cast  and  properly  secured  ;  an  in- 
cision was  made  in  the  left  flank,  when  all  the  intestines  suddenly  rushed  from  the  wound ; 
these  were  received  on  a  sheet,  which  was  kept  moist  with  tepid  water. 

The  uterus  was  then  exposed,  cut  into,  and  a  dead  Calf  pulled  out  by  the  tail.  The 
operation  occupied  less  than  twenty  minutes.  The  parts  were  well  cleansed  by  an  affu- 
sion of  warm  water,  intestines  returned,  incision  closed  by  twisted  suture,  and  covered 
with  fine  tow  steeped  in  warm  wine.  A  net  was  fixed  round  the  body  to  support  the 
sutures.  After  the  opei-ation  was  completed,  the  Cow  got  up  and  fed.  The  case  termi- 
nated favorably,  and  the  animal  was  subsequently  fattened  for  the  butcher. 

21.  Braga  (Archivio  di  Medic.  Vetertna7-ia,  June,  1S76)  was  called  in  haste  to  attend  a 
Cow — a  Primipara — which  had  been  some  time  in  labor,  the  "  water-bag  "  having  rup- 
tured, and  the  fore-limbs  of  the  foetus  were  presenting ;  but  nothing  more  was  advanced. 
Braga  found  the  animal  in  tolerably  satisfactory  condition,  but  the  vulva  was  twice  its 
normal  size,  and  was  partly  emphysematous.  The  mucous  membrane  of  the  vaginal  ves- 
tibulum  was  of  a  deep  red  color,  with  small  black  points,  showing  advancing  gangrene. 
The  fore-limbs  protruded  from  the  opening,  and  in  such  a  manner  that  their  posterior 
surface  was  superior.  An  exploration  of  the  vagina  discovered  the  mucous  membrane 
of  this  part,  as  well  as  of  the  cervix  uteri,  to  be  greatly  swollen  and  extremely  hot ;  while 
it  was  also  ascertained  that  the  foetus  was  in  the  dorsal  position — the  sternum  towards 
the  maternal  sacrum,  and  the  withers  on  the  symphysis  pubis,  with  the  head  and  neck 
deviated  towards  the  back.  Every  attempt  to  adjust  the  position,  or  effect  delivery, 
failed — notwithstanding  the  use  of  the  cords,  crotchets,  amputation  of  the  head,  etc. 

Although  it  was  now  late,  gastro-hysterotomv  was  proposed  to  the  owner,  and  the 
operation  was  allowed.  The  Cow  was  laid  on  its  right  side,  and  the  incision  was  made 
at  the  liriea  alha.  When  the  uterus  was  opened,  the  back  of  the  foetus  was  encountered, 
and  not  being  able  to  remove  it  in  this  position,  nor  yet  change  it  without  greatly  enlarg- 
ing the  uterine  wound,  the  hind-limbs  were  disarticulated  at  the  stifle,  and  the  remains 
of  the  creature  were  at  last  extracted.  The  incision  in  the  uterus  was  not  closed,  but 
left  to  itself  ;  while  that  in  the  abdominal  parietes  was  united  by  twisted  suture ;  a  wide 
bandage  was  applied  round  the  body.  A  stimulant  infusion  was  administered  to  the  Cow, 
and  aromatic  injections  thrown  into  the  vagina.  The  fever  ran  high,  though  there  was 
not  much  prostration;  but  towards  the  evening  the  proprietor  became  alarmed,  and 
fearing  to  lose  the  value  of\he  animal,  he  sent  for  the  butcher  and  had  it  killed  for  food. 

22.  Gohier  {Mhnoires  de  Gohier,  vol.,  ii.  p.  40)  mentions  the  case  of  a  Ewe  which  had 
been  in  labor  for  about  twelve  hours.  The  fore-feet  of  the  lamb  protruded  three  inches 
beyond  the  vulva,  and  the  head  was  bent  back  towards  the  withers.  '  The  foetus  was 
placed  in  a  favorable  position,  but  the  most  energetic  traction  only  succeeded  in  tearing 
away  the  fore-limbs.  The  Ccesarean  section  was  then  decided  upon,  and  an  incision, 
about  five  inches  in  length,  was  made  below  the  right  flank  ;  the  intestines  were  lifted 
out,  and  the  uterus  exposed  and  cut  into.  The  foetus  was  now  extracted,  and  afterwards 
the  placenta.  The  intestines  were  replaced;  the  abdominal  wound  closed  by  quilled 
suture  ;  a  compress  applied  around  the  body,  and  several  glasses  of  decoction  of  gentian 
administered  to  the  Sheep.  Death  occurred  next  day,  and  it  was  then  discovered  that 
the  iliu.ii  was  the  seat  of  an  old  fracture  which  had  become  united,  ;  nd  in  doing  so  had 
produced  an  oblique  deformity  of  the  pelvis.  The  head  of  the  lamb  had  been  arrested 
and  bent  back  against  the  callus,  opposite  the  cotyloid  cavity. 

23.  Morange  (D'Arboval.  Dictio)in.  de  Med.  Chiriiro-.  etc.,  Veterinnire)  furnishes  the 
case  of  a  Cow  which  had  gone  beyond  the  ordinary  period  of  gestation  bv  thirty-seven 
days.  The  cervix  uteri  was  altered  in  texture,  and  the  os  undilatable.  The  calf  was 
dead,  and  consequently  gastro-hysterotomy  was  decided  upon.  When  the  abdominal 
walls  were  cut  into,  an  enormous  quantity  of  reddish  serum  flowed  therefrom.  The  foetus 
was  removed,  as  well  as  the  placenta,  and  the  wounds  united  by  suture.  After  the  next 
day  the  appetite  had  returned ;  but  in  fifteen  days  the  owner,'thinking  the  animal  was 
suffering  from  hunger,  inconsiderately  gave  it  a  large  quantity  of  lucerne,  and  the  Cow 
soon  died  from  indigestion. 

24.  Chariot  {Journal  Prat,  de  Med.   Veterinaire,  1826,  p.  165)  mentions  a  Cow  which 


GASTRO-HYSTEROTOMY,  OR  THE  CESAREAN  SECTION.     563 

was  extremely  weak  from  having  been  in  the  pangs  of  impotent  labor  for  three  days. 
There  was  a  vaginal  tumor,  apparently  fibrous,  which  had  been  mistaken  for  the  "  water 
bag,"  and  punctured  ;  this  was  the  inverted  bladder!  The  neck  of  the  uterus  was  indu- 
rated. 

The  animal  being  now  considered  lost,  the  Caesarean  section  was  practised  in  the  hope 
of  saving  the  Calf.  The  operation  was  successful  ;  a  living  Calf,  which  was  afterwards 
reared,  being  removed  from  the  uterus.     The  Cow  died. 

25.  Chretien  {Ibid.,  loc.  cit.,  p.  221)  describes  a  similar  case  ;  the  Cow  having  been  in 
labor  for  three  days,  the  cervix  uteri  indurated,  and  the  genital  organs  greatly  inflamed. 
The  Cow  being  deemed  lost,  it  was  determined  to  sate  the  Calf  by  the  Caesarean  sec- 
tion. The  right  flank  was  opened  about  two  inches  in  front  of  the  anterior  spinous  pro- 
cess of  the  ilium,  the  Cow  being  in  a  standing  attitude;  the  incision  was  about  seven 
inches  in  length.  The  uterus  presented  at  the  wound,  and  was  incised  in  turn  ;  the  foe- 
tus was  removed  alive,  and  then  the  membranes.  A  portion  of  intestine  escaped  from 
the  wound ;  this  was  returned,  and  the  uterine  wound  closed  by  continuous  or  pointed 
suture ;  the  blood  which  had  escaped  into  the  abdomen  was  carefully  removed,  and  a 
double  suture  united  at  first  the  muscles,  then  the  skin.  The  Cow  died  eight  hours  after 
the  operation  ;  the  calf  appears  to  have  lived. 

26.  The  same  author  (ibid.)  alludes  to  another  Cow  which  was  in  labor  for  six  hours. 
Some  time  previously  it  had  been  treated  for  a  fracture  of  the  ilium,  which  united  ;  but 
the  animal  remained  lame,  and  the  callus  filled  one-third  of  the  pelvic  cavity.  The  fore- 
limbs  of  the  foetus  were  outside  the  vulva  ;  the  head  was  retained  and  thrown  over  the 
back.  It  was  brought  into  a  favorable  position,  and  energetic  traction  applied,  but  the 
obstruction  could  not  be  overcome.  The  Caesarean  section  was  deemed  indispensable, 
and  was  practised  as  in  the  previous  case,  except  that  a  small  opening  was  left  at  the 
lower  part  of  the  wound  for  the  escape  of  discharges.  The  Cow  recovered,  but  no  men- 
tion is  made  as  to  whether  the  calf  survived. 

27.  This  authority  (/(!5zV/.)  gives  another  instance  of  a  Cow  which  had  gone  twenty- 
seven  days  beyond  its  time  for  calving,  and  had  been  in  labor  for  twenty-four  hours. 
The  foetus  was  a  Celosomian  monstrosity,  which  could  not  be  extracted  per  vias  natur- 
ales ;  so  in  order  to  save  time,  and  fatigue  to  mother  and  operator,  gastro-hysterotomy 
was  performed,  and  practised  the  same  as  above.  The  extraction  of  the  monstrosity 
was  difficult,  and  it  had  to  be  divided — the  anterior  half  being  first  removed,  then  the 
posterior.  The  Cow  was  killed  next  day,  as  fears  were  entertained  for  the  result  of  the 
operation. 

28.  Pradal  {Recueil  de  Mid.  Vetcrinaire,  1833,  p.  195)  attended  a  Cow  which  had  been 
making  fruitless  efforts  to  calve  for  forty-eight  hours.  When  the  animal  was  lying,  on 
separating  the  labia  of  the  vulva  the  posterior  segment  of  the  uterus  could  be  seen  well 
advanced  in  the  vagina  ;  but  when  it  stood  the  tumor  receded  into  the  abdomen. 

The  cervix  uteri  was  swollen,  indurated,  and  almost  cartilaginous  in  consistence ;  di- 
lation of  the  OS  was  considered  impossible.  The  foetus  was  alive  and  strong,  as  its 
movements  showed.  The  Caesarean  section  was  adopted  ;  the  right  flank,  then  the 
uterus  was  largely  opened;  the  foetus  was  quickly  removed ;  and  the  Cow  immediately 
killed  by  the  butcher.     The  Calf  was  reared  by  another  Cow.* 

29.  Lecoq  {Man.  de  la  Soc.  Vet.  du  Calvados,  etc.,  No.  vi.)  refers  to  a  Cow  which  had 
been  straining  fruitlessly  for  twenty-four  hours,  and  was  weak  and  exhausted,  though 
the  pains  still  continued.  The  os  uteri  was  occluded.  Without  giving  any  reason  for 
the  preference,  Lecoq  decided  on  the  Caesarean  section  rather  than  vagftal  hvsterot- 
om)-.  An  incision  was  made  in  the  middle  of  the  right  flank,  downwards  and  backwards, 
for  about  seven  inches;  then  the  uterus  was  opened.  The  foetal  membranes  were  so 
thick  and  resisting  that  it  was  necessary  to  divide  them  with  the  knife  ;  the  foetus  was 
then  easily  extracted,  though  it  was  difiicult  to  remove  the  placenta  afterwards.  The 
abdominal  wound  was  closed  by  suture. 

Notwithstanding  every  attention,  the  calf,  which  was  weak  and  ill  when  extracted, 
died  on  the  same  evening ;  while  the  Cow  succumbed  next  day — twenty-four  hours  after 
the  operation. 

30.  31,  32.  T,y  Rainard  (Op.  cit.,  vol.  ii.,  p.  103)  states  that  he  had  performed  the  op- 
eration four  times — on  the  Sheep,  Goat,  and  Bitch,  and  he  was  never  successful  in 
saving  either  the  parent  or  progeny  ;  though  he  admits  that  the  animals  operated  upon 
were  always  in  a  desperate  condition — the  long-continued  efforts  to  remove  the  foetus 
by  the  genital  passages  having  exhausted  them. 

34.  Garreau  [Rec.  de  Med.  Veteriimire,  1854,  p.  513)  mentions  the  case  of  a  Cow  preg- 
nant with  its  fourth  calf,  and  which  had  gone  fifteen  days  beyond  its  time ;  though  at 
the  ordinary  period  it  had  exhibited  signs  of  parturition,  which  disappeared  only  to  re- 
appear at  the  end  of  the  fifteen  days. 

*  This  would  have  been  an  excellent  case  for  original  hysterotomy,  and  offered  a  good  prospect  of  suc- 
cess.   The  Cow  might  even  have  recovered  from  the  effects  of  the  operation  practised  on  it. 


564  >  OBSTETRIC  OPERATIONS. 

The  uterus  was  deviated  [see  p.  288),  and  there  was  induration  of  the  cervix.  Gar- 
reau  saw  no  other  means  of  relieving  the  animal  than  by  resorting  to  gastro-hysterot- 
omy;  though  he  did  not  venture  to  operate.  The  animal  was  not  interfered  with  until 
three  nionths  afterwards,  when  being  in  the  same  condition,  Garreau  was  requested  to 
perform  the  operation.  This  he  did  somewhat  after  the  procedure  already  indicated  ; 
the  foetus  was  extracted,  and  the  abdominal  wound  closed  by  quilled  suture.  Kept  on 
very  low  diet,  and  receiving  tonics  for  some  days,  the  Cow  completely  recovered; 
eight  months  afterwards  it  was  sold,  because  it  did  not  exhibit  any  inclination  for  the 
Bull. 

35.  Macorps  {Aimales  de  Medf  Veterinaire  de  Bruxelles,  1862,  p.  137)  had  under  treat- 
ment a  Bitch  which  had  in  the  right  flank,  towards  the  last  mamma,  a  tumor  the  size  of 
a  fist,  and  which  had  appeared  six  weeks  previously  in  a  very  gradual  manner.  It  was 
neither  hot  nor  painful  to  the  touch  or  on  pressure. 

As  it  was  supposed  to  be  a  mammary  neoplasy,  its  excision  was  attempted.  A  large 
incision  was  made  in  the  skin,  and  there  immediately  appeared  a  white  saccular  body 
which  was  at  once  recognized  as  a  titerbie  hernia.  Instead  of  returning  it  to  the  abdo- 
men, as  this  appeared  to  be  both  difficult  and  dangerous,  it  was  decided  to  extract  the 
entire  uterine  cornu  as  far  as  the  cervix  uteri,  apply  a  ligature  round  it  there,  and  thus 
extirpate  the  organ.  This  was  done  ;  a  few  sutures  firmly  united  the  skin  incision  ;  the 
animal  was  kept  quiet,  the  diet  attended  to,  a  few  enemas'.administered,  and  in  eighteen 
days  after  the  operation,  the  Bitch — of  a  sporting  breed — was  out  in  the  field  with  its 
master. 

36.  Thierry  {Bulletin  de  la  Soc.  Cent.  Veterinaire,  1873)  gives  an  interesting  case  of 
a  Cow,  three  years  old,  which  suffered  at  an  interval  of  three  days  from  a  double  luxa- 
tion of  the  coxo-femoral  articulations  from  some  unknown  cause.  A  rectal  and  vaginal 
exploration  led  to  the  discovery  of  a  slight  deformity  of  the  pelvis,  and  Thierry  satisfied 
himself  that  it  was  a  case  of  osteomalacia — a  diagnosis  which  subsequent  events  con- 
firmed. In  fact,  in  a  few  days  afterwards,  another  exploration  found  a  fracture  of  the 
pelvis,  which  appeared  to  have  occurred  spontaneously.  Finally,  symptoms  of  par- 
turition showed  themselves,  but  birth  could  not  take  place  ;  the  fracture  had  so  nar- 
rowed the  pelvic  canal  that  it  was  barely  possible  to  introduce  the  hand.  After  several 
ineffectual  attempts,  the  idea  of  extracting  the  foetus  by  the  natural  passage  was  given 
up,  and  the  Caesarean  section  practised.  A  fine  calf,  which  lived,  was  the  result ;  the 
Cow  was  immediately  killed,  and  at  the  autopsy  the  fractures  and  luxations  diagnosed 
during  life  were  found, 

37.  Saint-Cyr  [Op.  cit.,  p.  579)  gave  his  attention'to  a  Bitch  which  had  been  in  labor 
since  the  previous  evening.  It  had  given  birth  to  a  puppy  twelve  hours  before,  but  no 
more  could  be  expelled.  When  Saint-Cyr  first  saw  the  Bitch,  the  labor  pains  had 
ceased ;  by  vaginal  exploration  he  could  scarcely  touch  the  foot  of  the  most  advanced 
puppy — which  was  not  in  the  pelvis — with  his  finger ;  while  the  volume  of  the  abdomen 
led  him  to  believe  that  there  were  more  than  one  in  the  uterus.  The  general  condition 
of  the  animal  was  good;  so  it  was  decided  to  try  the  Caesarean  section,  incising  the 
right  flank,  where  the  foetuses  were  most  readily  felt  by  abdominal  exploration.  Three 
foetuses  were  removed  from  the  right  cornu  by  a  single  incision  ;  two  of  these  were 
dead,  but  one  was  still  alive.  The  operation  being  completed,  the  cornu  was  returned 
to  the  abdomen,  but  not  sutured ;  and  the  abdominal  incision  closed  by  interrupted 
suture,  a  bandage  being  placed  round  the  body. 

After  the  Ofseration  the  Bitch  was  very  weak  ;  it  died  in  eighteen  hours.  The  autopsy 
showed  a  moderate  degree  of  metro-peritonitis. 

38.  Ory,  in  a  communication  to  Saint-Cyr  {Op.  cit.,  p.  577)  states  that  he  was  called 
to  attend  a  Cow,  which,  for  seven  or  eight  days,  had  been  making  impotent  efforts  to 
calve  On  his  arrival  he  found  it  extended  on  the  litter,  and  quite  unable  to  get  up. 
For  eight  days  it  had  been  suffering  from  complete  paraplegia.  The  "waters"  had 
only  escaped  about  two  hours  previously,  and  the  uterine  contractions  were  feeble  ;  the 
Cow  was  fat,  but  nearly  dead.  Vaginal  exploration  discovered  the  foetus  to  be  alive,  in 
the  anterior  position,  head  on  the  withers,  and  the  fore-limbs  completely  retained  and 
deviated  backwards.  Attempts  were  made  to  rectify  this  malposition,  and  the  two  limbs 
were  brought  into  the  pelvis ;  but  the  Cow  was  evidently  sinking  and  death  imminent. 
Ory  endeavored  to  get  the  head  rectified,  but  quickly  saw  that  delay  would  only  entail 
the  sacrifice  of  the  calf  as  well  as  the  loss  of  the  Cow.  The  latter  was  killed  by  the 
butcher ;  then  at  once,  by  a  single  cut  of  the  bistoury,  he  made  a  large  opening  in  the 
abdomen,  and  by  another  incision  threw  open  the  uterus,  from  which  the  calf  was  taken. 
The  latter  was  well-shaped  and  alive,  and  being  reared,  became  an  excellent  Cow,  which 
Ory  had  under  observation  for  eleven  years. 

39.  In  1870,  the  same  veterinarian  (Saint-Cyr,  Op.  cit.,  p.  578)  had  to  attend  an  aged 
Mare  in  labor.  The  animal  was  pregnant  with  its  eleventh  foal ;  it  had  been  straining 
so  violently  for  some  hours  previously,  that  the  rectum  had  become  everted.     This  ever- 


GASTRO-HYSTEROTOMY,  OR  THE  CESAREAN  SECTION.     565 

sion  having  been  reduced,  Ory  practised  the  "touch,"  and  found  the  cervix  uteri  so 
contracted  that  he  could  scarcely  introduce  one  finger. 

After  long-continued  efforts,  he  contrived  to  introduce  three  fingers,  but  it  was  im- 
possible to  effect  more.  The  cervix  was  excised,  but  a  new  difficulty  then  presented 
itself :  the  foetus  filled  the  uterus  so  exactly,  that  the  hand  could  not  be  passed  between 
it  and  the  foetus.  However,  it  was  ascertained  that  all  the  feet  of  the  latter  presented, 
and  that  the  young  creature  was  doubled  on  itself ;  it  did  not  exhibit  any  sign  of  being 
alive.  Ory  then  came  at  once  to  the  conclusion  that  delivery  by  the  genital  canal  was 
impossible ;  though,  for  conscience  sake,  he  did  all  he  could  during  two  hours  until, 
exhausted,  he  was  compelled  to  cease.  The  Mare  being  very  old  and  of  little  value,  he 
determined  to  have  it  destroyed  ;  but  before  doing  so  he  resolved  to  save  the  foal — if  it 
still  lived — by  resorting  to  the  Cassarean  section  for  its  extraction.  The  operation  was 
easily  performed,  and  in  the  same  manner  as  in  the  previous  case.  But  the  foal  was 
dead.  Its  head  was  on  the  left  shoulder,  the  croup  ott  the  head, — the  creature  being 
thus  gathered  in  a  threefold  mass,  not  unlike  a  ball,  to  which  the  uterus  was  closely  ap- 
plied.    All  the  feet  were  directed  towards  the  os. 

The  Mare  was  killed  as  soon  as  the  operation  was  concluded,  and  its  uterus  showed 
a  somewhat  remarkable  disposition.  The  body  of  the  organ  alone  had  been  developed 
during  gestation,  and  it  had  a  globular  or  spherical  shape,  not  unlike  that  of  a  woman. 
The  cornua  were  ver^'  slightly  developed,  and  formed,  near  the  anterior  part  of  the 
organ,  two  nearly  equal  appendages  about  three  inches  long. 

40.  Rohhves  (Dieterich,  Geburtshiilfe,  p.  125),  in  1822,  refers  to  the  case  of  a  Mare 
which  could  not  foal.  He  had  the  animal  placed  on  its  back,  the  fore-feet  fastened  to 
as  many  posts,  and  opened  the  abdomen  at  the  linea  alba.  The  foal  was  alive,  and  was 
extracted;  it  was  reared  by  another  Mare,  its  mother  having  died,  and  was  afterwards 
a  stud  stallion.  This  is  the  earliest  recorded  case  of  gastro-hysterotomy  we  can  find 
any  notice  of. 

41.  Lehnert  {Sachs  JaJn-esbericht,  1S73,  P-  ^5)  performed  the  Caesarean  section  on  a 
Cow  which  was  dying  from  a  lung  disease,  and  extracted  three  living  calves. 

42.  Feser  (  Thierarztliche  Mittheilungen  der  Munchener  Schule,  Part  iii.,  p.  296)  op- 
erated on  a  Bitch  which  could  not  pup,  making  the  opening  in  the  left  flank,  against 
which  the  uterus  lay ;  three  puppies  were  extracted — one  from  each  horn  and  one  from 
towards  the  os  uteri,  the  latter  being  dead,  and  from  a  deviation  of  its  head  it  consti- 
tuted the  obstacle  to  birth.  The  heads  of  the  other  two  puppies  were  likewise  deviated. 
The  uterus  and  Fallopian  tubes — every  thing  behind  the  cervix  uteri — were  extirpated 
by  the  ecraseur.  The  uterine  and  ovarian  artery  were  ligatured.  The  incisions  were 
closed  by  suture,  and  ice  applied  to  the  left  side  of  the  abdomen.  The  animal  lost 
about  three  ounces  of  blood.  An  hour  after  the  operation  it  had  a  shivering  fit,  but 
this  soon  passed  off ;  though  it  recurred  three  times  a  day  for  some  time.  In  six- 
teen days  the  wound  had  healed  and  the  Bitch  was  quite  recovered.  The  puppies  were 
reared  artificially. 

43.  The  same  veterinarian  [Ibid.,  p.  297)  performed  the  Sedio  Ccesarean  on  another 
Bitch  two  years  old.  The  animal  had  been  in  labor  for  two  days,  and  was  extremely 
weak ;  no  puppies  has  been  born.  The  section  was  made  on  the  left  side,  and  four 
dead  puppies  extracted.  The  uterus  and  ovaries  were  extirpated  by  the  ecraseur,  and 
the  arteries  ligatured.  Frequent  rigors  appeared  after  the  operation.  In  twenty-four 
hours  death  ensued,  the  fatal  termination  being  apparently  due  to  septikasmia. 

44.  Feser  [Ibid.,  p.  298)  relates  another  instance  in  which  he  performed  the  operation, 
extracting;  four  living  puppies — two  from  each  cornu  ;  the  incision  was  made  in  the  left 
flank.  The  uterus  and  ovaries  were  also  excised  in  this  case,  the  animal  losing  about 
five  ounces  of  blood.  Extreme  prostration  ensued  after  the  wounds  were  closed,  but  this 
was  combated  by  stimulants,  and  sprinkling  sweet  spirits  of  nitre  over  the  body.  The 
appetite  was  good,  and  with  the  exception  of  traumatic  fever,  no  unfavorable  symptoms 
supervened.  In  eight  days  the  Bitch  had  recovered ;  two  of  the  puppies  were  reared 
artificially. 

45.  Adam  [Briijliche  Mittheibing)  performed  the  operation  on  a  Bitch,  under  chloro- 
form, making  the  section  at  the  linea  alba,  behind  the  umbilicus,  and  dividing  the  tissues 
with  the  scalpel,  the  peritoneum  with  scissors;  the  cornua  were  opened  by  incision. 
After  removal  of  the  foetuses,  the  wound  in  the  abdominal  muscles  was  united  by  suture, 
then  that  in  the  skin.  During  the  first  day  the  animal  was  very  depressed  and  feverish, 
but  on  the  third  day  it  was  able  to  move  about.  The  puppies,  which  were  very  large, 
were  reared  by  hand.  Eight  months  afterwards  the  Bitch  again  became  pregnant,  and, 
not  being  able  to  bring  forth,  died — no  assistance  having  been  rendered  on  this  occasion, 
apparently. 

46.  Soerensen  [Tidskrift  for  Veterinar..  186S)  gives  the  case  of  a  Sow,  the  vagina  of 
which  was  so  swollen  that  it  could  not  farrow  after  one  foetus  had  been  expelled.  Soeren- 
sen operated  as  for  ovariotomy ;  first  removing  the  bristles  from  the  left  flank  where  the 


566  OBSTETRIC  OPERATIONS. 

incision  was  made,  A  foetus  was  extracted  from  the  left  cornu,  and  through  the  same 
opening  another  was  obtained.     The   hsemorrhage  was  unimportant. 

The  ovaries  wdre  extirpated,  and  the  uterus  wound  being  left  untouched,  that  in  the 
abdominal  wall  was  sutured. 

The  Sow  was  fattened  and  soon  after  killed.  The  right  cornu  was  found  to  l>e 
normal ;  the  left  contained  about  a  pint  of  pus  at  the  part  where  the  incision  had  been 
made. 

47.  Jensen  [Ibid.,  1869)  relates  an  instance  in  which  a  Sow  could  not  farrow  ;  the  left 
cornu  of  the  uterus  had  been  previously  removed.  He  incised  the  right  flank,  opened 
the  right  cornu,  and  extracted  five  foetuses — three  of  which  were  alive,  and  lived.  The 
foetal  membranes  were  entirely  removed,  and  the  wound  closed  by  interrupted  suture. 
The  Sow  recovered  and  became  very  fat.  When  killed  there  was  a  litre  and  a  half  of 
pus  in  the  uterus. 

48.  This  authority  {Ibid.,  1S73)  had  occasion  to  resort  to  the  operation  again  in  1873. 
The  subject  was  a  Sow — pregnant  for  the  first  time — which  had  already  brought  forth 
three  dead  foetuses.  Next  day  the  abdomen  was  greatly  distended,  and  fluid  was  dis- 
charged from  the  opening.  In  the  left  cornu  was  found  only  one  very  large  foetus,  and 
in  removing  it,  the  friable  texture  of  this  part  was-torn.  The  abdominal  wound  was 
closed  by  suture  after  the  extraction.  The  Sow  recovered  and  was  fattened.  When 
killed,  a  well-marked  cicatrix  was  observed  in  the  left  cornu  with  some  tubercles 
( Tuberkel)  around  its  margin  ;  the  cornu  was  somewhat  contracted  at  this  part — else- 
where it  was  normal. 

49.  Adam,  sen.  (Miindliche  Mittheilung)  relates  that  a  worthless  Mare  became  acci- 
dentally impregnated,  and  at  the  end  of  pregnancy  could  not  foal,  owing  to  a  contracted 
pelvis.  The  case  being  hopeless,  the  Mare  was  killed,  the  abdomen  and  uterus  imme- 
diately opened,  and  a  living  foal  extracted ;  this  was  kept  alive  for  eight  days. 

50.  Adam,  junr.,  was  called  to  attend  a  pregnant  Mare  which  could  not  expel  the  foal. 
Attempts  were  made  at  extraction,  but  all  failed.  The  animal  was  killed  by  a  blow  on 
the  head,  and  the  abdomen  and  uterus  being  opened,  and  the  membranes  incised  towards 
the  head  of  the  foal,  the  latter  was  extracted.  The  entire  operation  did  not  occupy 
more  than  ten  minutes.     The  foal  lived  for  eight  days. 


CHAPTER  V. 

Symphysiotomy. 

Symphysiotomy,  as  the  name  implies,  consists  in  dividing  the  ischio- 
pubic  symphysis  throughout  ;  so  that,  by  allowing  the  bones  to  separate 
somewhat  in  the  pubic  region,  the  pelvic  cavity  may  be  enlarged,  and 
the  passage  of  the  foetus  through  it  rendered  possible.  But  even  in 
woman,  with  every  advantage  and  appliance,  and  after  a  most  serious 
mutilation,  the  separation  procured  between  the  bones  is  infinitesimal, 
and  therefore  can  have  but  little  influence  on  the  progress  of  the  foetus. 
And  when  we  remember  that  in  woman  the  mortality  is  more  than  32  per 
cent.,  while  among  those  which  survive  many  are  permanently  disabled, 
and  those  which  recover  often  require  months  before  convalescence  is 
established,  it  will  be  understood  that  the  operation  can  never,  with  our 
present  knowledge,  be  reckoned  among  those  which  the  veterinary 
obstetrist  must  practise.  It  may  be  sufficient  to  notice  the  fact  that,  in 
animals,  the  symphysis  pubis,  as  a  rule,  soon  becomes  ossified.  The 
operation  does  not  appear  to  have  been  resorted  to  in  veterinary  obstet- 
ricy,  and  it  would  require  a  bold  operator  to  attempt  it. 


RETENTION  OF  THE  FCETAL  ENVELOPES.  567 

BOOK  IV. 

ACCIDENTS   INCIDENTAL  TO   PARTURITION. 

The  accidents  incidental  to  the  act  of  parturition  are  rather  diverse,  and 
not  unfrequently  complicate  those  difficulties  already  alluded  to  as  hin- 
dering natural  birth.  These  accidents  may  occur  either  during  par- 
turition, immediately  after  delivery,  or  within  a  few  days  subsequent  to 
that  event. 

In  addition  to  the  accidents,  there  are  diseases  which  appear  during  the 
puerperal  period :  though  the  distinction  between  them  and  the  former  is 
not  always  easy  to  establish. 

Some  of  the  complications  just  alluded  to  may  succeed  a  perfectly  nor- 
mal delivery,  or  an  accidental  abortion,  as  well  as  a  difficult  birth. 

The  accidents  consecutive  to  or  accompanying  parturition,  may  be  enu- 
merated as  follows  :  (i)  Retention  of  the  foetal  etivelopes  in  the  uterus  and 
the  consequefices  ;  (2)  Post-partum  hce7norrhage  from  the  genital  organs  ;  (3) 
Displacement  or  hernia  of  one  or  fnore  of  the  i?iternal  genital  organs  through 
the  vulva  ;   (4)  Trau?natic  lesions  of  the  ge?iital  or  neighboring  orgafis. 

Some  of  these  accidents  are  either  very  serious  in  themselves  or  in 
their  consequences,  and  require  the  greatest  skill  to  remedy  \  or  they  are 
comparatively  trifling,  and  easily  repaired. 


CHAPTER  I. 

Retention  of  the  Fcetal  Envelopes. 

The  retention  or  the  foetal  envelopes,  placenta,  "  secundines,"  or  "  after- 
birth," beyond  a  certain  time  after  the  expulsion  of  the  foetus  from  the 
uterus,  must  be  looked  upon  as  an  accidental  or  pathological  condition 
which  requires  attention.  We  have  already  shown  that  the  placenta  is 
usually  shed  or  expelled  soon  after  the  young  creature  is  born,  and  par- 
ticularly with  such  animals  as  the  Mare,  Sow,  and  Bitch,  the  placenta  of 
which  is  diffused  or  zonular  ;  indeed,  with  multiparous  animals — as  the 
two  latter — the  placenta  of  each  foetus  is  extruded  soon  after  its  birth 
by  the  succeeding  foetus  ;  so  that,  if  retention  occurs  at  all,  it  is  only  the 
last,  or  the  two  last  placentae  which  remain  in  the  cornua  of  the  uterus. 

With  ruminant  animals,  however,  retention  is  far  from  rare  ;  though 
even  in  them  there  is  a  difference  in  this  respect,  according  to  species — 
this  accident  being  much  more  frequent  in  the  Cow  than  in  the  Sheep  or 
Goat.  This  frequency  in  ruminant  animals  is  doubtless  due  to  the  pecu- 
liar conformation  of  their  placentae — the  cotyledonal  arrangement  being 
evidently  opposed  to  segregation. 

But  if  the  Cow  is  the  animal  of  all  others  in  which  this  accident  occurs, 
it  is  also  the  one  which  appears  to  be  the  least  inconvenienced  by  it  ; 
for,  as  Saint-Cyr  correctly  observes,  it  is  not  uncommon  to  see  Cows 
which  four,  six,  eight,  and  even  ten  or  twelve  days  after  parturition,  have 
not  got  rid  of  the  placenta,  and  yet  are  lively,  the  appetite  is  Unimpaired, 
and  they  continue  to  ruminate  and  give  milk  as  if  there  was  nothing 
amiss. 


568  ACCIDENTS  INCIDENTAL  TO  PARTURITION. 

Symptoms  and  Termi fiat  ions. 

The  symptoms  are  generally  so  marked  that  the  obstetrist  readily  dis- 
covers the  state  of  affairs.  Nearly  always  there  is  a  more  or  less  consid- 
erable mass  of  the  foetal  envelopes — sometimes  only  the  umbilical  cord 
— hanging  from  the  vulvar  orifice,  the  labia  of  which  are  often  swollen 
and  injected.  Occasionally  the  mass  is  so  large  as  to  reach  below  the 
hocks,  with  little  bags  of  liquor  amnii  at  the  lower  end  ;  it  has,  if  recently 
expelled,  a  fresh  tint,  not  unlike  that  of  the  intestines  ;  but  if  exposed 
for  some  time,  and  especially  in  summer,  it  is  greyish-colored,  somewhat 
adhesive,  and  generally  soiled  by  faeces  or  litter, 

.  In  other  cases  nothing  is  noticeable,  except  when  the  animal  is  lying 
on  its  abdomen  ;  then  the  pressure  on  the  uterus  pushes  the  cervix  into 
the  vagina,  and  if  any  portion  of  the  membranes  is  through  the  os,  of 
course  it  is  visible.  And  in  others,  again,  nothing  whatever  is  to  be  seen 
whether  the  creature  is  lying  or  standing,  the  whole  mass  b^jng  retained 
in  the  uterus.  After  the  third  day  of  delivery  the  os  is  usually  closed  ; 
and  unless  a  portion  of  the  membranes  chanced  to  be  in  the  vagina  be- 
fore this  period,  the  entire  placenta  is  imprisoned  in  the  uterus,  and  a 
manual  exploration  will  not  always  discover  it.  Sometimes  only  a  frag- 
ment of  the  membranes  is  so  retained. 

We  have  mentioned  that,  in  many  cases,  the  animal  does  not  evince 
any  uneasiness  at  first  ;  sometimes,  when  the  portion  of  placenta  hang- 
ing outside  the  vulva  is  large  and  heavy,  when  the  creature  is  standing 
the  meatus  urinarius  is  pressed  upon,  and  micturition  is  rendered  diffi- 
cult. There  may  also  be  symptoms  of  abdominal  uneasiness — whisking 
the  tail,. stamping  with  the  feet,  and  making  efforts  as  if  to  defecate  or 
micturate,  with  slight  and  brief  uterine  contractions,  which  may  eventu- 
ally lead  to  the  expulsion  of  the  placenta. 

it  often  happens  that  when  the  os  is  not  completely  closed,  owing  to  a 
portion  of  the  membranes  lying  in  it,  spontaneous  expulsion  takes  place, 
after  a  variable  period. 

Deneubourg,  a  Belgian  veterinary  surgeon,  asserts  that  it  occurs  at 
fixed  intervals,  which  are  almost  regular  "tertiary  periods  ;"  that  is,  if 
expulsion  does  not  ensue  in  the  first  twenty-four  hours,  it  should  take 
place  on  the  third  day ;  and  if  not  then,  it  will  be  either  on  the  sixth, 
ninth,  twelfth,  fifteenth,  or  other  tertiary  interval — but  most  frequently 
on  the  ninth  day.  How  far  this  assertion  maybe  correct,  experience  can 
alone  decide  ;  what  is  more  to  the  point,  however,  is  the  fact  that,  when 
once  this  spontaneous  expulsion  has  been  effected,  there  is  little  to  be 
apprehended. 

It  is  not  so  when  retention  is  accompanied  by  decomposition  of  the 
membranes.  This  occurs  when  the  air  has  access  to  them  ;  and  all  the 
more  rapidly  does  putrefaction  progress  as  the  temperature  is  high,  and 
they  are  impregnated  with  discharges. 

The  odor  is  most  repulsive,  and  a  sanious  brown-tinted  discharge,  com- 
posed of  debris  of  the  membranes,  and  secretions  from  the  irritated  mu- 
cous lining  of  the  genital  canal,  fiow  from  the  vulva — soiling  it,  the  tail, 
thighs,  and  hocks,  and  often  excoriating  them  ;  this  discharge  is  most 
abundant  when  the  animal  extends  itself  to  micturate,  and  it  is  then 
horribly  fetid.  The  hand,  on  being  passed  into  the  vagina,  is  covered 
with  the  fluid,  and  it  may  encounter  shreds  of  the  placenta. 

In  such  cases,  the  hea'lth  of  the  animal  often  suffers :  there  is  dulness, 


RETENTION  OF  THE  FCETAL  ENVELOPES.  569 

prostration,  diminution  in  the  secretion  of  milk,  decreased  appetite,  re- 
spiration perhaps  quickened,  temperature  increased,  and  other  indica- 
tions of  illness. 

The  complications  from  placental  retention  are  somewhat  numerous. 
Contact  with  the  decomposing  membranes  may  so  irritate  the  interior  of 
the  uterus  as  to  occasion  metritis,  or  even  metro-peritonitis — a  diseased 
condition  which  is  always  serious,  and  often  fatal.  There  is  also  risk  of 
septik^emia ;  and  even  under  the  most  favorable  circumstances  there 
sometimes  remains  a  local  irritation — a  chronic  vaginitis  or  metritis  which 
leads  to  leucorrhoea. 

Some  authorities  have  observed  trismus,  tetanus,  metastatic  arthritis, 
and  chest  affections,  as  seqicelce  of  placental  retention. 

There  is  no  danger  when  the  retention  has  only  lasted  for  two  or  three 
days,  and  particularly  if  a  large  portion  of  the  membranes  protrudes  be- 
yond the  vulva,  and  they  have  a  fresh  tint.  Attention  is  necessary, 
however,  when  the  placenta  begins  to  putrefy,  and  a  fetid  discharge 
commences  from  the  vulva ;  though  even  so  late  as  fifteen  days  after  par- 
turition the  membranes  may  be  expelled  spontaneously,  without  any  in- 
jury occurring  to  the  animal  from  the  prolonged  retention.  The  case  is 
serious,  however,  when  the  animal  begins  to  show  symptoms  of  general 
illness,  and, particularly  if  no  portion  of  the  placenta  can  be  seen,  or  the 
OS  be  occluded.  Plastic  adhesion  of  the  placenta  to  the  uterus  is  also  a 
grave  complication,  though  happily  rare. 

In  these  instances,  the  animal  gradually  becomes  listless,  weak,  and 
emaciated,  loses  its  appetite,  and  ceases  to  yield  milk,  until  at  length  it 
falls  into  a  state  of  marasmus,  and  perishes  from  septikaemia.  Or  in 
more  rapid  cases,  with  these  general  symptoms  we  have  the  lining  mem- 
brane of  the  vagina  of  a  deep-red  color  and  intensely  hot,  a  fetid  sanguineo- 
purulent  discharge  from  the  vulva  ;  tremblings  over  the  whole  body, 
hurried  respiration,  intense  fever,  and  all  the  other  signs  of  metritis. 

Though  retention  is  not,  in  the  majority  of  cases  in  the  Cow,  a  very 
serious  affair,  yet  it  should  be  attended  to  even  in  this  animal.  With  other 
creatures  it  is  much  more  to  be  dreaded,  as  they  incur  greater  risks  by 
prolonged  retention. 

Saint-Cyr  mentions  the  case  of  a  fine  Mare  which  died  in  less  than 
eight  days  from  metritis,  due  to  the  fcetal  membranes  being  retained  ; 
though  the  cause  was  not  ascertained  in  time. 

Causes. 

Retention,  it  appears,  occurs  most  frequently  in  cases  of  abortion,  or 
when  birth  occurs  some  days  before  the  proper  time.  It  has  also  been  re- 
marked that  a  Cow  which  has  retained  its  placenta  unusually  long  after 
the  birth  of  its  first  calf,  will  do  so  at  every  succeeding  birth.  A  protract- 
ed and  laborious  birth  is  also  said  by  some  authorities  to  favor  retention, 
while  other  obstetrists  declare  that  the  converse  is  true.  The  accident 
is  stated  to  be  more  frequent  with  old  Cows,  and  especially  when  these 
are  employed  in  draught — as  in  France  and  other  countries.  Abnormal 
adhesion  between  the  maternal  and  fcetal  placentae,  of  course,  would  be 
a  sure  caqse  of  prolonged  retention,  and  we  have  given  instances  of  such 
adhesion  ;  indeed,  every  obstetrist  knows  that  at  times  there  is  much  dif- 
ficulty in  disuniting  the  cotyledons  in  the  uterus. 

When  the  cervix  uteri  contracts  rapidly  after  delivery,  and  the  os  is 


570  ACCIDENTS  INCIDENTAL   TO  PARTURITION. 

consequently  firmly  closed,  the  placenta,  though  non-adherent,  will  be 
retained. 

Rueff  mentions  that  the  accident  is  especially  frequent  in  certain  years. 
when  the  herbage  and  forage  is  not  good,  and  particularly  when  the  latter 
is  mouldy  ;  it  has  long  been  known  that  these  conditions  favor  abortion. 
He  also  alludes  to  a  popular  belief  in  Germany,  which  attributes  this 
ZurUckbkiben  der  JVachegeburf,  to  allowing  the  calf  to  take  the  teat  before 
the  placenta  has  been  expelled  ;  the  irritation  of  the  udder  so  produced 
reacts  sympathetically  on  the  uterus,  which  contracts  at  the  cervix,  and 
so  retains  the  membranes. 

According  to  Baumeister,  milking  too  soon,  or  giving  cold  water  to 
drink,  is  supposed  to  act  in  the  same  way. 

Numerous  other  causes  have  been  mentioned  as  influencing  this  reten- 
tion ;  but  we  need  not  notice  them,  as  there  is  really  no  proof  that  they 
do  operate  in  this  way.  The  accident  occurs  under  all  systems  of  man- 
agement, and  all  kinds  of  conditions  ;  it  is,  therefore,  probable  that  sev- 
eral causes  may  produce  it,  and  that  some  of  these  are  still  obscure. 

Treatment, 

The  treatment  of  placental  retention  appears  always  to  have  been  a 
subject  on  which  diverse  views  and  opinions  have  been  held :  many  ob- 
stetrists  maintaining  that — with  the  Cow  more  particubvly — this  reten- 
tion is  never  dangerous  in  itself,  and  that  unless  there  arise  complications,  • 
the  removal  of  the  foetal  membranes  should  in  every  case  be  left  to  the 
efforts  of  nature  ;  while  there  are  others  who  assert  that  there  is  great 
risk  in  this  retention,  and  that  when  it  has  exceeded  two  or  three  days 
after  the  birth  of  the  foetus,  there  is  need  for  active  intervention.  The 
experience  of  the  majority  of  obstetrists  will  negative  both  of  these  opin- 
ions j  for  it  is  a  matter  of  almost  daily  observation,  that  in  many  instances 
the  placenta  remains  without  inconvenience  in  the  uterus  for  several 
days — six  or  eight — before  it  is  spontaneously  expelled  ;  while  in  other 
cases  retention  for  the  same  period  is  marked  by  more  or  less  serious 
symptoms.  This  difference  undoubtedly  depends  upon  circumstances, 
the  precise  nature  of  wjiich  we  cannot  always  fully  ascertain  or  compre- 
hend. Nor  can  we  venture  to  lay  down  positive  rules  as  to  when  it  is 
time  to  interfere,  or  when  abstention  will  be  the  prudent  course  : — this 
can  only  be  learned  by  individual  experience  and  the  tact  of  the  practi- 
tioner. 

It  may  be  remarked,  however,  that  when  parturition  has  been  normal, 
when  the  Cow  does  not  appear  to  suffer  pain  or  inconvenience,  when  the 
"  straining  "  is  unfrequent  and  slight,  the  appetite  good  and  lactation  es- 
tablished, and  particularly  when,  during  a  low  or  moderate  temperature^ 
a  portion  of  the  membranes  protrude  beyond  the  vulva  ;  then  there  is 
no  great  reason  for  interference  until  a  week  or  even  more  has  elapsed. 

But  if,  on  the  contrary,  the  external  temperature  is  high,  the  labor  has 
been  difficult,  the  genital  organs  irritated  or  abraded,  and  if  fever,  rest- 
lessness, and  suffering  are  noted,  with  strong  and  frequent  straining,  and 
especially,  if  there  are  foul-smelling  discharges  from  the  vagina,  then  in- 
tervention is  called  for,  no  matter  whether  the  time  which  has  elapsed 
since  parturition  is  long  or  short. 

When  the  envelopes  form  a  somewhat  large  mass  hanging  from  the 
vulva,  it  may  be  anticipated  that  early  and  spontaneous  removal  wall  take 


RETENTION  OF  THE  FCETAL  ENVELOPES.  571 

place  ;  though  it  sometimes  happens,  as  we  have  pointed  out,  that  the 
weight  of  the  pendulous  portion  causes  inconvenience  in  micturition  ; 
while  it  fatigues  and  pains  the  animal  by  dragging  on  the  uterus,  and 
inducing  expulsive  but  futile  efforts.  Schaack  has  shown  that  in  nearly 
all  these  cases  it  will  be  found  that  a  loop  of  the  membranes  has  become 
twisted  around  the  pedicle  of  some  large  uterine  cotyledon  ;  and  as  this 
is  the  obstacle  to  separation,  it  is  necessary  to  release  the  loop  as  soon 
as  possible,  in  order  to  prevent  accidents. 

It  has  also  been  remarked  that,  even  when  birth  has  been  easy  and 
favorable,  primiparae  are  often  irritable  and  impatient,  and  the  presence 
of  the  secundines  in  the  vagina  and  vulva  exaggerate  the  restless,  and 
occasion  frequent  and  energetic  uterine  contractions.  In  such  cases  it 
will  generally  be  found  judicious  to  remove  the  membranes  as  soon  as 
possible — on  the  same  day,  or  the  day  succeeding  deliver)^,  if  necessary. 

If,  after  the  birth  of  the  foetus,  nothing  is  seen  at  the  vulva  except  a 
thin  cord,  formed  solely  by  the  umbilical  vessels,  we  may  be  almost  cer- 
tain that  there  is  a  strong  adhesion  between  the  maternal  and  foetal 
placentae,  and  that  the  separation  of  the  latter  will  be  protracted — in  all 
likelihood  require  to  be  removed  artificially.  But  even  in  such  a  case 
there  is  no  occasion  for  immediate  interference  ;  on  the  contrary,  it  is 
more  judicious  to  wait,  and  allow  time  for  the  placentae  to  soften  and 
the  adhesions  between  them  to  diminish  :  though  the  opportunity  for 
complete  detachment  must  not  be  overlooked. 

When  nothing  whatever  is  discernible  externally,  there  is  reason  to 
surmise  that  the  placenta  is  completely  retained.  But  even  in  this  case 
there  is  no  need  to  resort  at  once  to  removal  of  the  membranes  ;  though 
it  may  be  necessary,  in  order  to  prevent  imprisonment  for  sg>me  time, 
through  the  closure  of  the  os  uteri  upon  them,  to  introduce  the  hand 
into  the  uterus,  and  if  they  are  already  partially  detached,  to  extract 
them.  If  they  remain  firmly  adherent,  however,  it  is  better  to  .gather  as 
much  as  can  be  seized  into  a  single  mass,  carry  it  through  the  os  into 
the  vagina,  and  tying  it  there  by  a  long  piece  of  cord,  to  leave  the  latter 
hanging  without  the  vulva.  In  this  manner  the  os  is  prevented  from 
closing,  while  the  cord  will  assist  in  effecting  artificial  removal  at  a  later 
period,  should  such  be  demanded. 

Certain  medicaments,  more  or  less  of  the  nature  of  emmenagogues — 
such  as  rue,  savin,  laurel,  stramonium,  carbonate  of  potass,  etc. — have 
been  for  a  long  time  credited  with  the  power  of  hastening  the  expulsion 
of  the  membranes  ;  and  their  administration  has  been  recommended  be- 
fore resorting  to  manual  force  for  the  removal  of  the  placenta.  Some  of 
the  recipes  for  these  potions  are  very  antiquated,  and  others  are  quite 
modern,  and  lauded  by  the  highest  authorities. 

Zundel,  for  instance,  extols  laurel  berries,  and  gives  the  following 
recipe  : 

Laurel  berries         -         -         -        -     120  grammes. 

Aniseed 60         " 

Bicarbonate  of  soda        -         -         -     120         " 

These  are  infused  in  4  litres  of  water,  and  given  in  two  doses.  It 
may  be  repeated  the  following  day  ;  but,  as  a  rule,  the  membranes  are 
expelled  within  twenty-four  hours  after  the  last  dose  has  been  given. 
Zundel  asserts  that  this  infusion  has  rendered  excellent  service,  succeed- 
ing in  sixty  per  cent,  of  his  cases  of  retention.     Hering  and  Stockfleth 


572 


ACCIDENTS  INCIDENTAL  TO  PARTURITION. 


also  speak  highly  in  its  favor,  and  assert  that  it  is  always  successful,  pro- 
vided there  is  no  mechanical  obstacle  to  the  expulsion.  Baumeister  and 
Rueff  recommend  carbonate  of  potass  in  the  dose  of  45  grammes  daily, 
at  three  times,  and  in  an  infusion  of  chamomile  or  savin.  Hummer  pre- 
scribes 90  gramme  doses  for  three  consecutive  days,  and  Hertwig,  Lund, 
and  others  also  prescribe  it  with  the  same  object.  Hering  gives  the  fol- 
lowing formula  : 

Carbonate  of  potass          -         -         -     15  grammes. 
Savin  leaves 30         " 

These  are  infused  in  500  grammes  of  water,  filtered,  and  administered 
tepid.     The  dose  to  be  repeated  every  six  hours. 

Garreau  praises  Caramija's  uterine  tincture,  which  he  states  always 
succeeds  in  producing  expulsion  of  the  membranes,  even  when  they  have 
been  retained  for  two  months  after  parturition. 

The  formula  for  this  tincture  is  given  by  Tabourin  as  follows  : 


Powdered  savin     - 

- 

-     250  grammes. 

Treacle 

- 

-     190 

Powdered  cumin   - 

- 

-     125         ' 

Essence  of  rue      ) 

"  savin  j  ^^ 

-       80 

Alcohol 

- 

2  kilogrammes. 

Garreau  prescribes  this  tincture  in  doses  of  100  grammes,  given  in  2 
litres  of  savin  infusion. 

Cruzel  likewise  has  his  favorite  potion,  composed  of  30  to  40  grammes 
of  green  rue,  or  10  grammes  of  ergot  of  rye  and  20  grammes  of  powdered 
savin,  made  into  a  decoction  in  a  litre  and  a  half  of  water.  Delwart, 
Rainard,  and  Schrader  recommend  ergot  of  rye,  and  Ungefrohrn  stra- 
'monium  Seeds  (30  grammes  in  two  litres  of  water),  which  he  believes  to 
be  specific  in  their  action  ;  he  advises  that  linseed  decoction  be  given  in 
the  intervals,  as  it  acts  as  a  diuretic,  and  Rychner  asserts  that  this  sim- 
ple medication  is  particularly  useful  when  the  foetal  membranes  are  so 
decomposed  that  they  cannot  be  removed  by  the  hand. 

The  subcutaneous  injection  of  ergotine  or  ergot  of  rye  has  also  been 
advised.  Extract  of  ergot  of  rye,  one  to  three  grammes,  dissolved  in 
glycerine  and  spirits  of  wine  (fifteen  grammes  of  each),  has-  been  used 
for  injection. 

Though  medication  has  been  so  highly  vaunted  by  some  authorities, 
yet  some  others  have  not  much  faith  in  it.  Deneubourg  thinks  its  chief 
advantage  is  in  making  the  owner  of  the  animal  exercise  patience,  until 
spontaneous  expulsion  is  effected  ;  the  least  active  measures  being  the 
best.  Other  obstetrists  entertain  the  same  opinion  of  these  emmena- 
gogues. 

For  a  very  long  time,  an  empirical  mode  of  removing  the  placenta 
when  a  part  of  it  protruded  beyond  the  vulva,  was  to  exercise  slight  and 
continuous  traction  on  it  by  attaching  a  weight  to  the  pendulous  portion  : 
in  France  the  farmers  attach  a  "  sabot  "  filled  with  gravel.  Favre  of 
Geneva,  who  notices  this  rude  method,  admits  that  a  weight  not  exceed- 
ing two  pounds  may  be  suspended  from  the  membranes,  which  are  col- 
lected into  a  mass  and  tied  with  a  piece  of  hemp.  This  method  is,  how- 
ever, objectionable  from  several  points  of  view. 


RETENTION  OF  THE  FCETAL  ENVELOPES.  573 

Manual  traction  is  often  employed  when  a  portion  of  the  membranes 
is  visible.  This  is  seized  either  by  the  hands,  or  by  means  of  a  towel, 
or  wisp  of  hay  or  straw,  and  gently  pulled  at — particularly  when  the 
animal  strains — twisting  it  at  the  same  time,  until  the  whole  mass  is  re- 
moved from  the  uterine  cavity. 

This  traction  is  not  likely  to  be  productive  of  much  injury  to  the 
Mare,  Sow,  or  Bitch,  as  the  adhesion  of  the  placenta  is  .not  great,  and  is 
usually  limited  to  a  few  points  ;  it  is,  therefore,  as  a  rule,  generally  and 
quickly  successful  in  these  animals. 

With  the  Cow,  however,  it  is  not  so,  owing  to  the  numerous,  and  often 
strong  attachments  of  the  placentae,  and  the  fragile  texture  of  the  mem- 
branes, which  are  easily  torn  if  too  much  force  is  employed  ;  if  they  do 
not  give  way,  and  the  traction  is  immoderate,  then  there  is  risk  of  irrita- 
ting the  uterus,  tearing  away  the  cotyledons,  or  producing  partial  or 
complete  inversion  of  the  cornua,  or  even  of  the  entire  uterus.  Should 
the  membranes  alone  give  way,  this  may  lead  to  greater  difficulty  in  re- 
moving what  is  left  of  them  in  the  uterus. 

For  these  reasons,  some  practitioners  discountenance  this  mode  of  ab- 
stracting the  placenta  ;  but  there  can  be  no  doubt  that  if  the  traction  is 
moderate  and  judicious,  the  membranes  not  very  adherent  to  the  interior 
of  the  uterus,  and  a  good  part  of  them  beyond  the  os,  the  operation  is 
quite  justifiable,  and  will  be  successful.  When,  however,  the  resistance 
is  marked,  or  the  membranes  begin  to  tear,  it  is  better  to  desist. 

Deneubourg  recommends  the  following  method,  as  better  than  employ- 
ing the  hands  :  The  protruding  umbilical  cord  is  seized  between  two 
pieces  of  wood,  the  length  and  size  of  an  ordinary  walking-stick,  and 
rolled  round  them  until  they  are  close  to  the  vulva  ;  there,  by  a  slight  and 
gentle  circular  movement,  the  portion  engaged  in  the  vagina  produces  a 
kind  of  titillation  which  induces  the  animal  to  stretch  as  in  micturition — 
an  act  it  nearly  always  accomplishes — and  during  this  period  the  mem- 
branes are  rolled  round  the  pieces  of  wood  as  they  are  detached,  which 
usually  occurs  in  about  six  days,  when  the  whole  is  removed.  When  any 
resistance  is  experienced,  and  any  thing  is  found  to  tear  or  rend,  it  is  evi- 
dent that  adherences  still  exist,  and  the  rolling  must  cease  ;  but  then,  by 
a  kind  of  jerking  movement  from  side  to  side,  there  are  communicated  to 
the  uterus,  by  means  of  the  adherent  membranes,  a  series  of  shakes  more 
or  less  energetic,  according  to  the  state  of  the  organ.  Deneubourg  says 
that  there  need  be  no  hesitation  in  employing  a  certain  amount  of  force 
in  practising  these  movements :  "  We  may  act  strongly,  but  gently." 
Great  success  is  said  to  have  attended  this  method. 

But,  after  all,  it  is  doubtful  whether  the  more  scientific  and  surgical, 
and  old  plan — that  of  direct  extraction  by  enucleation  of  the  cotyledons 
— is  not  preferable.  This  method  consists  in  passing  the  hand  into  the 
uterus,  and  detaching,  or  enucleating  the  cotyledons,  one  by  one,  so  as  to 
destroy  the  adhesions  between  the  maternal  organ  and  the  foetal  envelopes, 
and  extract  the  latter. 

When  this  extraction  should  take  place  will  depend  upon  circum- 
stances. It  will  generally  be  found  that  it  will  not  be  successful  beforie 
the  third  day,  as  the  cotyledons  are  too  closely  and  firmly  united  to  allow 
their  disunion  without  injurious  force,  which  may  bring  about  inversion 
of  the  uterus,  or  laceration  of  the  maternal  cotyledons,  and  consequent 
haemorrhage.  About  the  third  day  is  generally  a  favorable  period,  as  the 
OS  is  still  sufficiently  relaxed  to  pass  the  hand  through  it  into  the  uterus, 


574  ACCIDENTS  INCIDENTAL  TO  PARTURITION. 

while  disintegration  between  the  fcetal  and  maternal  placentae  has  ad- 
vanced sufficiently  to  permit  the  hand  to  complete  the  disunion  without 
need  for  violence.  It  sometimes  happens,  however,  that  extraction  can 
be  effected  so  late  as  the  fifth  or  eighth  day  after  delivery ;  but  then  the 
membranes  are  extremely  friable,  and  will  scarcely  withstand  any  degree 
of  traction.  Besides,  the  operator  himself  incurs  great  risk  of  infection, 
either  Iccal  or  general,  from  the  absorption  of  the  putrid  matters  in  the 
uterus  by  the  skin  of  the  hand  and  arm,  which  have  been  engaged  in  that 
cavity. 

An  assistant  holds  the  tail  of  the  animal  to  one  side,  and  the  hand  and 
arm,  being  well  oiled,  are  passed  into  the  vagina ;  if  a  portion  of  the 
membranes  is  in  this  canal,  then  the  operation  is  not  so  difficult,  as  the  os 
will  probably  be  more  or  less  relaxed,  and  this  portion  lying  towards  the 
palm  of  the  hand — the  back  of  which  is  upwards — serves  as  a  guide ; 
while  the  left  hand  pulls  at  it  gently,  as  occasion  requires.  When,  how- 
ever, nothing  of  the  envelopes  is  to  be  found  outside  the  os,  and  that 
opening  is  firmly  closed — as  happens  four  or  six  days  after  birth — then  it 
may  be  very  difficult  to  reach  the  interior  of  the  uterus.  One  finger  must 
be  at  first  introduced,  then  two,  and  three,  and  so  on,  until  the  hand,  in 
the  form  of  a  cone,  and  by  a  semi-rotatory  motion,  can  be  passed  through. 
This  operation  is  often  long,  troublesome,  and  fatiguing,  and  requires  to 
be  carefully  managed,  so  as  not  to  bruise,  irritate,  or  wound  the  organ. 

When  the  hand  reaches  the  interior  of  the  uterus,  it  is  pressed  forward 
between  the  mucous  membrane  of  the  latter  and  the  chorion — the  palm 
towards  the  latter — separating  them  as  it  advances  until  it  meets  with  the 
cotyledons.  Some  of  these — the  maternal — may  be  detached  from  the 
membranes,  while  others  are  still  imbedded  in  them,  as  it  were,  through 
their  fcetal  cotyledons.  These  last  have  to  be  enucleated  ;  and  to  effect 
this,  the  cotyledon  is  gently  pressed  at  its  base  between  the  thumb  and 
index  finger,  and,  if  necessary,  the  fingers  are  moved  over  each  other  as 
if  removing  a  buttoi-Afrom  its  button-hole.  Other  practitioners  make  pres 
sure  on  the  summit  of  the  cotyledon  by  the  three  first  fingers,  and  thus 
destroy  the  adhesion.  In  this  manner  the  hand  passes  from  one  coty- 
ledon to  another,  effecting  disunion  as  rapidly,  yet  carefullv,  as  possible. 
At  times  a  cotyledon  will  be  met  with  which  adheres  so  very  firmly  that 
it  cannot  be  detached  in  the  way  just  mentioned.  Then  the  nail  of  the 
thumb  or  other  finger  must  be  gently  insinuated  at  the  border,  so  as  to 
gradually  raise  it,  and  pass  the  finger  over  its  entire  surface. 

The  tediousness  of  the  operation  will  be  inferred,  when  it  is  known  that 
the  number  of  adherent  cotyledons  may  sometimes  amount  to  more  than 
a  hundred  ;  and  the  fatigue  is  often  so  great  that  the  right  and  left  hand 
have  to  be  employed  alternately — a  circumstance  which  has  advantages 
otherwise. 

When  a  certain  number  of  cotyledons  are  detached,  the  portion  of  en- 
velopes so  released  is  carried  into  the  vagina,  and  beyond  the  vulva,  where 
the  other  hand,  or  an  assistant,  seizes  it,  and  pulls  gently  on  it.  As  the 
bulk  of  this  increases  by  the  detachment  of  more  cotyledons,  the  pulling 
must  cease,  and  the  mass  will  require  to  be  supported  so  as  to  prevent 
tearing  of  the  membranes,  or  painful  dragging  on  the  fundus  of  the  uterus. 

As  the  hand  reaches  the  cornua,  the  cotyledons  increase,  and  it  be- 
comes difficult  to  reach  them — particularly  the  cornu  in  which  the  hind- 
limbs  of  the  calf  were  lodged — because  o^  the  insufficient  length  of  the 
arm.     Moderate  traction,  however,  on  the  part  just  detached  will  bring 


RETENTION  OF  THE  FCETAL  ENVELOPES. 


575 


the  others  nearer,  and  facilitate  the  task  ;  but  the  traction  must  be  judi- 
ciously managed,  else  tearing  of  the  membranes,  the  adherent  cotyledons, 
invagination  of  the  cornu,  or  even  inversion  of  the  uterus,  may  result.  So 
likely  is  this  accident  to  happen,  that  some  practitioners,  instead  of  pull- 
ing at  the  membrane  in  this  way  in  order  to  disunite  the  most  distant 
cotyledons,  %re  content  to  await  their  natural  separation,  merely  tying 
near  the  vulva  the  portion  of  the  membranes  separated,  and  cutting  away 
the  parts  beyond — the  separation  generally  occurring  in  from  two  to  five 
days.  To  facilitate  the  traction,  Gunther  recommends  that  the  abdomen 
of  the  animal  should  be  well  raised  by  a  piece  of  wood  placed  under  it, 
and  held  by  assistants. 

It  has  sometimes  been  found,  as  already  mentioned,  that  the  greater 
part  of  the  membranes  has  been  expelled,  when  all  at  once  expulsion  has 
ceased,  notwithstanding  the  volume  and  weight  of  the  pendulous  mass, 
which  caused  so  much  disturbance  to  the  animal  that  it  has  refused  to 
eat,  persisted  in  lying,  and  when  compelled  to  get  up,  has  kept  stamping 
its  hind  feet  until  it  could  lie  down  again.  On  introducing  the  hand  into 
the  uterus,  it  has  been  discovered  that  this  unusual  interruption  to  the  ex- 
pulsion has  been  occasioned  by  one  or  two  large  maternal  cotyledons  be- 
coming entangled  in  the  loop  of  a  duplicature  of  the  membranes.  Some- 
times the  drag  on  these  cotyledons  has  been  so  great,  that  they  have  been 
brought  as  far  as,  or  even  beyond,  the  os. 

Relief  has  been  given  by  cutting  the  membranes  off  by  scissors,  close 
to  the  vulva,  and  then  releasing  the  cotyledons. 

When  extraction  of  the  membranes  has  been  properly  conducted,  there 
is  no  haemorrhage  ;  if  bleeding  ensues,  then  one  or  more  of  the  maternal 
cotyledons  have  been  injured,  or  perhaps  torn  off  altogether — an  acci- 
dent not  without  danger  sometimes,  and  all  the  more  serious  if  a  number 
of  the  cotyledons  is  involved.  This  injury  may  lead,  in  addition  to  he- 
morrhage, to  uterine  irritation,  metritis,  or  uterine  phlebitis. 

Still,  such  an  untoward  accident  is  not  always  the  result  o/  injury  to 
the  cotyledons,  as  instances  are  recorded  in  which  great  numbers,  or  even 
the  whole  of  the  maternal  placentae,  have  been  torn  away  by  ignorant 
empirics,  and  yet  the  animals  have  survived — we  have  shown  at  the  com- 
mencement of  this  work  that  fecundation  and  gestation  may  even  take 
place  after  ablation  of  the  cotyledons.  Nevertheless,  these  cases  must 
be  looked  upon  as  entirely  exceptional,  and  must  not  be  relied  upon  as 
evidence  that  these  bodies  can  be  injured  with  impunity. 

In  order  to  be  assured  that  the  whole  of  the  foetal  envelopes  has  been 
removed  from  the  uterus,  it  is  well  to  make  an  examination  of  them. 
Knowing  their  conformation  and  extent,  there  should  be  no  difficulty  in 
ascertaining  whether  they  are  all  present. 

After  the  removal  of  the  membranes,  there  always  remains  in  the  uterus 
a  quantity  of  thick,  grumous,  diversely-colored  fluid,  more  or  less  unpleas- 
ant smelling,  which  is  derived  from  the  foetal  fluids,  the  blood  which  has 
escaped  from  the  umbilical  cord,  and  the  partly-decomposed  envelopes. 
As  the  retention  of  this  fluid  is  likely  to  do  harm,  particularly  if  there  is 
any  wound  or  abrasion  of  the  mucous  membrane,  as  much  as  possible  of 
it  should  be  removed  by  the  half-closed  hand.  It  is  often  advisable  to 
wash  out  the  interior  of  the  organ  with  tepid  water,  and  to  inject  a  weak 
solution  of  carbolic  acid,  chloral,  or  permanganate  of  potass. 

When  extraction  of  the  envelppes  has  been  effected  in  good  time,  and 
with  the  necessary  precautions,  the  Cow  bears  the  operation  very  well, 


576  ACCIDENTS  INCIDENTAL  TO  PARTURITION. 

and  does  not  appear  to  be  much  inconvenienced,  while  but  little  after- 
treatment  is  needed.  Gentle  walking,  if  the  weather  is  fine,  in  order  to 
calm  its  restlessness  and  to  allay  the  straining,  if  it  is  still  present  ;  keep- 
ing in  a  well-lighted  and  properly  ventilated  stable  ;  a  blanket  over  the 
body  if  the  temperature  is  low  ;  a  few  enemas,  if  constipation  threatens; 
and  a  light  laxative  diet,  with  bran,  oatmeal,  or  linseed  gruel,' are  usually 
all  that  are  necessary. 

When  the  envelopes  have  putrefied  in  the  uterus,  through  delay  in  re- 
moving them,  and  an  abundant  and  fetid  discharge  flows  from  the  vulva, 
while  the  animal  itself  is  unwell  and  feverish,  then  the  case  is  serious, 
and  requires  instant  and  close  attention.  The  uterus  must  be  cleared, 
without  delay,  from  its  putrescent  contents,  and  in  order  to  accomplish 
this,  the  hand  must  be  passed  into  the  organ,  and  fevery  thing  removed 
which  it  can  possibly  seize.  Before  doing  so,  however,  the  hand  and 
arm  should  be  well  and  frequently  smeared  with  carbolized  lard,  butter, 
or  oil,  to  prevent  septic  infection  ;  if  there  are  wounds  or  abrasions  upon 
them,  the  greatest  care  should  be  taken  in  this  respect — indeed,  it  is 
questionable  whether  they  should  be  introduced  at  all  if  the  skin  is  not 
intact. 

When  every  thing  has  been  taken  away  which  the  hand  can  remove, 
then  the  interior  of  the  organ  should  be  thoroughly  cleansed  by  the  con- 
tinuous injection  of  tepid  water  from  a  large  syringe  and  tube,  until  the 
fluid  comes  away  perfectly  clean. 

Very  weak  solutions  of  the  before-mentioned  antiputrescents  should 
also  be  injected,  but  they  need  not  be  allowed  to  remain.  Should  the 
discharge  continue,  this  treatment  may  be  repeated  daily  until  it  ceases  ; 
and  tonics,  stimulants,  and  antiputrescents  (as  the  sulphite  of  soda) 
administered  internally.  Good  food  and  cleanliness  are  also  essentials 
in  treatment. 

The  hands  and  arms  of  the  operator  should  be  thoroughly  washed  as 
soon  as  passible  after  the  uterus  has  been  emptied  ;  for  this  purpose 
nothing  is  better  than  carbolized  soap.  On  the  slightest  sensation  of 
uneasiness  in  the  arm,  advice  should  be  taken  with  regard  to  it,  as  an 
attack  of  Ecthyma parturitionis  is  often  a  serious  affair,  and  has  necessi- 
tated the  amputation  of  fingers,  and  even  the  greater  portion  of  the 
arm. 

It  must  be  remembered  that  cleansing  and  detergent  injections  are 
absolutely  required  when  the  mucous  membrane  of  the  vagina  or  uterus 
is  inflamed,  abraded,  or  wounded,  and  has  been  in  contact  with  putrid 
membranes  of  fluids.  More  particularly  are  they  necessary  in  placental 
retention  in  the  Mare — an  animal  peculiarly  liable  to  septic  infection. 
Indeed,  so  much  is  this  the  case,  that  it  may  be  laid  down  as  a  rule  that 
manual  extraction  of  the  membranes  is  always  indicated  in  the  Mare, 
when  they  are  not  expelled  immediately  after  birth.  The  injection  of 
warm  water  will  materially  facilitate  the  operation. 

With  the  Mare,  however,  retention  of  the  placenta  does  not  invariably 
lead  to  serious  results,  as  several  cases  are  on  record  in  which  it  has  con- 
tinued for  two  days,  and  even  longer.  Binz  mentions  an  instance  in 
which  the  membranes  were  not  thrown  off  until  the  ninth  day,  owing  to 
adhesion  of  the  uterus  to  a  hernial  sac. 


POST  PAR TUM  HjEMORRHA GE.  577 


CHAPTER  II. 

Post  Partum  Haemorrhage. 

HEMORRHAGE  from  the  uterus,  or  "  flooding,"  after  abortion,  or  the  birth 
of  the  foetus  at  the  ordinary  term — an  accident  so  frequent  and  alarming 
in  woman — would  appear  to  be  far  from  common  in  the  domesticated 
animals.  This  difference  between  the  female  of  the  human  species  and 
that  of  animals,  is  evidently  due  to  the  dissimilarity  in  organization  of 
the  uterine  mucous  membrane  in  them,  particularly  at  the  insertions  of 
the  placenta  foetalis ;  as  well  as  to  the  absence  of  those  immense  vascu- 
lar lacunas  which  exist  in  the  uterus  of  woman,  the  walls  of  which  are  so 
thin  and  fragile  as  to  be  easily  torn  when  the  placenta  is  detached,  and 
which  renders  insufficient  contraction  of  the  uterus  after  delivery  such  a 
grave  matter.  Another  reason  for  the  unfrequency  of  metrorrhagia  in 
the  veterinary  obstetrist's  patients,  is  the  great  rarity  of  placenta  pravia 
in  them,*  and  which  is  a  somewhat  common  cause  of  liEemorrhage  either 
during  or  after  delivery  in  woman. 

Nevertheless,  whether  owing  to  some  anatomical  or  pathological  pecu- 
liarity, to  atony  of  the  uterine  walls,  rupture  of  vessels  during  removal 
of  the  foetal  placenta,  or  even  during  its  spontaneous  expulsion,  almost 
every  practitioner  of  any  experience  has  met  with  cases  of  metrorrhagia 
of  a  more  or  less  alarming  character.  So  serious,  indeed,  is  this  hae- 
morrhage, that  the  mortality  has  been  estimated  as  high  as  73  per  cent, 
of  the  cases  reported. 

We  have  already,  at  page  190,  alluded  to  metrorrhagia  occurring  dur- 
ing pregnacy.  In  what  Cox  has  designated  "  pre-placental  presentation  " 
{Veterinary  journal,  March,  1877,  p.  178),  we  may  have  haemorrhage  en- 
suing. According  to  this  authority,  such  presentations  are  rare,  and  if 
they  occur  at  the  termination  of  gestation,  may  be  looked  upon  as  un- 
favorable ;  though  they  are  most  frequent  in  cases  of  abortion,  and  are 
then  seldom  followed  by  serious  results.  Metrorrhagia  ensues  when  the 
usual  period  of  parturition  has  been  exceeded,  and  the  "  water-bag  "  has 
been  presented  and  ruptured,  the  entire  placenta  foetalis  coming  away 
before. the  foetus  itself.  "  In  some  cases  a  considerable  portion  of  the 
membranes  envelope  the  fore-parts  of  the  foetus,  and  occasionally  to 
such  an  extent  as  to  retard  delivery  ;  this  may  be  shredded  off  and  re- 
moved without  risk,  but  it  will  be  found  that  the  posterior  part  remains 
attached.  The  fatality  attendant  upon  these  cases  is  owing  to  neglect  of 
examination  and  proper  aid,  and  this  negligence  is  owing  to  the  absence 
of  'pains.'  After  the  removal  of  the  foetus,  it  is  found  that  haemorrhage 
has  taken  place  from  the  open  vessels,  and  the  quantity  indicates  that  it 

*Yx?cnc\i{Handbtich  de  Thierarztlichen  Geburtshiilfe,  and  Zeitshrift  fur  T/ieirmedictn)\\Z5  clearly 
demonstrated  the  occurrence  of  placenta  prjevia  in  animals.  Grey  {Veterinarian,  vol.  xxvi.,  p.  12)  gives 
two  instances  of  what  he  believed  to  be  this  condition.  A  farmer,  in  passing  through  a  field  in  which 
Cows  were  grazing,  came  upon  a  newly-expelled  placenta,  and  knowing  that  one  of  the  animals  was  in 
calf,  and  near  parturition,  he  returned  to  his  farm,  and  gave  directions  that  the  calf  should  be  looked  for, 
as  he  could  not  find  it  in  the  pastures.  Nothing  of  it  could  be  discovered,  however,  and  the  Cow  was 
therefore  driven  home.  While  being  milked,  however,  it  began  to  show  uneasiness,  and  to  evince  evident 
signs  of  approaching  labor.  Grey  was  sent  for,  and  he  states:  "On  examining  my  patient,  I  found  a  dead 
foetus  with  all  four  legs  presenting,  which  was  with  the  greatest  difficulty  extracted."  The  Cow  lived.  _  In 
the  second  instance,  he  was  called  to  attend  a  Cow  which  had  expelled  the  foetal  membranes,  and  exhibited 
great  uneasiness.  "  In  this  case,  on  making  an  exploration,  I  again  found  the  foetus  presenting  in  a  false 
position  ;  but,  after  a  little  manual  dexterity,  I  was  enabled  to  remove  a  dead  calf  of  unusually  large  size." 
The  Cow  survived. 

37 


578  ACCIDENTS  INCIDENTAL  TO  PARTURITION 

commenced  immediately  after  the  separation  of  tlie  placenta.     I  have 
seen  these  cases  only  in  cattle." 

In  certain  instances,  there  can  be  no  doubt  that,  as  in  woman,  insuffi- 
cient contraction  of  the  uterus  is  a  cause  of  post partum  haemorrhage  ; 
and,  according  to  Schroeder,  this  atony  of  the  organ  is  especially  observed 
after  a  rapid  emptying  of  its  cavity,  whether  artificially  or  naturally  pro- 
duced, also  after  a  previous  and  very  considerable  distention.  It  there- 
fore occurs  after  very  rapid  deliveries,  too  early  turning,  and  extraction, 
in  hydramnios,  and  twins.  The  haemorrhage  is  sometimes  also  due  to 
general  debility,  and  too  feeble  development  of  the  uterine  muscles 
(either  congenital  or  depending  upon  previous  very  difficult  labors). 
Partial  adhesions  of  the  placenta  to  the  uterine  wall,  which,  however, 
are  rarely  caused  by  real  connective-tissue  bands,  may  also  give  rise  to 
profuse  haemorrhage  ;  because  the  separated  places  in  the  vicinity  of  the 
adhesions  can  only  imperfectly  contract. 

Symptoms. 

The  symptoms  of  post  partum  haemorrhage  are  not  well  marked,  unless 
die  bleeding  is  visible,  though  they  are  those  of  profuse  haemorrhage  in 
general.  There  is  the  quick,  weak,  running  down  pulse,  which,  becomes 
imperceptible  as  death  approaches,  and  the  throbbing,  irregular  contrac- 
tions of  the  heart ;  the  decoloration  of  the  mucous  membranes,  rapidly 
increasing  prostration  of  the  animal,  with  the  unsteady  staggering  gait 
on  movement,  and  the  difficulty  of  maintaining  the  standing  position  to- 
wards the  end  ;  the  haggardy^^/Vj-/  with  chilliness  of  the  surface,  cold, 
clammy  perspiration  breaking  out  over  the  body  ;  and,  finally,  the  re- 
cumbent position,  convulsions  and  death. 

Sometimes  there  are  indications  of  abdominal  pain — indicated  by  paw- 
ing and  looking  anxiously  at  the  flanks  ;  but  these  indications  are  only 
likely  to  be  present  when  the  haemorrhage  is  due  to  traumatic  influences. 
When  the  haemorrhage /<?r  27///z'rt;/«  is  discernible,  then,  of  course,  there 
can  be  no  difficulty  in  diagnosing  the  accident ;  but  when  it  is  entirely 
internal,  the  manifestation  of  the  symptoms  above  indicated  should  give 
rise  at  once  to  a  suspicion  of  the  state  of  affairs,  and  lead  to  a  manual 
exploration  of  the  uterus. 

Treatment. 

The  essential  indication  in  the  treatment,  is  to  suppress  the  haemor- 
rhage as  speedily  as,  possible  ;  the  next,  to  sustain  the  vital  powers  of  the 
animal. 

If  the  foetal  membranes  have  not  been  expelled,  they  must  be  removed 
without  delay — yet  as  gently  as  may  be  \  as,  until  this  removal  is  effected, 
the  uterus  will  perhaps  not  contract.  The  contraction  of  the  organ  is 
very  important,  and  when  the  membranes  are  present,  it  often  happens 
that  the  manipulation  required  to  remove  them,  brings  about  this  result. 
If  the  membranes  are  not  present,  then  the  hand  and  arm  must  be  pushed 
into  the  uterus,  and  gently  mov^ed  about,  in  order  to  excite  contraction, 
if  the  organ  is  flaccid  and  uncontracted. 

At  the  same  time,  the  interior  of  the  organ  should  be  freed  from  the 
blood  and  clots  it  may  contain  ;  cold  water  douches  ought  to  be  applied 
to  the  loins  and  vulva,  as  well  as  injections  of  the  same.  If  deemed  neces- 
sary, a  towel,  or  sheet,  steeped  in  cold  water,  or  a  large   sponge  impreg- 


POST  PA R TUM  H^MOREHA GE.  ^jg 

nated  \<'ith  vinegar  and  water,  perchloride   of  iron,  or  any  other  styptic, 
may  be  passed  into  the  vagina,  or  even  into  the  uterine  cavity. 

Should  the  hcemorrhage  persist,  revulsives  in  the  form  of  mustard  cata- 
plasms, or  stimulating  liniments,  may  be  applied  to  distant  parts  of  the 
body,  as  the  chest,  neck,  or  limbs.  Internally,  tannic  acid,  salts  of  lead 
and  morphia,  perchloride  of  iron,  tincture  of  ergot  of  rye,  or  any  other 
agent  likely  to  act  as  a  haemostatic,  may  be  administered. 

1.  In  1822,  Gelle  [Pathologie  Bovine,  vol.  iii.,  p.  539)  was  called  upon  to  attend  a  Cow 
which  was  losing  much  blood  from  the  vulva.  The  animal  had  calved  two  days  before, 
and  on  the  previous  day,  as  the  Secundines  had  not  come  away,  the  owner  had  attempted 
to  remove  them  himself.  In  doing  so,  however,  owing  to  ignorance,  he  had  taken  away 
not  only  the  membranes,  but  also  a  good  number  of  maternal  cotyledons,  and  so  caused 
the  haemorrhage.  When  Gelle  saw  the  animal,  a  long  stream  of  blood,  as  thick  as  a 
straw,  flowed  from  the  vulva  ;  the  pulse  was  full  and  strong  ;  the  creature  very  restless. 
Four  kilogrammes  of  blood  were  abstracted  (!),  and  the  injection  of  cold  water  into  the 
vagina  ordered.  Soon  after,  the  uterus  was  explored,  and  about  one-third  of  the  mem- 
branes— which  had  been  left  by  the  owner — were  removed,  as  well  as  some  clots.  The 
treatment  was  continued  until  the  next  day,  when  the  animal  was  well. 

2,  3.  Schaack  reports  [Jourttal  de  Med.  Vet.  de  Lyon,  185 1)  that  on  two  occasions,  in 
pulling  at  the  membranes  in  order  to  remove  them,  he  has  torn  away  large  cotyledons. 
"  This  accident  has  been  followed  by  haemorrhage  and  muscular  tremblings  ;  then  en- 
sued suffering,  fever,  tumefaction  around  the  vulvar  opening,  and  in  eight  or  ten  days 
death  occurred."  This  unfortunate  result  happened  during  summer,  and  death  was 
probably  due  to  septic  metritis  rather  than  to  the  haemorrhage — though  the  latter  may 
have  been  indirectly  the  cause  of  the  metritis.   ■ 

4.  Saint-Cyr  [Op.  cit.,  p.  600)  observed  a  case  of  uterine  haemorrhage  under  the  fol- 
lowing circumstances.  A  fine  Mare,  three  years  old  and  a  primipara,  gave  birth  to  a  foal 
after  much  difficulty,and  inversion  of  the  uterus  soon  followed.  When  Saint-Cvr  arrived, 
the  organ' was  entirely  expelled,  and  hung  as  low  as  the  hocks,  forming  a  tumor  much 
larger  than  an  ordinary  bucket.  The  Mare  was  straining  incessantly.  Despairing  of 
effecting  reposition  of  the  organ  in  the  condition  in  which  it  then  was,  a  number  of 
somewhat  deep  scarifications  were  made  in  the  tumefied  and  reddened  mucous  mem- 
brane, by  means  of  a  lancet ;  and  as  soon  as  the  blood  began  to  flow  in  abundance  the 
tumor  diminished  in  volume,  until  at  length  it  was  so  much  smaller  that  reduction  was 
attempted — it  being  anticipated  that  the  haemorrhage  would  cease  when  this  was  achieved. 
But  though  reposition  of  the  uterus  was  ultimately  accomplished,  the  blood  still  con- 
tinued to  flow,  and  soon  its  interior  was  so  distended  as  to  induce  new  expulsive  efforts, 
which  terminated  in  the  uterus  being  again  inverted.  It  was  in  vain  that  attempts  to 
check  the  bleeding  were  made  by  abundant  affusions  of  acidulated  cold  water  ;  the  ani- 
mal became  weak,  staggered  about,  fell,  and  died  without  the  haemorrhage  being  checked 
in  the  slightest  degree. 

The  whole  of  the  performance  "did  not  occupy  more  than  half  an  hour.  This  occurred 
at  the  commencement  of  Saint-Cyr's  professional  career,  and  it  taught  him  a  lesson  as 
to  the  danger  of  scarification — in  the  jNIare  at  least — in  inversion  of  the  uterus. 

5.  Peuch  (Saint-Cyr,  Op.  cit.,  p.  6oo)  was  sent  for  at  mid-day  in  haste,  to  see  a  Mare 
which  could  not  foal.  The  animal  was  found  standing,  the  head  drooping,  eyes  half- 
closed,  and  exhibiting  great  prostration  ;  it  was  much  emaciated.  The  owner  said  that 
from  time  to  time  it  strained,  but  nothing  appeared;  the  "waters"  had  escaped  in  the 
morning.  Exploration  found  the  hind-limbs  engaged  in  the  vagina;  they  were  secured, 
and  by  traction  a  foal  was  readily  extracted,  but  it  was  dead.  No  sooner  was  delivery 
effected,  however,  than  the  Mare  sank  on  the  ground,  and  at  the  same  time  there  appeared 
at  the  vulva  an  enormous  mass,  which  in  a  second  or  two  descended  to  the  hocks  :  in  a 
few  seconds  complete  inversion  of  the  uterus  had  taken  place,  and  from  the  mucous 
membrane,  which  was  now  external,  an  abundance  of  blood  oozed  and  streamed — bright- 
red,  like  arterial  blood.  In  presence  of  such  a  formidable  haemorrhage,  there  was  not  a 
moment  to  lose.  The  owner,  who  was  the  only  assistant  present,  was  requested  to  get 
the  Mare  up,  and  this  was  happily  accomplished  without  very  much  difficulty,  when 
Peuch  seized  the  uterus  with  both  hands,  and  in  a  few  minutes  the  organ  was  reduced. 
As  soon  as  this  was  effected  the  bleeding  ceased.  To  prevent  a  relapse,  Peuch  kept  his 
irm  in  the  uterus  for  about  a  quarter  of  an  hour,  when  it  was  cautiously  withdrawn  and 
ao  more  blood  flowed.  A  good  bed  of  litter — higher  behind  than  before — was  then 
prepared,  and  on  this  the  Mare  was  led  and  its  head  secured  to  the  rack,  to  prevent  ly- 
ing down.  It  was  watched  for  several  hours,  during  which  it  received  some  gruel.  On 
the  next  day,  an  injection  of  dilate  perchloride  of  iron  was  administered,  and  afterwards 


580  ACCIDENTS  INCIDENTAL   TO  PARTURITION 

injections  of  decoction  of  willow  bark.     The  following  day  nothing  amiss  was  observed, 
and  some  months  later  the  Mare  was  sold. 

6.  Vernant  [Rec.  de  Med.  Vet.,  1872,  p.  523),  in  1867,  was  called  to  attend  a  Mare 
which  had  foaled  during  the  night,  and  had  lost  an  enormous  quantity  of  blood  per 
vulvam.  The  owner  had  removed  the  placenta,  by  pulling  at  the  portion  hanging  out 
of  the  vulva,  and  the  bleeding,  immediately  ensued.  Though  no  time  was  lost  in  attend- 
ing the  Mare,  the  distance  Wing  very  short,  when  Vernant  arrived  the  animal  was 
dead. 

7.  Vernant  (/<J;^.)  relates  an  exactly  similar  case  which  occurred  in  his  practice  in 
1872,  and  which  was  also  due  to  removing  the  placenta  artificially  from  a  Mare  after  a 
normal  delivery. 

8.  Anderson  ( Veterinarian,  1844,  p.  357)  attended  a  Mare  which,  while  in  foal,  had 
fallen  into  a  saw-pit,  and  this  accident  brought  on  labor;  inversion  of  the  uterus  imme- 
diately followed  the  expulsion  of  the  foetus,  and  the  animal  died/rom  haemorrhage. 

9.  Mayer  {Ibid.,  vol.  xvi.,  p,  45)  gives  an  instance — almost  exceptional,  we  believe — 
of  bleeding  from  the  funis  umbilicalis  after  calving.  The  subject  was  a  valuable  young 
Cow,  "  of  full  plethoric  habit,"  which  had  been  rather  uneasy  during  parturition.  "  The 
consequence  was,  that  after  the  foetus  was  expelled  there  were  two  or  three  quarts  of 
blood  poured  out  from  the  cord;  but,  as  sometimes  happens,  the  parties  did  not  take  the 
proper  alarm,  until  the  blood  kept  issuing  from  time  to  time  in  such  quantities  as  to  en- 
danger the  animal's  life  ;  they  then  sought  for  assistance,  but  before  it  could  be  rendered, 
the  animal  was  dead." 

10.  Mayhew  {Ibid.,  vol.  xxi.,  p.  559)  had  under  treatment  a  small  terrier  Bitch,  which 
had  been  for  some  hours  in  labor.  Two  dead  puppies  and  a  living  one  were  extracted. 
The  animal  was  greatly  exhausted,  and  while  a  stimulant  was  being  administered  a 
stream  of  bright  arterial  blood  was  observed  fiowinc;  from  the  vagina.  "  The  haemor- 
rhage gradually  increased,  and  the  Bitch  raising  itself,  began  to  show  symptoms  of  deli- 
rium. The  case  looked  desperate,  and,>  concluding  that  the  bleeding  was  proceeding 
from  the  uterus,  which,  in  consequence  of  the  enfeebled  condition  of  the  animal,  had  not 
power  to  contract.  I  resolved  to  resort  to  the  injection  of  cold  water.  Half  an  ounce  of 
the  tincture  of  galls  was  mixed  with  a  quart  of  water  ;  but  not  more  than  the  third  of  a 
pint  was  injected,  before  a  sharp  but  low  cry  informed  me  that  the  agent  had  done  its 
work.  No  more  was  injected ;  but  the  haemorrhage  ceased,  and  the  Bitch  seemed  re- 
freshed."    It  recovered. 

11.  Cox  {Ibid.,  vol.  xxvii.,  p.  16)  reports  the  Case  of  a  Cow  which,  showing  symptoms 
of  calving  the  previous  day,  the  owner  examined  it  and  found  the  calf  in  a  wrong  posi- 
tion, but  with  the  help  of  a  neighbor  contrived  to  accomplish  delivery.  From  that  time 
the  Cow  became  unwell,  refusing  all  food,  etc.  Cox  found  the  pulse  quick  and  weak ; 
the  mucous  membranes  blanched ;  breathing  quick  and  laborious  ;  constipation  ;  limbs 
cold  and  nose  dry.  Suspecting  rupture  of  the  uterus,  he  introduced  his  arm,  and  al- 
though very  little  blood  had  been  discharged,  the  case  was  discovered  to  be  one  of 
"flooding,"  the  uterus  being  full  of  coagulated  blood;  the  Cow  was  evidently  sinking. 
A  sponge,  impregnated  with  acetic  acid  and  tincture  of  opium  mixed,  was  passed  into 
the  uterus;  stimulants  were  administered,  with  plenty  of  gruel;  and  cold  water  was 
constantly  applied  to  the  loins,  vulva,  etc.  The  animal  recovered.  There  was  no 
straining  until  the  arm  was  passed  into  the  uterus,  and  in  all  probability  this  stimulus  to 
contraction  was  the  principal  factor  in  suppressing  the  haemorrhage. 

12.  Sarginson  {Ibid.,  vol.  xxx.,  p.  329)  alludes  to  a  Cow  which  was  brutally  maltreated 
by  an  empiric,  who  forcibly  dilated  the  os  uteri,  and  tore  away  a  calf,  which  soon  after 
died.  Profuse  haemorrhage  commenced  immediately,  "the  blood  fairly  spouting  out."| 
The  placenta  had  been  extracted  along  with  the  calf.  The  os  uteri  and  vagina  were| 
lacerated  to  some  extent ;  the  Cow  was  sinking  from  loss  of  blood.  Cold  water  W3 
continually  applied  to  the  loins  for  many  hours,  and  dilute  sulphuric  acid  given  internally., 
This  checked  the  haemorrhage,  and  stimulants  and  tonics,  with  good  food,  being  allowed,| 
the  animal  in  seven  days  was  convalescent. 

13.  14.  King  [Ibid.,  vol.  xlii.,  p.  157)  gives  a  description  of  two  cases  of  post  partunA 
uterine  haemorrhage  in  the  Cow,  in  which  he  succeeded  in  suppressing  the  bleeding  bj 
slowly  injecting  cold  water  into  the  uterus.     By  furnishing  himself  with  two  bladders 
and  holding  each  in  succession — when  filled  with  water — in  contact  with  the  large  end  of 
the  pipe  of  an  ordinary  clyster  syringe,  and  pressing  the  bladder  with  the  other  hand,  hel 
was  enabled  to  introduce  the  fluid  very  gradually  and  with  little  force.     Three  gallons  of^ 
water  were  thus  injected.      The  animals  were  freely  supplied  with  stimulants  at  ii 
tervals. 

15.  Cox  {Veterinary  ymirnal,  March,  1877)  delivered  a  Cow  of  its  calf  without  diffi- 
culty ;  the  placenta  followed,  and  every  thing  appeared  to  be  well  until  soon  after,  when| 
it  was  reported  that  the  animal  was  - "  parting  with  great  quantities  of  blood.  Thisf 
proved  to  be  the  case  ;  it  was  discharged  in  volume  equal  to  an  ordinary  pump  spout.! 


INVERSION  OF  THE  UTERUS.  581 

It  was  an  urgent  case.  I  soaked  four  or  five  double  towels  and  a  sheet  in  cold  water, 
and  passed  them  through  the  vagina  into  the  uterus,  and  then  blocked  that  passage  up  in  a 
similar  manner.  From  fifty  to  sixty  cans  of  cold  water  were  thrown  on  her,  and  a  double 
cloth  over  her  loins  was  kept  constantly  wet.  Acetate  of  lead  and  opium  were  admin- 
istered internally,  with  alternate  doses  of  laxative  medicine.  On  the  third  day  the 
cloths  were  eased  by  twisting  them,  and  on  the  fourth  day  they  were  expelled.  The  ani- 
mal recovered,  and  was  in  usual  milk  in  ten  or  twelve  days." 

16.  The  same  veterinary  surgeon  {Ibid.)  was  sent  for  in  great  haste  to  see  a  Mare 
which  had  foaled,  and  was  reported  to  be  losing  great  quantities  of  blood.  When  he 
arrived,  he  found  the  animal  so  exhausted  that  it  was  staggering  about.  "In  several 
places  where  she  had  stood  for  a  short  time^  were  clots  of  blood  the  size  of  a  man's 
head,  besides  much  fluid  blood  that  had  been  evacuated,  and  had  sunk  into  the  ground. 
I  douched  her  with  a  great  volume  of  cold  water,  and  adopted  the  treatment  before  men- 
tioned.    I  did  not  introduce  cloths  into  the  vagina.     The  Mare  recovered." 


CHAPTER  III. 

Inversion  of  the  Uterus. 

Inversion,  procidence,  prolapse  of  the  uterus,  or  vagino-uteral  inversion,  sig- 
nifies a  kind  of  hernia  of  the  organ,  consisting  in  its  partial  or  complete 
turning  inside  out:  the  inverted  fundus  escaping  through  the  os  uteri 
{partial  i?iversion),  vagina,  and  vulva,  and  perhaps  descending  as  low  as 
the  hocks  {comptete  inversion),  where  it  forms  a  more  or  less  voluminous 
tumor. 

When  the  inversion  is  very  partial,  nothing  whatever  is  seen  externally, 
and  an  exploration  alone  reveals  the  existence  of  the  accident ;  if  more 
developed,  the  uterus  appears  as  a  round  tumor  between  the  labia  of  the 
vulva  when  the  animal  is  lying,  and  especially  if  the  floor  is  sloping  back- 
wards, which  causes  the  gastro-intestinal  mass  to  press  upon  the  organ. 
Sometimes  the  procidence  is  so  very  slight  that  there  is  merely  a  bulging 
inwards  at  the  fundus  of  the  uterus,  or  in  one  of  the  cornua. 

In  complete  inversion,  we  not  unfrequently  have  prolapsus  of  a  portion 
of  the  vagina  ;  and  it  is  recognized  as  appearing  in  two  forms  or  degrees, 
according  as  there  is  inversion  of  the  body  of  the  uterus,  or  inversion  of 
the  cornua  as  well  ;  sometimes  it  is  only  one  cornu,  which  is  then  de- 
viated to  the  right  or  left  of  the  vertical  direction  of  the  body  of  the  organ, 
according  as  it  is  one  or  other  of  these  parts.  If  both  cornua  are  com- 
pletely inverted,  they  terminate  inferiorly  in  the  form  of  a  cone  ;  but  if 
they  are  only  incompletely  so,  then  they  remain  cylindrical  at  their  lower 
end,  and  at  the  centre  of  the  cylinder  is  a  depression  or  caecal  cavity. 

Inversion  of  the  uterus  is,  of  course,  only  possible  when  the  os  uteri  is 
dilated ;  consequently,  it  occurs  either  immediately  before  or  after  birth. 

Again,  inversion  is  simple  or  complicated.  It  is  simple  when  the  viscus 
is  intact,  uninjured,  and  not  accompanied  by  the  extrusion  or  displace- 
ment of  any  other  organ.  When  it  is  wounded  or  torn,  or  when  there  is 
accompanying  hernia  or  protrusion  of  other  viscera,  then  it  is  complicated. 

As  we  have  said,  ruminants  are  most  liable  to  this  accident :  the  Cow 
coming  first,  then  the  Sheep  and  Goat ;  the  Mare  is  less  frequently 
affected,  and  the  Sow  and  Bitch  perhaps  not  so  often  as  the  Mare.  In- 
version of  the  uterus  has  been  observed  in  the  Cat  and  Rabbit. 

With  the  Bitch  and  Sow,  incomplete  inversion  of  the  uterus  is  far  from 
uncommon,  as  is  also  simple  inversion  of  the  vagina,  for  which  it  might 
be  mistaken.     In  uniparous  animals,  the  whole  of  the  organ  is  usually  in- 


582  ACCIDENTS  INCIDENTAL   TO  PARTURITION 

verted  ;  while  in  multiparous  creatures,  generally  little  more  than  the  por- 
tion which  contained  the  foetuses  is  involved. 

•The  accident  has  been  observed  in  animals  kept  in  houses  and  stables, 
as  well  as  in  those  roaming  about  at  liberty  ;  and  it  has  been  known  from 
time  immemorial.  The  Roman  veterinarian,  Vegetius,  alludes  to  it,  and 
recommends  the  employment  of  an  inflated  pig's  bladder  as  a  very  good 
pessary.  , 

Symptoms. 

The  symptoms  of  uterine  inversion  vary  with  its  extent.  With  uniparous 
animals,  inversion  always  commences  at  the  fundus  of  the  organ,  most  fre- 
quently towards  the  largest  cornu  where  the  greater  p^rt  of  the  foetus  was 
lodged.  Under  the  influence  of  an  irregular,  and  kind  of  spasmodic  con- 
traction, this  part  is  drawn,  or  pushed  inwards,  just  as  the  foot  of  a  stock- 
ing is  inverted  ;  and  this  action  continuing,  the  fundus  or  cornu  is  more 
or  less  rapidly  carried  towards  the  os,  through  which  it  passes  into  the 
vagina  {incojnplete  inversion),  dragging  after  it  the  body  of  the  organ,  which 
also  becomes  inverted  as  it  proceeds. 

It  is  rare  indeed  that  inversion  does  not  go  beyond  this;  for  the  con- 
siderable alteration  in  position  and  relations  which  has  already  taken 
place,  gives  rise  to  sensations  of  discomfort  and  pain,  and  these  react  on 
the  nervous  system,  and  induce  contraction  of  the  uterine  and  abdominal 
muscles.  Powerful  and  hurried  expulsive  efforts  ensue,  and  soon  the  or- 
gan is  pushed  beyond  the  vulva,  where  its  own  weight  carries  it  down- 
wards, and  renders  the  ^rcAdt^isns  comJ>kte — the  lining  or  mucous  membrane 
having  become  external. 

When  inversion  is  complete,  the  uterus  has  the  form  of  an  enormous 
pear  or  calabash-shaped  tumor,  hanging  between  the  posterior  limbs  : 
the  wider  and  rounded  portion  being  inferior,  and  sometimes  extending 
as  low  as  the  ho.cks,  the  narrow  extremity  or  pedicle  being  at  the  vulva, 
in  the  interior  of  which,  and  between  the  labia  and  the  tumor,  is  a  more 
or  less  deep  and  circular  ctil-de  sac,  according  as  the  prolapsus  has  in- 
volved a  certain  extent  of  the  vagina. 

That  the  surface  of  the  tumor  is  composed  of  the  uterine  mucous  mem- 
brane, is  easily  apparent  from  its  softness  and  color — which  is  sometimes  m 
a  bright  red,  at  other  times  somewhat  violet  or  brown,  according  as  it  is  1 
much  injected  with  venous  blood,  or  irritated  by  the  external  air,  or  the 
litter,  fqeces,  etc.,  with  which  it  may  have  come  in  contact,  and  which  may 
be  adhering  to  it.  With  the  Mare  and  Sow,  we  can  recognize  the  uterine 
placental  villi,  and  the  innumerable  depressions  for  the  reception  of  those 
of  the  foetal  placenta  ;  in  the  Cow,  Sheep,  and  Goat,  we  have  the  deep- 
red  isolated  fungiform  eminences  or  cotyledons,  and  in  the  Bitch  and  Cat, 
the  wide  dark-brown  zone.  Sometimes  we  notice  with  the  Cow, — more 
rarely  with  the  Mare, — portions  of  chorion  still  attached  to  the  placental 
surface  of  the  uterus  ;  and  nearly  always  are  seen  excoriations,  more  or 
less  extensive  ecchymoses,  and  even  gangrenous  patches,  on  the  membrane 
— indications  of  the  injury  the  organ  has  sustained,  either  during  or  after 
parturition.  This  mucous  surface  is  not  so  sensitive  as  might  be  im- 
agined ;  it  is  more  or  less  hot,  and  bleeds  at  the  slightest  touch,  though 
the  haemorrhage  may  not  be  profuse  ;  at  one  side  or  the  other  may  be 
noticed  a  kind  of  depression — the  opening  to  the  cornu  which  is  not  yet 
inverted. 

The  longer  the  period  which  has  elapsed  since  inversion  occurred,  so 


INVERSION  OF  THE  UTERUS.  583 

the  larger  is  the  tumor.  This  increase  is  due  to  the  violent  expulsive 
efforts  of  the  animal,  as  well  as  to  the  increase  in  weight  of  the  organ  in 
consequence  of  the  congestion  and  infiltration  which  has  taken  place  in 
its  textures  :  constricted — even  strangulated — at  its  upper  part,  the  cir- 
culation is  maintained  with  great  difficulty,  and  the  capillaries  become 
gorged  with  blood.  The  walls  of  the  organ  lose  their  elasticity,  become 
thickened  and  dense,  and  darker  tinted,  until,  from  its  increased  volume 
and  altered  aspect,  it  can  scarcely  be  recognized  ;  while  its  reposition  is 
rendered  extremely  difficult,  if  not  impossible. 

In  consequence  of  the  excessive  hyperaemia,  ulceration  and  gangrene 
usually  supervene  ;  these  are  serious  lesions,  and  may  induce  afatal  termi- 
nation. * 

Such  a  grave  accident  as  this,  in  which  we  have  such  extensive  dis- 
placement, with  severe  straining  at  the  suspensory  ligaments  of  the  uterus, 
and  sometimes  their  rupture  ;  the  irritation  and  perhaps  abrasions  or 
wounds  of  the  mucous  membrane  ;  the  tension  on  the  vagina,  and  the 
compression  of  various  parts  or  organs — all  this  might  be  expected  to 
produce  general  disturbance.  And  this  is  the  case.  From  the  very 
commencement,  and  even  before  any  thing  is  apparent  at  the  vulva,  the 
animal  is  uneasy  and  anxious-looking;  it  paws  with  the  fore,  or  stamps 
with  the  hind-feet ;  switches  the  tail  as  if  driving  off  insects  ;  lies  down 
and  gets  up  frequently,  finding  no  ease  in  either  attitude  ;  and  strains 
more  or  less  energetically  at  closer  or  wider  intervals,  thus  adding  to  the 
extruded  mass.  Not  unfrequently  the  Mare  kicks  at  the  prolapsed  uterus, 
or  endeavors  to  attack  it  with  its  teeth. 

At  first  there  is  no  perceptible  fever,  and  the  animal,  in  the  intervals 
of  straining,  attentive  to  what  is  going  on  around  it,  is  solicitous  about  its 
progenx^,  and  may  even  eat.  This  state  is  not  of  long  duration,  however ; 
for  soon  after  inversion  is  complete,  indications  of  fever  manifest  them- 
selves :  quickened  pulse  and  respiration,  elevated  temperature,  and  an 
expression  of  anxiety  and  pain.  The  straining  is  more  frequent  and 
energetic,  and  soon  exhausts  the  animal ;  and  the  prostration,  together 
with  the  great  weight  of  the  pendant  uterus,  compels  it  to  assume  and 
maintain  the  recumbent  posture,  in  spite  of  attempts  to  make  it  get  up. 
The  organ  assumes  a  gangrenous  or  intensely  inflamed  appearance,"  and 
the  animal  soon  succumbs,  either  from  the  nervous  prostration  resulting 
from  its  sufferings,  or  from  the  condition  of  the  uterus. 

In  woman,  sudden  inversion  of  the  uterus  always  leads  immediately, 
according  to  Schroeder,  to  great  general  disturbance — the  heart's  action 
is  deranged,  and  syncope,  convulsions,  vomiting,  etc.,  may  sometimes  be 
caused  by  the  sudden  change  in  the  position  of  the  uterus.  More  fre- 
quently those  symptoms  depend  upon  acute  cerebral  anaemia,  to  which 
the  sudden  emptying  of  the  uterus  of  its  contents  already  predisposes, 
but  which  must  be  still  greater  when  not  only  the  contents  of  the  uterus, 
but  the  whole  organ  itself,  passes  out  of  the  abdominal  cavity.  .The 
blood  then  rushes  into  the  vessels  of  this  cavity,  which  are  suddenly 
under  a  greatly  diminished  pressure,  and  the  cerebral  anaemia  that  en- 
sues is  due  to  the  scanty  supply  which  the  upper  half  of  the  trunk  now 
receives. 

A  similar  condition  is  sometimes — though  rarely — observed  in  animals, 
and  particularly  in  the  Mare.  A  good  instance  is  that  furnished  by 
Peuch  at  page  579  (case  5). 


584  ACCIDENTS  INCIDENTAL  TO  PARTURITION 

Complications. 

^One  of  the  ordinary  complications  of  this  accident,  is  the  adherence  of 
the  foetal  placenta  to  the  uterine  surface  ;  though  this  is  much  more 
frequent  with  animals  which  have  a  multiple  placenta — Cow,  Sheep, 
and  Goat — than  with  the  Mare,  Ass,  Sow,  Carnivorous  animals,  or  the 
Rabbit. 

The  inversion  of  the  uterus — when  complete — also  brings  about  dis- 
placement of  the  vagina,  as  Hurtrel  d'Arboval  has  remarked  ;  the  deep- 
er portion  of  this  part  is  found  folded  on  the  neighboring  surface  of  the 
cervix  ;  the  bladder  and  inferior  wall  of  the  rectum  are  drawn  into  the 
middle  of  the  pelvic  canal,  and  occupy  the  place  the  uterus  has  quitted  -, 
the  meatus  urinarius  is  doubled  on  itself,  and  so  compressed  that  no 
urine  can  flow  through  it ;  while  the  ureters  continuing  to  carry  that  fluid 
to  the  bladder,  this  reservoir  soon  becomes  filled  and  greatly  distended, 
without  relief  being  possible.  Hence  results  another  source  of  suffering, 
and  another  cause  of  exhausting  efforts  which  are  added  to  those 
occasioned  by  the  prolapsed  uterus.  In  certain  cases  there  may  also 
exist  prolapsus  of  the  rectum,  and  displacement,  or  even  inversion,  of 
the  bladder. 

The  uterus  may  also  be  wounded  or  torn,  either  from  bad  management 
during  parturition,  or  from  injudicious  attempts  at  reposition  ;  or  the 
injury  may  be  due  to  rats,  cats,  dogs,  or  pigs  gnawing  at  the  bleeding 
mass  ;  sometimes  it  is  the  creature  itself,  or  a  neighboring  animal  which 
inflicts  the  damage. 

The  contact  of  the  air,  and  particularly  of  foreign  bodies,  induces 
inflammation,  which  frequently  runs  on  gangrene,  and  this  to  dissolution. 
Gangrene  is  readily  induced  in  the  Sheep.  Sometimes  perforation  of 
the  vagina  or  uterus,  arising  at  times  from  sloughing  of  a  gangrenous 
patch,  has  caused  fatal  peritonitis  ;  at  other  times  pelvic  abscesses  have 
formed. 

After  reduction  has  been  effected,  metritis  and  metro-peritonitis  may 
appear  ;  this  is  not  at  all  unlikely  in  the  Mare.  Lafosse  mentions  para- 
plegia also  as  a  complication  ;  this  may  be  a  consequence  of  gangrene 
and  septic  infection. 

An  exceptional  complication  is  hernia  of  the  intestines,  through  a 
rupture  in  the  uterus.  It  may  be  noted  that  in  prolapsus  uteri  in  the 
Mare,  it  has  happened  that  the  colon  has  followed  the  fundus  of  the 
organ,  and  become  invaginated  in  the  inverted  sac.  Funk  also  mentions 
the  case  of  a  Bitch  in  which  one  of  the  cornua  became  inverted,  and 
prevented  the  expulsion  of  the  remaining  foetuses  from  the  other  cornu  -, 
thus  necessitating  the  performance  of  the  Caesarean  section. 

Ayrault  has,  on  three  occasions,  encountered  an  unusual  complication 
after  reduction  of  the  prolapsed  organ,  in  the  form  of  severe  lameness, 
with  knuckling  over  of  the  two  hind-fetlock  joints,  but  without  any  artic- 
ular swelling.  This  complication  disappeared  as  the  animals  recovered 
from  inversion. 

T'rognosis. 

There  can  scarcely  be  any  doubt  that,  if  no  assistance  is  rendered  to 
an  animal  suffering  from  prolapsus  uteri,  death  must  ensue,  and  more  or 
less  speedily  :  as  gangrene  is  inevitable,  while  spontaneous  reduction  is 
impossible. 

In  some   instances  death  occurs  in  less  than  twenty-four  hours,  but 


INVERSION  OF  THE  UTERUS,  585 

most  frequently  the  animal  may  live  from  three  to  five  days — very  rarely 
longer.  Sabini  {younial  des  Vetir.  du  Midi,  1869,  p.  175),  an  Italian 
veterinarian,  cites  a  case  in  which  treatment  was  not  adopted  until  the 
seventh  day ;  but  this  is  an  altogether  exceptional  instance. 

Inversion  of  the  uterus  is  generally  fatal  when  owners  of  animals  have 
neglected  to  procure  assistance  until  too  late,  or  who  employ  ignorant 
people  to  attempt  reduction.  If  attended  to  sufficiently  early  by  those 
who  are  competent,  the  number  of  recoveries  is  considerable,  and,  as 
Saint-Cyr  truly  observes,  perhaps  in  no  other  pathological  condition  is 
the  utility  and  power  of  art,  when  invoked  at  the  proper  time,  better 
demonstrated. 

The  prognosis  is  not  equally  favorable,  however,  in  all  the  domesti- 
cated animals  ;  and  between  the  Mare  and  Cow,  for  instance,  the  differ- 
ence is  considerable. 

With  regard  to  the  latter  animal,  Deneubourg,  who  has  often  had  to 
treat  this  accident,  has  never  lost  one  of  his  patients.  In  one  hundred 
cases,  Donnarieix  has  only  had  three  deaths.  Moens,  in  twenty-seven 
cases,  has  not  had  a  fatal  termination.  Guillaume,  cited  by  Gelle,  lost 
three  cases  out  of  forty-two :  Loyer,  of  Nemours,  nine  out  of  twenty- 
seven  ;  and  Mazure,  Holland,  one  in  four. 

With  regard  to  the  mare,  Donnarieix  had  eight  cases,  and  all  perished  ; 
Cruzel  had  three,  and  they  also  succumbed ;  Schaack  only  saved  one  of 
two. 

In  249  cases  of  prolapsus  uteri  in  the  Cow,  collected  by  Saint-Cyr, 
there  were  30  deaths — or  a  mortality  of  12  per  cent.  For  the  Mare  he 
only  found  19  cases,  and  of  these  14  were  fatal — a  mortality  of  74  per 
cent. 

A  number  of  authorities  quoted  by  Zundel  give  the  percentage  of  re- 
coveries in  the  Cow  as  97,  and  in  the  Mare  as  50. 

It  would,  therefore,  appear,  and  it  is  no  doubt  true,  that  this  accident 
is  much  more  fatal  in  the  Mare  than  the  Cow. 

Inversion  in  the  Sow  is  nearly  always  fatal,  unless  amputation  of  the 
uterus  is  resorted  to ;  but  this  animal  and  the  Bitch  will  live,  in  very 
rare  cases,  for  two,  three,  or  four  days  with  the  uterus  prolapsed. 

It  has  often  been  stated  that  inversion  of  the  uterus  leads  to  infecun- 
dity  ;  but  though  it  may  do  so-  in  some  instances,  yet  it  cannot  be  ac- 
cepted as  a  rule.  Numerous  cases  are  on  record,  and  particularly  for 
the  Cow  and  Bitch,  in  which  fecundation  has  taken  place  after  this  acci- 
dent. 

Though  inversion  is  likely  to  recur  after  another  pregnancy,  or  even 
during  a  succeeding  gestation,  yet  even  in  this  case  it  is  not  invariably 
so  ;  though  to  avert  it  care  may  be  necessary. 

Causes. 

Inversion  of  the  uterus  is  generally  consecutive  to  parturition,  and  is 
most  frequent  in  the  Cow,  w^iose  uterine  ligaments  are  so  extensive  and 
extensible.  It  usually  occurs  within  two  or  three  days  after  parturition, 
rarely  later. 

With  multiparous  animals,  in  which  each  uterine  cornu  forms  a  kind  of 
independent  uterus,  it  can  be  understood  that  one  of  these  may  alone  be 
inverted,  the  foetus  contained  in  the  other  cornu  being  retained  there  for 
some  time — though  not  without  danger  to  its  existence  should  this  oeriod 
be  much  prolonged. 


586  ACCIDENTS  INCIDENTAL  TO  PARTURITION 

With  uniparous  animals,  however,  this  cannot  take  place,  it  appears ; 
as  the  uterus  cannot  become  inverted  without  the  fcetus  being  expelled. 
Nevertheless,  Aubry  {Reaieil  de  Med.  Veiermaire,  1859,  p.  731)  has  pub- 
lished a  very  curious  observation,  in  which  it  is  mentioned  that  a  Cow, 
affected  with  a  prolapse  of  the  vagina  during  pregnancy,  had  complete 
inversion  of  the  left  cornu  at  the  end  of  that  period  ;  but  the  calf,  which 
was  lodged  in  the  right  cornu,  and  which  was  alive  and  well  developed, 
was  retained  there  for  two  entire  days.  It  was  then  necessary  to  inter- 
fere and  effect  delivery,  which  was  followed  by  total  inversion  of  the 
organ.  This  incident,  which  appears  to  be  unique,  does  not,  however, 
prevent  us  from  accepting  the  rule  as  general,  that  inversion  of  the  uterus 
is  absolutely  incompatible  with  the  prolongation  of  gestation. 

In  order  that  this  inversion  can  take  place,  it  is  essential  that  the  os 
uteri  is  more  or  less  dilated  ;  consequently,  the  accident  is  only  ob- 
served in  breeding  animals,  and  either  during  or  soon  after  parturition  or 
abortion. 

In  order  that  it  can  occur,  a  certain  degree  of  relaxation  of  the  sub- 
lumbar  uterine  ligaments  must  be  present ;  there  must  also  be  some 
cause  of  irritation  in  operation  after  the  expulsion  of  the  fcetus,  suffi- 
cient to  excite  the  contraction  of  the  muscles  of  the  uterus  and  lead 
to  inversion — though  it  is  often  difficult  to  ascertain  what  this  ciuse 
may  be. 

In  very  many  instances  gestation  has  gone  on  to  its  full  term,  the  an- 
imal is  strong  and  healthy,  birth  natural  and  easy,  and  there  is  nothing 
to  indicate  the  advent  of  such  an  accident — when,  suddenly,  after  a  few 
expulsive  efforts,  the  uterus  is  ejected  in  an  inverted  state. 

It  has  been  attempted  to  explain  the  occurrence  of  the  accident  in 
such  cases,  by  alluding  to  the  lymphatic  temperament  of  the  animals, 
and  their  consequent  laxity  of  tissue  ;  and  it  is  often  the  case  that  Cows 
which  are  "  soft,"  and  kept  on  food  that  is  better  suited  for  the  produc- 
tion of  milk  than  flesh,  are  the  most  frequent  subjects  of  inversion  ;  this 
sometimes  occurring  after  each  birth,  and  though  parturition  was  perfectly 
normal. 

Inversion  or  retropulsion  of  the  vagina  during  pregnancy,  has  also  been 
accused  as  the  cause  of  inversion  of  the  uterus  ;  and  it  may  be  so  in 
some  instances,  but  it  certainly  is  not  s«  in  all.  Indeed,  excellent  au- 
thorities maintain  that  there  is  no  proof  that  this  accident  is  more  fre- 
quent in  animals  suffering  from  inversion  of  the  vagina  than  those  which 
are  not.  And  it  must  be  remembered,  as  already  stated,  that  the  os 
must  be  more  or  less  dilated  and  dilatable  for  inversion  of  the  uterus  to 
occur — a  condition  which  does  not  always,  nor  yet  frequently,  co-exist 
with  vaginal  inversion.  The  latter,  indeed,  is  far  from  rare  in  non-preg- 
nant animals,  and  in  those  which  have  never  been  pregnant ;  and  it  is 
not  at  all  uncommon  in  those  which  are  advanced  in  pregnancy,  and  yet 
do  not  suffer  afterwards  from  this  uterine  displacement. 

Difficult  and  laborious  parturition,  when  much  manipulation  and  ener- 
getic traction  on  the  foetus  have  been  employed,  has  likewise  been  ac- 
knowledged as  a  cause  of  uterine  inversion  ;  and  it  is  certain  that  the 
efforts  to  remove  a  foetus  which — whether  from  malposition,  deviation  of 
parts,  excess  of  volume,  etc. — cannot  be  expelled  in  a  natural  manner, 
are  somewhat  frequently  followed  by  this  accident.  But  on  the  other 
hand,  how  often  do  we  find  that  the  most  vigorous — even  painful  and 
violent — traction,  and  long  and  complicated  manoeuvres — are   not  sue- 


INVERSION  OF  THE  UTERUS. 


587 


ceeded  by  inversion  ;  while,  on  the  contrary,  the  easiest  and  most  rapid 
birth  sometimes  is. 

The  retention  of  the  foetal  placenta  beyond  the  ordinary  period,  must 
also  be  taken  into  account  as  one  of  the  exciting  causes  ;  as  it  then  acts 
as  a  foreign  body,  irritates  the  interior  of  the  uterus,  and  so  by  a  reflex 
action  induces  contraction  of  its  muscular  layer — thus  giving  rise  to  in- 
vagination of  the  extremity  of  one  of  the  cornua,  which  is  supposed  to 
be  the  commencement  of  inversion. 

It  is  also  extremely  probable  that  injudicious  traction  on  the  foetal 
membranes  may,  for  mechanical  and  physiological  reasons,  bring  about 
this  result  in  a  flaccid  and  dilated  uterus,  when  the  cervix  is  also  relaxed. 
More  especially  is  this  likely  to  happen  if  the  placenta  is  adherent  to- 
wards the  fundus  of  the  organ,  or  in  one  of  the  cornua. 

Much  mystery  appears  to  have  attached  to  this  inversion  of  the  uterus, 
and  though  various  causes  have  been  assigned  as  operating  in  its  produc- 
tion, yet  as  these  were  not  present  in  every  case,  it  has  been  admitted 
that  a  particular  predisposition  must  have  existed. 

We  are  much  inclined  to  believe  that  several  causes  may  be  invoked  to 
account  for  the  accident.  A  flaccid,  non-contracted  uterus  after  birth, 
with  a  weak  cervix  and  dilated  os,  and  relaxed  broad  ligaments,  we  would 
certainly  look  upon  as  a  predisposing  condition  ;  and  this  is  most  likely 
to  be  present  in  lymphatic  animals,  or  those  suffering  from  atony,  brought 
about  by  debility  through  disease,  or  bad  or  insufficient  food,  exposure  to 
weather,  etc.  When  this  condition  is  present,  it  is  easy  to  understand 
why  inversion  may  occur  from  abdominal  pressure  at  the  cornua  or  fun- 
dus of  the  organ,  or  external  mechanical  force  ;  and  we  can  also  compre- 
hend why  an  antiperistaltic  movement  of  one  of  the  cornua,  or  a  portion 
of  it — ^just  as  happens  in  intussusception  of  the  intestines — may  take 
place  sometimes,  and  lead  to  this  condition  immediately  after  birth,  and 
before  the  cervix  has  had  time  to  contract.  Any  trifling  irritation  may 
lead  to  this  wrong  movement,  and  once  commenced  it  is  far  more  likely 
to  continue  than  to  cease — as  in  the  case  of  the  intestines,  when  one  por- 
tion becomes  invaginated  within  another. 

We  believe  this  will  be  found  to  be  the  correct  opinion. 

♦     Treatment. 

Whatever  may  be  the  cause  of  inversion  of  the  uterus,  the  obstetrist 
must  lose  no  time  in  remedying  the  accident ;  as  when  interference  is  not 
prompt,  a  fatal  termination,  or,  at  the  very  least,  most  serious  conse- 
quences rapidly  ensue. 

In  treating  the  inversion,  several  important  indications  are  to  be  ob- 
served, but  they  may  be  classed  as  :  (i)  the  imfjiediate  ox  preliminary  mea- 
sicres  which  the  local  symptoms  demand,  (2)  the  reduction  or  reposition  of 
the  uterus^  (3)  the  retenfiojt  of  the  organ,  (4)  the  after-treatment ;  or  should 
reposition  be  impossible  or  contra-indicated,  then  recourse  must  be  had 
to  (5)  excision  or  a7npiitation  of  the  uterus. 

Preliminary  Measures. 

The  preliminary  measures  consist  in  combating  the  local  and  general 
symptoms. 

The  animal  is  sometimes  standing,  sometimes  lying  down.  If  the  lat- 
ter, it  must  be  got  up  by  some  means  or  other,  as  the  standing  attitude 


588  ACCIDENTS  INCIDENTAL  TO  PARTURITION, 

is  by  far  the  best  for  reducing  the  inversion,  there  being  more  space  in 
the  abdomen  when  its  walls  are  not  compressed  by  the  ground,  and  the 
obstetrist  can  operate  more  easily  and  quickly,  while  the  downward  in- 
clination of  the  lower  surface  of  the  pelvis  and  abdomen  is  favorable  for 
reduction  and  retention.  If  the  animal  is  not  very  feverish,  but  only 
debilitated,  and  there  is  otherwise  no  great  urgency  in  the  case,  a  strong 
diffusible  stimulant  may  be  administered,  with  the  view  to  enabling  it  to 
get  up.  It  may  also  be  induced  to  rise  by  bringing  a  dog  before  it  ;  or 
it  may  be  aided  by  a  sack  or  sheet  passed  under  its  chest. 

If  it  cannot  be  made  to  get  up,  or  is  unable  to  stand  when  raised,  then 
of  course  reposition  must  be  effected  while  it  is  lying — fatiguing,  and 
often  troublesome,  as  the  operation  then  is.  This  fatigue  and  difficulty 
may  be  somewhat  diminished  in  raising  the  hind-quarters  of  the  animal 
as  much  as  possible,  by  means  of  bundles  of  straw  placed  under  them, — 
all  the  litter  being  removed  from  beneath  the  abdomen,  so  as  to  relieve 
the  viscera  it  contains  from  pressure  as  much  as  possible.  Cosse, 
Tyvaert,  Haubner,  Andersen,  and  others  advise  placing  the  animal  on  its 
back,  with  the  croup  so  raised  ;  while  Viborg,  Fassler,  Bettinger,  Ober- 
mayer,  Hering,  Merkt,  Adam,  and  several  other  obstetrists,  recommend 
raising  or  suspending  the  animal  by  the  hind  limbs,  over  a  beam — a  pro- 
cedure which,  they  assert,  is  most  adv^tageous  when  reposition  is  possible 
or  advisable.  But  as  has  just  been  said,  the  recumbent  position,  with 
the  larger  animals,  is  always  to  be  avoided  when  possible,  and  every 
means  should  be  tried  to  get  them  to  stand.  With  the  smaller  animals 
— as  the  Sheep,  Goat,  Sow,  Bitch,  or  Cat — it  is  convenient  to  place  them 
on  a  bench  or  table,  and  lying  either  on  the  side  or  back,  with  the  hind- 
quarters well  raised. 

If  the  accident  is  recent — an  hour  or  two,  or  even  a  little  longer — the 
uterus  may  be  returned  at  once  \  but  should  a  longer  interval  have 
elapsed,  it  is  well  to  ascertain  the  condition  of  the  rectum  and  bladder, 
and  to  empty  them  if  necessary  ;  though  it  must  be  confessed  that  it.  is 
often  a  most  difficult  task  to  accomplish  evacuation  of  the  bladder.  It 
may  be  done,  however,  by  causing  assistants  to  raise  the  uterus,  and  to 
seek  for  the  meatus  urinarius  on  its  lower  surface,  near  the  vulva,  intro- 
ducing one  or  two  fingers  into  that  canal,  or  a  catheter  through  it  into 
the  bladder. 

Should  the  fcEtal  membranes  still  be  adherent  to  the  uterine  surface — 
wholly  or  partially — then  they  must  be  carefully  removed  without  injur- 
ing the  cotyledons,  enucleation  being  effected  in  the  manner  already 
described.  If  properly  performed,  this  removal  should  not  cause  any 
haemorrhage  ;  and  if  any  pulpy  gangrenous  cotyledons  are  found,  it  is 
better  to  remove  them  at  once  with  scissors  than  kave  them  to  be  elimi- 
nated in  the  ordinary  way ;  though  if  they  show  any  vitality  at  all  they 
need  not  be  interfered  with.  Torn  or  gangrenous  portions  of  mucous 
membrane  are  also  to  be  excised  in  the  same  manner. 

This  done,  the  uterus  should  be  cleansed  from  matters  adhering  to  its 
surface — such  as  litter,  mud,  dirt,  filth  or  blood  ;  and  this  may  be  effected 
by  means  of  a  fine  soft  sponge  or  cloth,  the  fluid  employed  being  either 
cold  or  tepid  water,  milk  and  water,  some  astringent  or  soothing  lotion,  if 
there  is  much  tumefaction  or  irritation,  or  a  stimulating  fluid— as  the 
dilute  tincture  of  opium — if  the  organ  is  much  bruised  and  congested. 
Some  practitioners  immerse  the  entire  uterus  in  a  bucket  containing 
either  of  these  fluids  ;  and  some  particularly  prefer  cold  w^ater,  allowing 


INVERSION  OF  THE  UTERUS.  589 

the  organ  to  remain  in  it  for  as  long  as  five  or  ten  minutes.  By  tliis 
means  it  is  freed  from  extraneous  matters  and  cleansed  ;  while  the  con- 
gestation  is  allayed  and  the  mass  considerably  reduced  in  size.*  Meyer, 
Pfirter,  and  others  state  that  this  immersion  in  cold  water  has  an  astonish- 
ing effect,  and  greatly  facilitates  reposition.  Schnee  even  recommends 
the  application  of  ice,  which,  he  asserts,  not  only  diminishes  the  volume  of 
the  protruded  organ,  but  allays  its  irritability  and  contractions.  When 
attempting  to  reduce  the  cornu  or  uterus,  he  holds  a  piece  of  ice  in  the 
hand  he  applies  to  the  part. 

If  from  long  inversion  and  consequent  congestion,  infiltration,  or  in- 
flammation, the  volume  of  the  uterus  is  so  increased  that  it  appears 
impossible  to  return  it,  scarifications  may  be  made  on  its  surface  ;  these 
often  lead  to  a  notable  decrease  in  its  size,  and  reduction  may  then  be 
effected.  If  it  is  determined  to  scarify  the  organ,  the  greatest  circum- 
spection should  be  observed  in  making  the  incisions  ;  they  must  be  quite 
superficial,  and  only  a  few  at  a  time.  Should  the  hagmorrhage  prove  ex- 
cessive— which  it  sometimes  does,  when  the  scarifications  are  deep  and 
numerous — then  styptics  must  be  applied. 

If  the  uterus  is  torn,  it  may  be  necessary  to  close  the  wound  by  the 
continuous  suture — but  this  must  not  be  drawn  too  tight ;  mere  apposition 
of  the  edges  being  all  that  is  necessary.  If  the  wound  is  not  extensive, 
it  need  not  be  closed  ;  indeed,  there  are  many  cases  on  record  in  which 
wounds  of  the  uterus  have  not  been  sutured — the  organ  having  been 
merely  returned  to  the  abdominal  cavity,  and  yet  recovery  has  taken 
place. 

If  hernia  of  the  intestine  or  any  other  viscus  in  present,  then,  of  course, 
this  must  be  reduced  before  the  uterus. 

Reduction  or  Reposition. 

When  inversion  of  the  uterus  is  incomplete — a  very  rare  occurrence — 
and  the  organ  has  not  passed  beyond  the  vagina,  reduction  is  compara- 
tively easy.  It  is  sufficient,  with  the  larger  animals,  to  introduce  the 
closed  fist"  into  the  vagina,  and  to  push  the  uterus  as  far  into  the  abdo- 
men as  may  be  deemed  necessary.  When  the  animal  strains,  the  opera- 
tor must  not  push,  but  maintaining  what  he  has  accomplished  as  well  as 
he  can,  recommence  as  soon  as  the  expulsive  effort  has  ceased.  Whether 
inversion  is  complete  or  incomplete,  and  if  the  animal  is  standing  or 
lying,  it  is  always  well  to  have  the  hind-parts  higher  than  the  fore. 

When  it  is  complete,  then  four  assistants  are  necessary.  One  of  these 
stands  at  the  animal's  head,  and  holds  it  firmly — if  a  Cow  he  may  seize 
it  by  a  horn  with  one  hand  and  nasal  septum  by  the  other  ;  if  it  is  a 
Mare,  a  twitch  on  the  nose  or  ear  may  be  required,  and  it  may  even  be 
necessary  to  have  a  side-line  on  one  of  the  hind-limbs.  Another  assistant 
holds  the  tail  over  the  croup  with  one  hand,  and  with  the  other  he  presses 
or  pinches  the  loins  in  order  to  diminish  the  straining  ;  while  a  man 
stands  at  each  side  of  the  croup  to  aid  in  raising  and  returning  the  uterus. 
It  is  well  to  attract  the  animal's  attention  as  miich  as  possible,  as  it  then 
offers  less  opposition  to  the  manipulations,  and  does   not  strain   so  vio- 

*  A  little  care  on  the  part  of  owners  of  animals  would  often  prove  of  great  advantage  in  averting  serious 
consequences  in  such  an  accident  as  inversion  of  the  uterus,  beiore  the  arrival  of  the  veterinary  surgeon. 
This  care  should  be  mainly  directed  to  keeping  the  animal  in  a  standing  attitude  ;  and  preventing  the  uterus 
from  being  soiled,  bruised  or  torn,  as  well  as  swollen.  The  or^an  may  readily  and  easily  be  preserved 
from  injury  by  receiving  it  on  a  sheet  or  large  cloth,  or,  better  still,  a  basket  or  tray,  and  holding  it  well 
raised  until  prof.'ssional  assistance  arrives. 


590  ACCIDENTS  INCIDENTAL  TO  PARTURITION. 

lently.  Pinching  the  nose  and  loins  will  be  found  very  effective  in  this 
respect,  and  if  a  Cow,  a  dog  may  be  introduced  in  front  of  it.  Should 
the  animal  be  much  exhausted  or  unsteady,  two  additional  assistants  may 
be  required  to  stand  at  each  side. 

The  uterus  must  be  placed  on  a  cloth  or  sheet  in  two  or  three  folds 
and  well  moistened,  the  ends  being  held  by  the  two  assistants  at  the 
croup,  so  that  the  organ  maybe  lifted  as  high  as  the  vulva.  By  doing  so, 
there  is  neither  traction  nor  compression  on  the  mass,  and  as  the  circula- 
tion in  it  is  thereby  much  facilitated,  the  tumefaction  subsides  to  a  cor- 
responding degree.  It  also  allows  the  operator  more  freedom,  as  he 
could  not  sustain  the  weight  of  the  prolapsed  organ — sometimes  as  much 
as  ICO  to  140  pounds — and  at  the  same  time  attempt  its  reposition. 

Indeed,  some  practitioners  recommend  that  the  two  corners  of  each  end 
of  the  cloth  on  which  the  uterus  is  placed,  should  be  tied  round  the  neck 
of  the  assistants,  so  that  their  hands  may  also  be  free  to  aid  the  operator 
in  his  manoeuvres :  though  this  device  must,  one  would  imagine,  have 
more  disadvantages  then  conveniences. 

When  the  animal  strains  very  severely  and  almost  continuously — as 
sometimes  happens  during  reposition — it  is  useful  to  constrain  the  chest 
as  much  as  possible  by  a  girth,  so  as  to  prevent  its  expansion.  It  may 
even  be  necessary  to  give  a  strong  anodyne  draught  of  chloral  or  opium. 

For  effecting  reposition,  three  methods  are  recommended,  and  these 
we  will  now  notice  :  merely  observing  that  whichever  may  be  adopted,  the 
operator  always  stands  directly  behind  the  animal,  with  the  inverted  organ 
immediately  before  him. 

First  Method. — If  the  inverted  tumor  formed  by  the  uterus,  external  to 
the  vulva,  is  not  very  voluminous,  and  if  by  the  application  of  cold  water 
to  it — should  it  be  tumefied — it  is  reduced  in  size,  then  reposition  may 
be  effected  by  pressure  on  the  fundus  of  the  organ.  This  pressure  is  to 
be  made  by  the  closed  fist  against  the  central  part  of  the  tumor  ;  and  in 
some  instances,  if  it  is  well  directed,  and  the  inversion  not  serious,  the 
organ  may  be  returned  to  the  pelvic  cavity  by  one  push,  while  another 
will  carry  it  into  the  abdomen. 

Rainard  and  other  practitioners  approve  of  this  method,  and  describe 
it  somewhat  in  detail.  The  operator  is  to  seek  for  the  largest  cornu — 
that  which  contained  the  foetus — seize  it  by  the  fundus,  and  reduce  this 
by  pushing  it  inwards,  as  we  would  the  finger  of  a  glove  which  has  been 
turned  outside  in  :  continuing  the  reduction  by  successive  portions  until 
the  pedicle  of  the  tumor  is  reached,  when  more  serious  resistance  is 
encountered  from  the  os  uteri.  This  being  overcome,  the  body  of  the 
uterus  is  next  replaced,  either  by  the  fist  pressing  against  ^the  widest  part, 
or  by  using  a  pessary.  The  pressure  is  to  be  directed  straight  forward, 
though  the  vulva  and  pelvic  canal,  upwards  and  inwards. 

Great  care  is  necessary  in  exerting  the  pressure,  which  should  not  be 
applied  while  the  animal  is  straining.  During  expulsive  efforts,  the 
operator  must  be  content  to  wait,  merely  keeping  the  parts  where  he  has 
carried  them,  until  the  straining  has  ceased.  The  pressure  must  be 
steady  and  well-directed,  so  as  not  to  bruise  or  lacerate  the  uterus. 
When  a  portion  is  got  within  the  vulva,  it  is  held  there  by  one  hand, 
while  the  other  manipulates  the  next  part  to  be  returned.  Reduction 
must  be  effected  progressively,  so  that  the  organ  may  be  completely 
replaced  ;  if  it  is  not,  then  reinversion  is  certain  to  occur. 

Some  practitioners  employ  the  pad  or  cup-shaped  pessary,  to  aid  them 


INVERSION  OF  THE  UTERUS.   '  5gi 

in  this  operation  ;  the  round  end  is  applied  to  the  fundus  of  the  uterus, 
and  the  pressure  is  made  at  the  other  end  of  the  instrument  by  the  chest 
or  abdomen  of  the  operator,  whose  hands  are  thus  at  liberty  to  direct  the 
viscus  into  the  vulva  and  vagina. 

Seco7id  Method. — If  the  uterine  tumor  is  voluminous,  and  hangs — a 
heavy  mass — as  low  as  the  hocks,  then  the  first  method  is  dangerous,  if 
not  impracticable,  and  must  not  be  attempted.  The  best  method  now 
undoubtedly  is  to  return,  first,  the  parts  of  the  organ  nearest  the  vulva,  and 
not  act  directly  on  the  fundus  of  the  uterus  until  the  greater  portion  has 
been  replaced  in  the  pelvis. 

In  order  to  accomplish  this,  the  assistants  on  each  side  of  the  croup 
raise  the  uterus  in  the  manner  already  described,  so  as  to  bring  it  near 
the  vulva,  and  opposite  the  axis  of  the  pelvis.  Then  the  operator  gently 
presses  with  open  hands  on  eacli  side  on  the  parts  close  to  the  vulvar 
opening,  in  order  to  force  them  gradually  into  it.  By  acting  in  this  w^ay 
with  care  and  patience,  and  preventing,  as  well  as  he  can,  the  expulsion 
of  those  portions  he  has  already  reduced,  the  tumor  by  degrees  becomes 
diminished,  and  may  even  be  entirely  returned.  But  it  is  not  necessary 
to  continue  the  method  after  two-thirds  or  three-fourths  of  the  total  mass 
has  been  conveyed  into  the  pelvic  cavity  ;  for  it  is  then  more  expeditious, 
and  quite  as  safe,  to  apply  the  closed  fist  to  the  extremity  of  the  tumor, 
and  push  it  directly  into  the  vagina  and  abdomen.  In  some  instances  it 
will  be  found  that,  towards  the  termination  of  reduction,  the  organ  itself 
returns  to  its  normal  position,  and  often  quite  suddenly,  as  if  it  had  been 
thrown  back  by  a  spring. 

Sometimes  a  combination  of  the  first  and  second  methods  is  most  useful : 
an  assistant  pressing;  on  the  extremity  of  the  tumor,  while  the  operator 
manipulates  near  the  vulva. 

Third  Afethod. — This  method  was  first  brought  to  notice  by  Coculet 
i^Jounial  dcs  Vet.  dii  Midi,  1862),  who,  finding  the  previous  methods  long 
and  laborious,  set  himself  the  task  of  improving  it. 

This  he  has  succeeded  in  doing  by  an  ingenious  procedure,  which  is 
described  as  follows.  A  dry  and  clean  piece  of  linen,  about  a  yard  in 
length,  and  twenty-eight  to  thirty  inches  wide,  is  passed  beneath  the 
inverted  uterus,  and  close  up  to  the  vulva  ;  its  lower  border  is  then  lifted 
over  the  organ,  one  of  the  ends  folded  over  it,  and  then  the  other  end 
over  this,  so  as  to  envelop  the  entire  uterus — the  four  corners  of  the 
wrapper  being  uppermost.  Tepid  w^ater  is  now  kept  incessantly  applied 
to  this  cloth,  which  is  gradually  tightened  every  minute,  by  placing  the 
open  hand  beneath  the  mass,  and  with  the  other  hand  pulling  at  the 
upper  end  of  the  wrapper. 

This  equable,  gentle,  and  sustained  pressure  over  the  entire  organ,  soon 
(fifteen  to  twenty  minutes)  brings  about  a  marked  diminution  in  its  size, 
and  renders  its  reduction  easier. 

The  method  has  been  most  successfully  employed  on  several  occasions  ; 
though  some  practitioners  prefer  immersing  the  protruded  uterus  in  cold 
water  at  once,  as  being  a  quicker  plan  for  reducing  it,  while  also  effecting 
the  necessary  cleansing  process. 

Certainly  cold  water  might  frequently  be  substituted  for  tepid,  and 
compression  might  commence  at  the  lower  extremity  of  the  organ,  par- 
ticularly if  the  bandage  is  elastic,  on  the  Esmarch  principle  ;  this  would 
greatly  expedite  the  operation,  and  would  prevent  injury  to  the  uterus. 

Jensen  (Hering's  Repcrtorium,  1874,  p.  183)  describes  a  similar 
method  to  that  of  Coculet. 


592  ACCIDENTS  INCIDENTAL   TO  PARTURITION. 

When  the  uterus  has  been  returned  to  the  abdominal  cavity,  the  oper- 
ator has  then  to  ascertain  if  it  is  properly  disposed.  It  sometimes  hap- 
pens that  the  extremity  of  one  or  other  of  the  cornua  remains  invaginated 
in  itself  to  a  certain  extent,  and  thus  renders  reduction  incomplete  ;  this 
will  undoubtedly  induce  renewed  straining,  and  in  all  probability  bring 
about  reinversion.  It  is,  therefore,  essential  that  the  hand  of  the  operator 
should  carefully  examine  every  part  of  the  interior  of  the  uterus  and 
the  genital  canal,  and  particularly  around  the  cervix. 

This  is  more  especially  necessary  when,  after  reposition  has  been 
effected,  straining  continues — a  sure  indication  that  the  parts  are  not  in 
their  normal  position.  The  hand  must  then  be  again  introduced,  and  if 
any  abnormal  folds  of  the  mucous  membrane — any  commencing  invagi- 
nation— is  encountered,  this  must  be  gently  smoothed  down,  or  adjusted, 
and  replaced — not  forgetting,  should  '  the  cornua  be  involved,  the  very 
dissimilar  disposition  of  these  in  the  Mare  and  Cow. 

When  reposition  has  been  finally  accomplished,  the  straining  ceases,  and 
the  animal  soon  appears  to  be  quite  easy  :  that  is,  if  reduction  is  made 
early — on  the  same  day,  for  instance — and  provided  there  is  no  injury  to 
the  organ.  It  is  generally  advisable  to  keep  the  hand  in  the  uterus  for 
a  short  time  until  the  latter  begins  to  contract  freely  ;  if  this  is  not  done, 
the  flaccid  organ  may  again  become  inverted. 

With  the  smaller  animals,  reposition  is  rendered  difficult,  because  of  the 
small  pelvis  not  admitting  the  hand  ;  and  with  some,  and  particularly  the 
Sow,  reduction  of  the  prolapsed  cornu  or  cornua  is  often  a  serious  mat- 
ter. The  cornua  must  be  reduced  in  the  manner  already  indicated,  the 
finger,  or  even  a  tallow  candle,  being  employed  to  replace  them,  then  the 
body  of  the  organ  should  follow;  a  small  pessary  with  a  handle  or  retro- 
verter,  may  be  used  to  complete  the  operation.  Frick,  a  Swiss  veterina- 
rian {Sc/iweizer  Archiev.^  vol.  xii.,  p.  249),  has  adopted  a  plan  which  has 
succeeded  in  his  hands,  and  also  with  other  obstetrists  who  have  tried  it. 
The  inverted  organ  being  reduced,  the  animal  is  raised  by  the  hind  limbs, 
and  a  quantity  of  mucilaginous  fluid  is  injected  into  the  vagiha  and 
uterus,  until  they  are  filled.  This  fluid  acts  in  a  mechanical  manner, 
forcing  the  uterus  to  distend  and  assume  its  ordinary  form. 

In  some  cases,  when  reduction  is  attempted,  the  animal  continues  to 
strain  so  violently  that  it  is  almost  impossible  to  operate,  notwithstanding 
the  adoption  of  the  measures  already  recommended. 

In  these  cases  bleeding  has  been  advised  and  practised,  but  not  always 
with  success  ;  if  the  animal  is  not  strong,  it  may  do  positive  harm.  Opium 
is  not  always  a  soothing  remedy  for  ruminants,  and  if  given  in  narcotic 
doses  may  lead  to  mischief.  Ether  has  been  employed  to  produce  in- 
complete anaesthesia  in  the  Mare,  so  as  to  diminish  the  expulsive  efforts, 
and  with  success.  Andelfinger,  Rueff,  and  Baumeister,  as  well  as  Saint- 
Cyr,  recommend  this  partial  anaesthesia. 

Van  Dommelen,  a  Dutch  veterinary  surgeon,  gives  the  preference  to  a 
very  strong  dose  of  alcohol,  so  as  to  produce  semi-narcosis.  He  has  em- 
ployed it  in  a  great  number  of  instances  of  inversion  of  the  uterus  in 
which  there  was  violent  straining,  and  has  never  observed  any  accident. 

Chloral  hydrate,  either  in  draught  or  enema,  should  be  found  an  excel- 
lent agent  in  such  cases,  as  well  as  the  subcutaneous  injection  of  acetate 
of  morphia.  The  injection  of  dilute  tincture  of  opium  into  the  uterus  may 
also  be  found  beneficial. 

It  must  not  be  forgotten  that  a  tight  surcingle  round  the  chest  or  abdo- 


INVERSION  OF  THE  UTERUS.  593 

men  or  both,  and  raising  of  the  hind  parts  of  the  animal  as  high  as  pos- 
sible, will  greatly  assist  in  diminishing  the  straining. 

,     Cont£7itio7i  or  Retentiofi  of  the   Uterus. 

Reduction  of  the  inverted  uterus  having  been  accomplishecl,  and  every 
thing  done  to  remove  the  slightest  traces  of  invagination,  the  animal — 
unless  serious  injury  has  been  inflicted  on  the  organ — immediately  begins 
to  look  easier  and  happier,  and  the  inexperienced  would  suppose  that 
there  was  no  further  occasion  for  interference.  The  experienced  ob- 
stetrist,  however,  is  well  aware  that  certain  precautions  must  be  adopted 
against  a  possible  recurrence  of  the  accident.  True,  this  recurrence  is  to 
a  certain  extent  provided  for  by  raising  the  croup  of  the  animal  as  high 
as  may  be  convenient,  either  by  means  of  litter  or  boards,  and  keeping 
the  forehand  low.  But  this  is  not  always  a  preventive,  and  veterinary 
obstetrists  have  therefore  devised  other  means  for  retaining  the  uterus  in 
its  place  until  all  risk  of  another  inversion  has  passed  away.  These  de- 
vices consist  oi  pessaries,  sutures,  and  bandages. 


Fig.  196. 
Pad  Pessary, 

Pessaries. — These  are  instruments  of  various  forms,  which  are  introduced 
into  the  genital  organs,  and  kept  there  for  a  certain  time,  in  order  to 
prevent  displacement  of  the  uterus  after  its  reduction.  There  are  several 
described  and  used  by  veterinary  obstetrists, 

T\-i^ pad pe^ssary  (Fig.  196)  is  a  round  piece  of  wood,  from  twenty  to 
twenty-five  inches  in  length,  with  a  hole  at  one  end,  through  which  passes 
a  loop  of  strong  cord  six  to  eight  inches  long  ;  and  at  the  other  end  a 
round  pad,  three  or  four  inches  in  diameter,  composed  of  tow  or  rags, 
covered  by  a  piece  of  soft  cloth,  and  firmly  tied  to  the  stalk  by  a  piece  of 
twine  fixed  in  a  small  circular  groove  therein. 

In  using  this  pessary,  the  pad  is  steeped  in  oil  or  melted  lard  ;  it  is 
then  carefully  introduced  into  the  vagina,  and  placed  against  the  cervix 
uteri,  and  cords  from  each  side  of  the  loop  at  the  other  end,  attached 
to  a  surcingle  round  the  chest,  keep  it  firmly  in  its  place.  The  pad  por- 
tion of  the  pessary  may  be  of  wood,  though  the  elastic  material  is  to  be 
preferred,  A  transverse  piece  of  wood,  with  an  eyelet  at  each  end,  and 
made  to  move  up  and  down  the  handle  by  means  of  a  screw,  is  some- 
times substituted  for  the  loop  of  cord. 

This  pessary  may  be  most  usefully  employed  as  a  repositor,  in  effecting 
reduction  of  the  inverted  uterus. 

The  ring  pessary  (Fig.  197)  is  equally  simple,  and  is  preferred  by  some 
practitioners  to  the  pad  one.  It  is  composed  of  a  wooden,  or  better,  an 
iron  ring,  about  two-and-a-half  inches  in  diameter,  pierced  by  an  elongated 
or  mortised  hole  at  opposite  sides,  and  of  a  strong  wooden  stem  about 
twenty  inches  long,  cleft  in  two  as  far  as  the  middle,  where  it  is  tied  by  a 
piece  of  twine  or  wire.  The  ends  of  the  two  branches  (A  A)  are  firmly 
tennoned  in  the  mortises  of  the  ring ;  and  the  other  end  of  the  stalk  (B) 
is  flat,  and  passes  through  the  central  opening  of  a  transverse  piece  (T  T), 

38 


594 


ACCIDENTS  INCIDENTAL   TO  PARTURITION. 


which  is  about  eight  inches  long,  and  has  at  each  end  an  aperture  (O  O), 
in  which  are  fastened  the  cords  or  straps  destined  to  fix  the  apparatus. 

When  required  for  use,  the  ring  is  wrapped  in  a  narrow  piece  of  fine 
linen,  which  is  rolled  round  it  in  a  uniform  manner,  so  that  it  may  not 
irritate  the 'neck  of  the  uterus,  with  which  it  has  to  come  in  contact. 
This  part  is  well  oiled,  and  being  passed  through  the  vagina,  is  so  placed 
against  the  uterus  that  the  cervix  will  be  in  the  middle  of  the  ring,  which 
should  make  pressure  on  the  cul  de  sac  of  the  vagina.  It  is  secured  by 
means  of  cords  or  straps  at  the  end  of  the  transverse  portion,  in  a  simi- 
lar manner  to  the  other  pessary. 

The   Cup-and-ball  pessary  (Fig.  198),  invented,   or  first  described  by 


Fig.  197. 
Ring  Pessary. 


Fig. 
Cup-and-Ball  Pessary. 


Chabert,  is  not  at  all  unlike  the  last.  It  is  composed  of  a  round  iron  or 
steel  ring  (A  A),  about  the  same  in  diameter  as  the  other ;  from  this 
springs  three  stalks  (B  B  B)  which  unite  about  six  or  seven  inches  from 
the  ring  into  a  single  stalk  (T  T),  which  is  screwed  from  a  little  beyond 
this  union  to  the  end.  On  this  screwed  portion  moves  a  transverse  piece 
(C  C),  by  its  middle  opening,  or  female  screw  (E)  ;  this  piece  has  open- 
ings (G  G)  at  its  extremities,  which  receive  straps  or  cords. 

To  use  it,  the  ring  and  the  three  branches  are  dipped  in  melted  wax, 
then  cooled,  and  again  and  again  dipped  and  cooled,  until  the  instrument 
has  acquired  a  sufficient  volume,  and  the  middle  of  the  ring  is  reduced  to 


INVERSION  OF  THE  UTERUS. 


595 


about  one  and  a  half  inch.  This  prevents  its  injuring  the  genital  organs, 
when  it  is  applied  exactly  in  the  same  manner  as  the  preceding  pessary 
— thecervix  uteri  being  in  the  centre  of  the  ring. 

A  rondelle  pessary  has  been  devised  by  Leblanc,  and  Rainard  has  in- 
vented a  pessary  (similar  to  Fig.  197)  for  small  animals. 

A  bottle  pessary  has  frequently  done  good  service,  when  nothing  more 
suitable  has  been  at  hand.  An  ordinary  glass  bottle,  with  a  deep  con- 
cave and  smooth  bottom,  has  a  long  piece  of  wood  fixed  in  the  neck, 
and  can  thus  be  made  to  act  like  the  other  pessaries  ;  though  its  weight 
is  objectionable,  and  there  is  also  the  danger  of  its  breaking. 

A  very  ancient  pessary — employed  even  by  the  Greeks  of  an  early 
period — and  one  which  has  been  most  usefully  resorted  to  by  Tolney, 
Laubender,  Willburg,  and  others,  is  the  bladder  of  the  pig  or  ox.  When 
required  for  use,  the  bladder  is  steeped  in  warm  water,  then  a  long 
wooden  tube,  or  a  piece  of  india-rubber  tubing,  is  fastened  to  the  neck  of 
it ;  the  bladder  is  introduced  into  the  uterus  and  inflated,  the  tube  being 
then  closed. 

Rainard  recommends  that  it  be  only  placed  in  the  vagina  ;  but  the 
majority  of  obstetrists  prefer  it  in  the  uterus.  It  has  been  allowed  to 
remain  there  as  long  as  ten  and  fourteen  days. 

For  valuable  animals,  it  has  been  suggested  that  Gariel's  air  pessary 
might  be  employed.  This  acts  on  the  same  principle  as  the  bladder ;  in 
fact,  it  is  an  india-rubber  bladder,  which  is  inflated  by  means  of  a  long 
tube  with  a  stop-cock.  This  tube  may  be  in  connection  with  another  bag 
and  stop-cock,  the  former  being  already  filled  with  air,  which  can  be 
transferred  to  the  other  bag  when  it  is  placed  in  the  vagina  or  uterus. 

The  smaller  animals  rarely  require  pessaries  of  this  description  ;  though 
there  is  no  reason  why,  if  necessary,  modifications  of  the  three  first,  and 
on  a  proportionately  small  scale,  might  not  be  employed.  The  ring 
might  be  made  of  india-rubber,  or  cork.  For  the  Bitch,  more  particularly, 
the  cuvette  pessary,  however,  has  been  recommended  and  used.  This  is 
an  imitation  of  that  employed  for  woman,  and  is  merely  an  oval,  circular, 
or  oblong  piece,  made  of  gum,  india-rubber,  gutta-percha,  or  ivory,  one 
to  two  inches  in  diameter,  and  having  a  hole  in  the  middle.  When 
required  to  be  introduced,  this  pessary  is  well  oiled  ;  the  narrow  end  is 
passed  edgeways  into  the  vulva,  and  the  piece  is  pushed  in  beyond  the 
bulb  of  the  vagina.  Then,  by  means  of  the  index  finger,  it  is  placed  ver- 
tically :  the  hole  in  the  middle  allowing  the  finger  to  fix  it  in  the  centre 
of  the  ^allva,  its  two  fends  being  retained  by  the  branches  of  the  ilium,  or 
at  least  in  front  of  the  ischium  and  the  bulb. 

A  spring,  or  elastic  pessary,  such  as  is  now  frequently  employed  for 
woman,  and  which  can  be  more  easily  introduced  into  the  vagina,  might 
be  useful  with  the  smaller  domesticated  animals. 

Salt,  of  Birmingham,  has  introduced  into  human  gynecology  a  new 
flexible  annular  pessar\',  which  might  be  advantageously  employed  by  the 
veterinarian  for  the  smaller  animals.  It  consists  of  a  watch-spring  coiled 
spirally,  with  the  extremities  left  free,  and  encased  in  caoutchouc  ;  it  col- 
lapses for  introduction,  and  when  in  situ,  it  expands  to  the  circular  form, 
or  such  other  shape  as  may  best  accommodate  its  contact  with  surround- 
ing parts. 

The  value  of  pessaries  in  inversion  of  the  uterus  in  animals  has 
been  a  good  deal  discussed.  We  are  not  aware  that  they  have  been 
much,  if  at  all,  employed  in  England  j    and  in   Germany  they  do  not 


596  ACCIDENTS  INCIDENTAL  TO  PARTURITION. 

appear  to  have  obtained  much  favor  ;  while  in  France,  though  they  have 
often  been  resorted  to,  yet  their  use  has  been  only  limited,  as  their  prac- 
tical utility  has  been  questioned  by  many  excellent  obstetrists. 

It  has  been  pointed  out  that  if  they  can  be  supported  without  incon- 
venience by  some  phlegmatic  unimpressionable  animals,  more  frequently 
they  irritate  the  organs  in  the  pelvis,  cause  straining  and  uneasiness,  and 
produce  those  relapses  which  their  application  was  intended  to  prevent. 
Therefore  it  is  that,  nowadays,  they  are  not  made  available  to  any  thing 
like  the  extent  of  a  few  years  ago. 

Saint-Cyr  admits  that  if,  in  some  exceptionable  case,  it  is  necessary  to 
employ  a  pessary,  the/z^V  bladder  deserves  the  preference  for  the  larger 
animals.  It  is  found  nearly  everywhere,  requires  no  other  preparation 
than  merely  softening  its  texture  by  pouring  some  tepid  water  into  it, 
whilst  its  outer  surface  is  well  oiled.  It  is  easily  placed  where  desired, 
even  in  the  uterus  ;  its  soft,  flexible  walls  cannot  bruise  or  excoriate ; 
and,  by  inflation,  it  can  be  distended  to  the  size  necessary  for  each  par- 
ticular case. 

Sutures. — The  suture  is  generally  preferred  to  the  pessary,  as  being 
simpler,  more  easily  applied,  and  having  fewer  inconveniences  than  the 
latter.  Being  inserted  outside  the  genital  organs,  they  do  not  irritate 
those  which  are  most  concerned  in  inversion,  neither  do  they  provoke  ex- 
pulsive efforts  on  the  part  of  the  animal. 

The  sutures  may  be  of  hemp  or  silk,  or  metal  ;  and  they  may  be 
passed  directly  through  the  lips  of  the  vulva,  or  include  the  skin  towards 
the  point  of  the  hip,  on  each  side.  The  first  may  be  named  the  labial 
suture.,  the  second  the  hip  suture. 

The  labial  suture  may  be  "  interrupted,"  or  "  quilled,"  and  is  made  ac- 
cording to  the  principles  of  surgery.  A  saddler's  large  needle,  or  a  sack- 
ing-needle with  a  handle  at  one  end  and  an  eye  near  the  point,  is  the 
most  useful.  Through  the  eye  is  passed  a  piece  of  whipcord,  two  or 
three  strands  of  well-waxed  thread,  or  a  piece  of  cotton  or  silk  tape,  or 
moderately  thick  carbolized  catgut.  The  needle  is  passed  through  one 
lip  of  the  vulva — say  the  right — from  the  outside,  and  near  the  upper 
commissure ;  it  is  then  passed  through  the  left  lip,  from  within  to  with- 
out, towards  the  inferior  commissure. 

The  needle  is  then  cut  from  the  suture,  sufficient  of  the  latter  being 
left  for  both  ends  to  tie  in  the  middle  of  the  vulva.  A  second  suture  is 
then  placed  in  the  contrary  direction — upper  part  of  left  to  lower  part  of 
right  lip — so  that  the  two  sutures  cross  each  other  obliquely,  in  an  X 
fashion.  The  ends  are  now  tied  towards  the  centre  of  the  vagina ;  and, 
if  thought  necessary,  a  third  suture,  directly  transverse,  may  be  placed 
between  these. 

It  is  more  convenient  than  painless  to  pass  the  needle  first  through  the 
tissues,  then  the  suture  through  the  eye  of  the  needle,  withdrawing  the 
latter,  which  carries  the  suture  with  it. 

This  labial  ^\x\MX%  is  painful,  as  it  is  placed  in  textures  already  swollen 
and  sore,  and  it  does  not  always  retain  a  sufficiently  solid  hold  to  pre- 
vent the  uterus  tearing  it  out  when  the  straining  is  very  severe  and  vio- 
lent. The  hip  suture  has  therefore  often  been  resorted  to  in  these  cases, 
and  with  advantage.  The  needle — either  the  above,  or  a  small  seton 
needle — is  passed  through  a  fold  of  skin  lifted  up  at  the  point  of  the  hip 
or  ischium,  on  a  level  with  the  upper  commissure  of  the  vulva,  and  carried 
across  to  the  other  hip.     The  next  suture  is  a  trifle  lower,  and  the  others 


INVERSION  OF  THE  UTERUS. 


597 


below  this  :  there  being,  in  all,  about  four  to  six  sutures,  the  ends  of 
each  being  tied  in  the  middle,  or  fastened  to  bits  of  round  wood  at  each 
side.  In  this  way,  the  vulva  lies  behind  a  number  of  strong  cords — 
their  strength  and  durability  being  in  proportion  to  the  width  of  skin 
they  are  made  to  enclose.  .  The  sutures  may  be  drawn  more  or  less 
tightly,  and  they  may  either  be  transversely  parallel,  or  cross  each  other 
obliquely. 

When  the  animal  is  not  pregnant,  the  vulva  is  not  nearly  on  a  level 
with  the  ischial  tuberosities.  After  parturition,  however,  the  vulva  is 
swollen  and  prominent,  and  stands  beyond  these  parts.  It  will  therefore 
press  against  the  hip  sutures,  and  may  even  become  excoriated  or  cut  by 
them  ;  so  that,  to  avoid  injury,  and  diffuse  the  pressure,  it  is  well  to 
place  a  thick  pledget  of  tow,  or  other  soft  material,  on  each  side  of  the 
vulva,  on  which  the  sutures  may  chiefly  rest. 

Though  good  service  has  been  obtained  from  these  sutures,  in  a  num- 
ber of  instances,  yet  many  practitioners  prefer  the  metallic  suture.  This 
may  be  of  lead,  or  iron  wire  softened.  The  needle  is  like  that  used  for 
the  other  sutures  ;  a  pair  of  wire-pliers  is  necessary,  and  two  sizes  of  wire 
are  recommended.     The  thickest  size  is  cut  into  pieces   of  a  convenient 


Fig.  199. 
Zundel's  Labial  Sutures. 


length,  and  an  eyelet  turned  at  one  end,  while  the  other  is  made  into  a 
hook.  The  left  lip  of  the  vulva  is  seized  by  the  left  hand,  and  the  needle 
pushed  through  it  from  the  outside,  a  little  obliquely  upwards,  so  as  to 
bring  it  out  above  the  superior  commissure  ;  the  wire  is  passed  into  the  e3'e 
at  the  point,  and  the  needle  being  smartly  withdrawn,  the  wire  is  pulled 
through.  The  needle  is  introduced  into  the  right  lip  in  the  same  man- 
ner but  downwards,  and  the  wire  pulled  through  it.  The  hooked  end  is 
now  passed  into  the  one  with  the  eyelet,  drawn  sufficiently  through,  cut  off, 
and  the  end  bent  also  into  an  eyelet,  the  suture  constituting  an  ellipse 
at  this  part,  which  is  opposite  the  vulvar  opening.  Beneath  this  suture, 
one  or  two  more  are  placed,  and  all  are  joined  together  by  the  thinner 
wire,  which,  doubled,  is  longer  than  the  space  occupied  by  the  sutures  ; 
each  piece  is  passed  into  each  eyelet  of  the  upper  suture,  and  firmly 
crossed  and  twisted  as  far  as  the  two  points  of  the  suture  ;  the  same  is 
done  with  the  second  and  the  third  suture — the  whole  being  joined  into 
a  solid  piece,  which,  according  to  report,  does  not  interfere  with  the 
phvsiological  functions  of  the  animal. 

The  same  objection  applies  to  w4re  sutures  through  the  vulva,  as  to 
vegetable  sutures  ;  and  there  can  be  no  doubt  that  they  are  less  painful 


598  ACCIDENTS  INCIDENTAL  TO  PARTURITION 

and  more  effective  when  passed  through  the  skin  at  the  point  of  the  hip. 
Two  wires  across  are  generally  sufficient ;  the  ends  are  bent  round  by 
pliers  after  they  are  inserted,  and  through  these  eyelets  on  each  side  a 
vertical  wire  is  passed  (Fig.  199).  This  keeps  the  horizontal  wires 
together,  and  in  place. 

Other  metallic  sutures,  in  the  form  of  pins,  screwed  at  one  end  to  fix 
into  plates  after  being  pissed  through  the  labia  of  the  vulva,  and  other 
contrivances  of  this  description,  have  been  described ;  but  in  principle 
they  are  all  the  same,  and  there  is  no  manifest  advantage  in  their 
employment. 

In  fact,  it  may  be  said  of  all  the  labial  or  other  sutures,  that  they  in  no 
respect  prevent  the  inversion  of  the  organ  internally,  but  merely  prevent 
its  escaping  beyond  the  vulva ;  and,  as  their  integrity  depends  not  only 
upon  the  material  of  which  they  are  composed,  but  also  upon  the  integ- 
rity, or  power  of  resistance  of  the  textures  through  which   they  pass, 


Fig.  200. 
The  Loop  of  Delwart's  Truss. 

it  often  happens  that  they  either  give  way  themselves,  or  they  "  tear  out " 
prematurely,  leaving  oftentimes  troublesome  wounds  or  cicatrices. 

It  must  not  be  forgotten,  too,  that  even  under  the  most  favorable  cir- 
cumstances, these  sutures,  both  during  their  insertion  and  their  main- 
tenance, are  a  source  of  uneasiness  and  pain  to  the  animal. 

Bandages^  or  Trusses. — To  dispense  with  the  inconveniences  of  the 
pessary  and  suture,  the  bandage  or  truss  has  been  proposed,  and  exten- 
sively employed  ;  and  we  must  confess  that,  in  the  great  majority  of 
cases  of  uterine  inversion,  it  should  be  adopted  in  preference  to  the 
other  methods  of  retention. 

The  truss  or  bandage  may  be  composed  of  cords,  surcingles,  leather, 
canvas,  etc.,  which  are  so  arranged  and  disposed  as  to  make  pressure 


jy  VERSION  OF  THE  UTERUS. 


599 


I 


upon  the  sides  of  the  vulva,  and,  by  keeping  it  closed,  prevent  the  extru- 
sion of  the  uterus,  without  interfering  with  defecation  or  micturition. 

There  are  several  kinds  of  truss  in  use,  and  these  vary  somewhat  in 
their  details,  though  in  principle  they  are  the  same.  Some  of  them  are 
fixed  around  the  shoulders  and  neck^  others  round  the  chest  only,  and 
others  again  round  both  regions-^most  frequently  to  a  collar,  or  sur- 
cingle.    We  will  allude  to  those  which  are  recognized  as  most  useful. 

Two  of  the  most  useful  and  readily-made  trusses  are  composed  of  light 
rope  or  thick  cord — something  like  a  clothes-line.  One  of  these  is 
termed  ""  Delwart's  Truss,"  and  is  formed  by  cords  united  by  a  loop 
in  their  middle,  in  such  a  manner  that  an  oval  space  {a.  Fig.  200)  suffi- 
cient  to  admit   the   vulva,   and  compress   it   laterally,  is  formed — the 


Fig.  201. 
Delwart's  Tkuss  Api'Lied. 

inferior  commissure  being  left  free,  to  allow  the  escape  of  urine,  and 
uterine  discharges,  should  there  be  any.  The  two  portions  of  one  of  the 
cords  {b  b,  Fig.  200)  passing  over  the  back,  are  secured  to  a  collar  or 
band  round  the  neck  or  chest ;  while  those  of  the  other  cord  {c  c)  pass 
between  the  thighs,  and  are  tied  to  the  lower  part  of  the  collar  or  sur- 
cingle, in  the  manner  depicted  in  Fig.  201.  The  loop  may  be  wrapped  in 
tow  or  cloth,  to  prevent  chafing  to  the  parts  under  the  tail. 

Another  rope  truss,  described  by  Renault  in  the  Maison  Rustique  du 
XIX  Siede  (vol.  ii.,  p.  286),  is  perhaps  more  simple,  and  yet  quite  as,  if 
not  more,  effective  as  the  preceding.  This  is  composed  of  a  leather 
strap  which  buckles  round  the  neck,  and  a  rope  from  twenty-four  to 
thirty  feet  long,  and  the  thickness  of  the  little  finger,  or  a  trifle  less, 
according  to  the  size  of  the  animal.  The  neck-strap  is  not  indispensable, 
though  it  is  useful  in  giving  more  firmness  to  the  truss ;  it  may  be 
replaced  by  a  thicker  rope,  or,  in  the  case  of  the  Mare,  by  an  ordinary 
draught  collar. 


6oo 


ACCIDENTS  INCIDENTAL   TO  PARTURITION. 


In  order  to  apply  the  bandage,  the  neck-strap  or  collar  is  first  to  be 
put  on  j  the  cord  is  then  to  be  doubled  in  equal  parts,  and  put  across  the 
back,  behind  the  withers,  so  that  each  portion  may  fall  behind  the 
shoulders,  to  be  passed  under  the  chest.  In  front  of  the  chest,  the  two 
portions  are  crossed,  the  left  passing  to  the  right,  and  the  right  to  the 
left.  Each  side  is  carried  through  the  collar,  and  back,  over  the  front  of 
the  shoulder,  at  the  top  of  which  both  are  tied  in  a  simple  knot,  so  as  to 
be  easily  untied  when  required.  At  ten  or  twelve  inches  from  this,  a 
firmer  knot  is  tied,  then  several  others  beyond  it  towards  the  loins — 
according  to  the  length  of  the  animal — and  at  neady  equal  distances,  as 
far  as  the  root  of  the  tail,  where  a  simple  knot  is  tied.  The  branches  of 
the  cord  then  separate  on  each  side  of  the  vulva,  and  unite  again  by  a 
simple  knot  below  the  inferior  commissure  ;  again  separating,  each  cord 
is  carried  between  the  hind  legs,  brought  up  by  the  flank  towards  the 


Fig.  202. 
Renault's  Truss. 


loins  on  each  side,  and  tied  over  the  back  to  one  of  the  loops  there,  as 
shown  in  figure  202.  This  truss  can  be  made  as  easy  or  tight  as  may  be 
necessar}^,  and  its  simplicity  is  its  great  recommendation. 

Horsburgh  [Veteritmriayi,  vol.  xiv.  p.  490),  describes  a  similar  truss,  which  he  applied 
to  a  Mare  that  had  inverted  the  uterus  three  days  after  foaling.  Giving  the  animal  some 
extract  of  hyoscymus  and  gum  opii,  dissolved  in  a  pint  of  warm  water,  to  allay  the 
straining,  as  soon  as  this  dose  began  to  operate  he  reduced  the  organ.  This  was  done 
by  securing  the  animal,  sponging  over  the  uterus  with  a  little  vinegar  and  water,  and 
"taking  hold  of  a  clean  towel  in  the  left  hand,  doubled,  and  the  corners  of  the  towel 
falling  back  on  the  arm — made  bare  for  the  purpose.  I  then  applied  the  doubled  fist  to 
the  fundus  of  the  uterus,  with  the  assistance  of  the  right  hand  in  bearing  it  up  by  a 
moderate  degree  of  force,  and  returned  it  to  its  place,  slowly  withdrawing  the  hand,  and 
leaving  the  towel  for  a  few  minutes.  I  next  proceeded  to  remove  the  towel,  by  intro- 
ducing the  hand,  greased  for  the  purpose,  into  the  vagina,  taking  it  by  the  corners, 
turning  it  several  times  round,  and  at  the  same  time  bringing  it  out  slowly.  After  which, 
I  introduced  the  arm  to  the  full  length,  in  order  to  ascertain  whether  it  was  in  its  proper 


INVERSION  OF  THE  UTERUS. 


6oi 


position,  using  a  little  force  on  the  further  end,  in  order  to  stretch  it.  I  then  withdrew 
the  arm,  and  proceeded  to  apply  the  necessary  bandages.  First,  a  strong  girt,  or  sur- 
cingle was  buckled  tightly  round  the  abdomen,  to  prevent  the  muscles  acting  with  such 
force  as  again  to  expel  the  uterus.  This  is  essentially  necessary.  I  then  took  a  small 
rope,  or  narrow  web  (the  one  used  on  this  occasion  was  a  cavesson  for  breaking  horses 
in  the  menage),  forming  an  eye  (loop)  in  the  middle,  to  be  passed  over  the  neck,  as  if  for 
casting.  I  then  passed  the  ends  between  the  fore-legs  and  along  the  belly — one  on  each 
side  of  the  udder,  up  between  the  hind  legs — tying  a  single  knot  exactly  at  the  inferior 
part  of  the  vulva.  Another  was  placed  superior  to  the  anus,  carrying  the  ends  up  on 
each  side  the  tail,  fixing  them  securely  and  tightly  to  the  loop  round  the  neck,  and  on 
each  side  of  the  withers."  This  truss  was  a  perfect  success,  and  could  be  dispensed 
with  in  three  days.     Horsburgh  condemns  sutures  passed  through  the  labia  pudendi. 

A  very  efficient  and  suitable  truss  is  that  made  of  a  piece  of  stout 
leatlier,  with  a  round  opening  in  it  above,  corresponding  to  the  anus,  and 
an  oblong  opening  beneath  this,  through  which  the  vulva  passes.     The 


Fig.  203. 
Leather  Truss. 


leather  is  so  shaped  as  to  embrace  and  lie  close  to  the  root  of  the  tail  and 
between  the  buttocks,  extending  for  some  distance  below  the  \»ulva,  as  in 
figure  203.  It  is  maintained  in  position  by  four  strong  leather  straps — 
two  above  and  two  below — which  pass  on  each  side  to  a  surcingle  around 
the  chest,  which  may  again  be  attached  to  a  collar  or  breast-strap,  should 
the  straining  be  violent. 

Anoiher  kind  of  truss  is  formed  by  an  ordinary  crupper  attached  to  a 
surcingle,  and,  if  need  be,  this  to  a  breast-strap  or  collar.  From  the  part 
of  the  crupper  under  the  tail  proceeds  two,  three,  or  four  narrow  leather 
straps,  which,  passing  over  the  vulva,  are  attached  to  the  loop  of  a 
doubled  rope  in  the  perinaeum,  each  portion  of  the  rope  being  passed 
between  the  hind-legs  and  tied  to  the  lower  part  of  the  surcingle.  Or  a 
cord  may  be  attached  to  the  crupper  at  each  side  of  the  vulva,  and 
carried  forward  between  the  hind-legs  and  underneath  the  belly  in  the 
same  manner,  two  or  three  transverse  narrow  straps  passing  between  the 
two,  immediately  over  the  vulvar  opening. 

When  there  is  much  swelling,  a  soft  cloth  doubled  several  times,  or  a 
sponge  steeped  in  cold  water,  may  be  placed  over  the  vulva  beneath  the 
straps,  though  in  such  a  way  as  not  to  interfere  with  micturition  or 
defecation. 


6o2  ACCIDENTS  INCIDENTAL  TO  PARTURITION 

Various  other  trusses  for  the  Mare  or  Cow  have  been  proposed  by 
veterinary  obstetrists,  but  in  principle  they  are  all  the  same.  We  need 
only  notice  one  of  these,  which  has  been  proposed  by  Lund,  a  Danish 
veterinary  surgeon,  and  which  has  been  greatly  lauded  by  Dieterichs  and 
others  for  its  cheapness,  simplicity,  and  efficiency.  The  chief  part  of  it 
is  a  narrow  piece  of  iron,  nine  millimetres  thick  (about  one-third  to  three- 
eighths  of  an  inch),  welded  at  its  extremities,  and  turned  into  a  triangular 
shape  that  enables  it  to  include  the  vulva,  while  the  loops  at  its  three 
corners  allow  it  to  receive  cords  (fig.  204).  The  base  of  the  triangle, 
which  fits  under  the  tail,  is  about  two  to  two  and  a  half  inches  wide,  and 
the  sides  from  five  to  seven  inches  long.  The  loopholes  at  the  angles 
may  be  replaced  by  small  hooks  to  receive  the  cords. 


Fig.  204. 
Lund's  Truss  Iron. 

This  metal  plate,  which  may  be  round  iron,  and  convex  on  one  side, 
concave  oti  the  other,  fits  over  the  vulva  and  the  base  to  the  tail,  the 
apex  being  below  the  lower  commissure,  while  the  convex  side  is  towards 
the  animal.  Cords  pass  through  the  loops  or  around  the  hooks,  one 
above,  another  below — as  in  figure  205 — and  are  fastened  to  a  surcingle 
or  collar,  or  both,  like  the  preceding  trusses.  Any  blacksmith  can  make 
the  plate  in  a  few  minutes  ;  and  from  what  has  been  said  in  praise  of  this 
cheap  and  simple  method  of  retaining  the  uterus,  there  can  be  no  doubt 
that  it  will  be  found  most  useful. 

All  these  trusses  are  intended  for  the  larger  animals,  and  cannot  well 
be  applied  to  the  smaller  creatures,  with  the  exception  perhaps  of  Lund's 
plate,  which,  much  diminished  in  size  and  made  of  a  piece  of  strong  iron 
wire,  might  be  serviceable  for  the  Ewe,  Sow,  Goat,  or  large  Bitch.  For 
these  smaller  animals  Rainard  recommends  a  triangular  bandage,  made 
by  folding  a  piece  of  strong  cloth  in  a  triangular  manner.  The  base  of 
this  triangle  lies  over  the  loins,  is  carried  down  by  the  flanks  to  beneath 
the  abdomen,  where  the  corners  are  tied  together;  while  the  point  of  the 
triangle  is  passed  over  the  croup  and,  vulva — a  hole  being  made  for  the 
tail  to  pass  through,  and  another  for  the  anus,  brought  between  the  hind- 


INVERSION  OF  THE  UTERUS. 


603 


legs,  and  either  by  means  of' tapes  attached  to  it,  or,  if  sufficiently  long, 
by  splitting  up  the  end  to  a  short  distance  so  as  to  make  two  strips  of  it, 
and  fastening  the  piece  to  the  ends  already  tied  beneath  the  belly. 

It  must  be  acknowledged  that  these  trusses,  no  matter  how  skilfully 
they  may  be  contrived  or  however  well  they  may  be  adjusted,  will  not  hin- 
der vaginal  inversion  of  the  uterus  ;  all  they  can  do  is  to  prevent  the 
organ  from  being  suddenly  protruded  beyond  the  vulva  again,  and  so  ex- 
posed to  the  air  and  the  irritating  effects  of  extraneous  matters  bef(fre  it 
could  be  returned  once  more.  This  alone,  however,  is  an  important  ob- 
ject achieved,  and  is  a  great  step  towards  permanent  retention.  Be- 
sides, by  maintaining  the  labia  of  the  vulva  in  close  apposition,  the  truss, 
if  well  applied,  prevents  the  admission  of  air  into  the  genital  canal  ;  and 
thus  does  away  with  one  source  of  irritation.  And  as  the  apparatus  does 
not  cause  any  pain  or  inconvenience  to  the  animal,  it  is  for  these  reasons 
to  be  preferred  to  any  other  means  for  maintaining  the  reposition  of  the 
uterus. 


Fig.  205. 

Lund's  Truss  Applied. 

With  regard  to  the  best  kind  of  bandage,  this  is  of  secondary  impor- 
tance to  its  proper  application.  •  Simplicity  and  efficiency  are  the  desider- 
ata, and  these  will  be  found,  we  believe,  in  the  trusses  we  have  described, 
and  particularly  in  those  of  Renault  and  Lund. 

If  reposition  of  the  uterus  is  properly  effected,  and  the  truss  well  ap- 
plied, there  is  but  little  reason  to  apprehend  a  recurrence  of  the  accident. 

After-Treatment. 

When  the  uterus  has  been  returned  to  its  natural  situation,  an  antisep- 
tic injection  or  ''swabbing"  of  the  interior  accomplished  if  deemed  ne- 
cessary, and  precautions  against  a  recurrence  of  the  inversion  adopted, 
little  more  remains  to  be  done  except  to  observe  some  simple  directions, 
which  are  to  be  followed  out  for  a  few  days  after  reposition. 


6o4  ACCIDENTS  INCIDENTAL  TO  PARTURITION 

If  the  weather  is  favorable,  and  little  or  no  fever  present,  Saint-Cyr 
recommends  that  the  animal — covered  with  a  rug — should  be  walked 
about  for  a  few  minutes  ;  as  this  takes  away  its  attention  from  the  acci- 
dent, regulates  the  general  circulation,  and  allays  the  expulsive  efforts. 
If,  however,  there  is  fever,  with  the  pulse  quick,  full  and  hard,  and  the 
animal  is  strong,  he  advises  the  abstraction  of  blood. 

In  any  case,  the  animal  should  stand  with  the  hind  parts  well  raised, 
and  It  ought  not  to  be  allowed  to  lie  down  for  a  day  or  so. 

Great  attention  should  be  paid  to  the  diet,  particularly  in  ruminants, 
from  the  tendency  to  tympanitis  and  constipation.  Indeed,  tympanitis 
may  be  sometimes  considered  a  cause  of  inversion  in  the  Cow  and  Ewe  ; 
and  the  rumen  is  at  times  so  distended  with  gases,  and  accordingly 
proves  such  an  obstacle  to  reduction,  that  it  has  to  be  punctured  in  the 
usual  way  before  reposition  can  be  effected.  For  the  same  reason,  this 
inflation  of  the  digestive  organs  has  to  be  guarded  against  in  the  after- 
treatment.  For  the  first  day  only  oatmeal  gruel,  with  barley-water — both 
tepid — should  be  allowed  in  small  but  frequent  quantities.  Subsequently 
for  some  days,  easily-digested  sloppy  food  may  be  given,  and  if  the  appe- 
tite is  fickle  it  should  be  tempted  by  choice  portions  of  diet ;  though  the 
quantity  must  not  be  large  at  any  time  until  all  danger  is  past. 

Should  there  be  a  tendency  to  constipation,  soap-and-water  enemas 
may  be  administered. 

Micturition  is  rarely  deranged  ;  but  if  no  urine  is  passed  within  twenty- 
four  hours  after  reposition,  an  examination  should  be  made,  and  the 
bladder  emptied  in  the  usual  manner.  The  different  disposition  of  the 
urethral  valve  in  the  Mare  and  Cow  will,  of  course,  be  borne  in  mind  in 
passing  the  catheter. 

Nearly  always  these  simple  measures  suffice  to  restore  the  animal  to 
its  usual  condition  in  three  or  four  days,  in  uncomplicated  cases.  In  ex- 
ceptional cases,  however,  we  may  have  metritis  or  metroperitonitis,  or 
leucorrhoea  follow  the  accident.  The  animal  may  go  off  its  milk  and 
fall  into  low  condition,  without  exhibiting  any  acute  symptoms  ;  or  indi- 
cations of  puerperal  fever  may  supervene.  Sometimes  the  animal  re- 
mains sterile  for  a  variable  period.  With  the  Ewe,  chronic  inversion  of 
the  uterus  often  leads  to  loss  of  the  wool. 

In  complicated  cases  we  may  have  wounds,  lacerations,  rupture  of  the 
uterus,  cornua,  or  vagina,  lesions  of  neighboring  organs  or  textures,  etc.  ; 
these  we  will  refer  to  hereafter. 

A  curious  complication  of  uterine  inversion  has  been  mentioned  by 
Ayrault  {Recueil  de  Med.  Vet'erinaire,  1857,  p.  723),  who  has  witnessed  it 
in  three  cases.  This  consisted  in  great  lameness  in  the  limbs,  without 
swelling  of  the  joints,  but  with  marked  knuckling  over  in  the  hind-pasterns. 
This  complication  disappeared  spontaneously  as  the  patients  recovered 
from  the  other  effects  of  the  inversion. 

Amputation  of  the  Uterus — Metrotomy. 

Though  it  should  be  recognized  as  a  rule,  that,  provided  there  is  no 
serious  complication  and  the  obstetrist  is  called  in  good  time,  with  pa- 
tience and  skill  reposition  of  the  inverted  uterus  is  possible,  yet  cases 
will  occur  in  which  the  operator  is  baffled  in  his  attempts  at  reduction,  or 
when,  at  the  first  glance  or  after  an  examination,  he  has  to  recognize  this 
as  impossible  or  useless.    "  Since  I  have  been  in  practice,"  says  Schaack, 


INVERSION  OF  THE  UTERUS.  605 

"  I  have  been  often  called  upon  to  remedy  this  kind  of  displacement,  and 
from  what  I  have  seen  I  am  led  to  believe  that  the  impossibility  of  reduc- 
tion is  not  so  much  due  to  the  difficulties  in  the  cases  themselves,  as  to 
the  hurtful  manoeuvres  which  have  been  performed.  Nevertheless,  it 
must  be  acknowledged  that  the  development  of  the  hernia  and  the  rigid- 
ity of  the  tissues  are  sometimes  so  great  that  it  requires  a  certain  amount 
of  confidence  in  one's  self  neither  to  be  disconcerted  nor  afraid.  -  .  To 
be  successful  it  is  necessary  to  insist — to  insist  in  spite  of  every  thing — 
on  applying  one's  self  to  seize  each  alternative  point  of  relaxation  ;  to 
engage,  bit  by  bit,  the  displaced  organ  in  the  vulva,  in  commencing  with 
that  which  is  nearest  this  opening,  then  successively  all  the  remainder." 

This  advice  is  judicious  and  sound  ;  but,  as  we  have  said,  in  certain 
cases  the  extruded  organ  is  so  injured,  either  by  the  unskilful  attempts 
of  ignorant  men  to  return  it,  or  from  other  causes,  that  it  would  be  cer- 
tain death  to  the  animal  to  replace  it  in  the  abdomen.  We  refer  now  to 
extensive  lacerations  and  bruises,  or  when  the  organ  has  become  softened 
and  gangrenous.  Lacerations  and  ruptures  are  always  more  serious,  it 
must  be  remembered,  in  the  lower  than  the  upper  wall  of  the  uterus. 

In  other  cases,  when  reduction  has  not  been  complete,  and  one  horn 
remains  more  or  less  invaginated,  or  the  body  of  the  d^'gan  is  not  well 
adjusted,  inversion  will  again  and  again  occur  in  spite  of  all  attempts  at 
retention  ;  and  this  only  too  frequently  leads  to  such  grave  injury,  that 
there  is  no  hope  of  the  organ  regaining  its  normal  condition,  even  should 
reposition  be  at  last  successful.  Indeed,  its  walls  are  so  softened  and 
friable  that  they  cannot  withstand  the  least  pressure,  but  tear  whenever 
an  attempt  is  made  to  carry  the  uterus  into  the  vulva. 

With  certain  animals,  too— as  Swine — reposition  is  extremely  difficult, 
particularly  when  one  or  both  cornua  are  inverted  ;  as  the  smallness  of 
the  organ,  as  well  as  of  the  pelvis,  is  a  great  obstacle  to  manipulation. 

In  such  exceptional  circumstances  complete  extirpation  of  the  uterus 
(^Metrotomy)  has  been  recommended  and  practised. 

It  is  now  many  years  since  the  operation  was  introduced  into  veterinary 
surgery,  as  Binz  states  that  it  was  performed  by  Jenne,  a  German  veter- 
inarian in  Forchheim,  so  long  ago  as  1802. 

Though  the  operation  is  apparently  a  most  formidable  and  painful  one, 
and  only  to  be  ventured  upon  as  a  last  resource,  yet,  on  the  whole,  it  is 
tolerably  successful.  Of  twenty-five  cases  collected  by  Saint-Cyr,  no 
fewer  than  nineteen  recovered  from  the  operation.  Franck  refers  to 
thirty  cases,  eighteen  of  which  recovered,  and  four  (two  Cows  and  two 
Goats)  were  killed,  though  not,  it  would  appear,  on  account  of  the  opera- 
tion. Of  these  thirty  cases  only  one  was  a  Mare  ;  17  were  Cows  ;  3  Goats  ; 
4  Sows ;  I  Ewe  ;  2  Bitches  ;  and  2  Cats.  He  remarks  that  of  the  unfor- 
tunate cases,  there  were  probably  some  which  died  from  other  causes 
than  the  amputation  ;  while  some  evidently  perished  from  septic  infec- 
tion. We  know  that  recoveries  have  taken  place  after  the  C^esarean  sec- 
tion and  excision  of  the  uterus  in  the  same  animal,  at  the  same  time. 

The  operation  might  be  more  successful  did  it  not  happen  that  it  is 
late  before  it  is  resorted  to,  and  very  often  the  animal  is  already  greatly 
exhausted. 

It  is  curious  to  note  that  it  has  been  recorded  by  several  observers,  that 
some  Cows  which  recovered  have  shown  signs  of  oestrum — doubtless  be- 
cause the  ovaries  were  left  intact  ;  while  other  Cows  have  yielded  milk 
after  the  operation.     Lecoq  informed  Saint-Cyr  that  he  knew  of  a  Cow 


.6o6  ACCIDENTS  INCIDENTAL  TO  PARTURITION. 

from  which  the  uterus  had  been  remov'ed,  and  which  gave  an  abundance 
of  milk  for  two  years  afterwards. 

Operation. — Various  modes  of  operating  have  been  practised  and  recom- 
mended. With  the  larger  animals,  the  hind-limbs  should  be  secured — 
especially  with  the  Mare — or  the  animals  may  be  thrown  down,  or  fixed  in 
a  travis  if  there  is  one  convenient. 

Chloroform,  chloral,  or  morphia  may  be  administered  to  the  animals 
about  to  be  operated  upon.  It  is  also  a  good  plan  to  tie  the  uterus  up  in 
a  large  cloth,  so  that  it  may  be  easier  moved  about  by  the  operator  or  his 
assistants,  and  render  the  operation  cleaner  and  less  repulsive-looking. 

The  oldest,  and  perhaps  most  popular,  method  is  the  ligature  in  mass. 
A  piece  of  strong  whipcord,  well  waxed  and  made  into  a  running  loop,  is 
passed  over  the  tumor  as  near  to  the  vulva  as  possible,  but  without  in- 
cluding the  meatus  urinarius.  When  evenly  placed  around  the  pedicle, 
it  is  then  gradually,  but  firmly,  tightened  by  pulling  at  each  end  so  as 
completely  to  intercept  the  circulation  in  the  mass.  This  done,  the  cord 
is  tied  in  a  knot. 

Though  this  method  has  been  much  employed,  and  with  a  fair  amount 
of  success,  yet  it  has  been  condemned  by  some  good  authorities,  on  the 
plea  that  it  is  (fengerous  to  tie  such  a  voluminous  mass  ;  as  all  the  parts 
cannot  be  sufficiently  and  equally  compressed  to  become  mortified  at  the 
same  time.  Those  parts  which  have  not  been  firmly  bound  still  retain  a 
certain  amount  of  circulation,  become  inflamed,  and  occasion  violent 
pain. 

Rainard  therefore  recommends  tht  double  ligature.  A  long  sacking  or 
saddlers'  large  needle  is  armed  with  a  somewhat  long  double  piece  of 
whipcord.  This  is  passed  through  the  middle  of  the  pedicle  of  the  tu- 
mor, from  below  to  above,  and  the  needle  cut  away  from  the  cord.  The 
pedicle  is  thus  perforated  by  two  pieces  of  cord  ;  one  of  these  is  very  firm- 
ly tied  round  the  right  half  of  the  pedicle,  the  other  round  the  left,  so  as 
to  include  the  whole  in  two  separate  ligatures. 

Claverie  {Journal  des  Vdt.  du  Midi,  i860,  p.  535)  reports  a  serious 
haemorrhage  by  this  double  ligature,  after  removal  of  the  uterus,  which 
necessitated  the  application  of  a  ligature  in  mass  above  the  others,  as  well 
as  the  application  of  the  actual  cautery  to  the  cut  surface.  It  is  possible 
that  the  needle  wounded  some  large  vessel,  which,  of  course,  would  not 
be  included  in  either  of  the  ligatures. 

The  uterus  of  the  Cow  has  been  successfully  deprived  of  its  circulation 
by  means  of  clams  about  an  inch  thick  and  ten  inches  long. 

They  were  applied  close  to  the  vulva,  and  the  two  ends  fastened  to- 
gether by  twine. 

Saint-Cyr  alludes  to  a  successful  case  of  amputation  of  the  uterus  in  a 
woman,  by  means  of  caustic  clams,  or  rather  a  clamp  ;  the  operator  being 
M.  Valette  of  Lyons  ;  and  he  believes  that  the  same  procedure  might  be 
advantageously  adopted  by  veterinary  surgeons.  He  recommends  the 
long  curved  clams  used  for  hernia,  and  suggests  that  the  groove  be  filled 
either  with  chloride  of  zinc,  or  with  tallow  powdered  over  with  corrosive 
sublimate. 

By  whatever  procedure  the  pedicle  of  the  tumor  is  rigidly  compressed, 
the  uterus  has  afterwards  to  be  excised.  Some  veterinarians  are  of  opin- 
ion that  it  is  better  to  wait  until  it  is  completely  mortified,  or  even  until 
it  sloughs  away  spontaneously ;  and  they  allege,  in  justification  of  this 


INVERSION  OF  THE  UTERUS.  607 

opinion,  the  danger  of  haemorrhage  when  dealing  with  such  a  large  and 
vascular  organ  as  the  uterus  is  at  parturition.  Others,  dreading  the  dan- 
gers resulting  from  the  retention  of  such  an  enormous  mass  suspended 
behind  the  animal,  counsel  its  immediate  amputation.  The  incessant 
traction  it  exercises  on  the  vagina,  the  obnoxious  odor  it  gives  off,  the 
contact  with  the  absorbing  surface  of  the  septic  products  resulting  from 
its  mortification,  expose  the  animal,  they  declare,  to  serious  accidents, 
which  can  only  be  averted  by  at  once  cutting  away  the  uterus. 

We  quite  agree  with  these  authorities,  and  with  Saint-Cyr,  that  these 
dangers  are  most  serious  ;  and  as  the  risk  of  hgemorrhage  may  be  obvi- 
ated by  sufficiently  constricting  the  base  or  pedicle  of  the  mass,  it  is  cei'- 
tainly  most  advisable  to  amputate  it  at  once,  and  at  a  short  distance — 
from  an  inch  to  three  inches — behind  the  constriction. 

Trasbot  (^Bulletin  de  la  Soc.  Centrak  de  Med.  Vetermaire,  1870)  brings 
under  notice  the  use  of  the  ecraseiir  in  amputating  the  uterus.  The  case 
to  which  he  refers  was  not  successful  ;  but  it  is  probable  that  this  result 
was  due  to  the  imperfect  or  improper  manner  in  which  the  instrument 
was  used. 

With  the  kraseur^  the  tissues  should  be  slowly  and  gently  cut  through. 
The  entire  pedicle  may  be  included,  or  the  chain  may  be  passed  through 
the  middle  of  it  by  means  of  a  needle,  like  the  double  ligature. 

The  elastic  ligature  (Dittel's)  has  been  suggested  as  worth  a  trial,  and  if 
properly  applied  we  think  the  result  might  be  favorable.  This  consists  in 
applying  a  long  piece  of  india-rubber  tubing  around  the  pedicle,  and  tying 
it  firmly  there.  The  tissues  are  cut  through  by  the  continuous  pressure, 
which  causes  obliteration  of  the  vessels  and  cessation  of  nutrition. 

It  has  also  been  suggested  that  Esmarch's  method  of  amputation  by 
elastic  compression  of  the  part  to  be  excised,  might  be  most  successfully 
employed  in  ablation  of  the  uterus  in  animals.  Considering  the  volume 
of  the  uterine  tumor  and  its  great  vascularity,  there  must  be  an  immense 
advantage  in  sending  back  into  the  circulation  of  the  animal  the  larger 
part,  or  even  the  whole,  of  the  blood  contained  in  the  organ,  before  sep- 
arating this  from  the  body,  and  in  addition  performing  a  bloodless  opera- 
tion. Coculet's  method  of  reducing  the  volume  of  the  inverted  uterus  by 
compression  has  been  already  alluded  to,  and  is  the  same  in  principle. 
Esmarch's  method  essentially  consists  in  winding  around  the  part  to  be 
amputated — commencing  at  the  distal  extremity — an  elastic  band,  so  as  to 
press  the  blood  from  this  part  into  the  body ;  and  above  the  band  to  tie 
firmly  a  piece  of  india-rubber  tubing,  so  as  to  prevent  a  reflux  of  blood 
by  the  arteries.  The  elastic  band  is  now  removed  and  the  part — pale  and 
bloodless — is  excised. 

When  the  uterus  has  been  cut  away,  the  portion  of  vagina  or  cervix  re- 
maining should  be  returned  as  far  as  possible  into  the  genital  canal,  and 
if  there  is  any  haemorrhage,  injections  of  cold  water  will  probably  check 
it.  Cicatrization  generally  occurs  within  fourteen  days.  If  ablation  of 
the  uterus  is  not  effected  immediately  after  constriction  of  the  pedicle, 
but  is  allowed  to  take  place  spontaneously,  mortification  and  sloughing 
are  completed  in  from  six  to  ten  days. 

In  some  cases,  the  animal  does  not  appear  to  be  much  disturbed  after 
the  operation,  in  others  it  is  very  uneasy.  Ledru  describes  an  instance 
{Rec.  de  Med.  Vet'erinaire,  1866,  p.  115)  in  which  the  Cow  operated  upon 
was  for  an  hour  as  if  mad.  It  lay  down,  got  up,  rolled  about,  kicked  and 
stamped,  and  climbed  into  the  manger.     Its  eyes  appeared  to  be  starting 


6o8  ACCIDENTS  INCIDENTAL  TO  PARTURITION. 

from  their  orbits  ;  it  flexed  its  hind  limbs  like  a  horse  attacked  with  par- 
aplegia, and  it  was  impossible  to  get  near  it.  These  symptoms  appear  to 
have  been  caused  by  the  intense  pain  ;  though  they  gradually  subsided 
and  the  animal  ultimately  recovered. 

In  many  instances  no  unusual  symptoms  have  been  observed,  and  the 
mother  has  anxiously  occupied  itself  with  its  progeny.  This  has  been 
noticed  with  the  Sow. 

After  the  operation  the  cows  appear  to  have  fatted  well  ;  and  when 
killed,  in  those  which  were  examined  large  masses  of  fat  have  been  found 
in  the  place  of  the  uterus,  and  filling  the  pelvis. 

It  may  be  remarked  that  in  one  case  recorded — in  the  Cow — a  portion 
of  intestine  had  become  prolapsed  with  the  uterus,  the  interior  of  the  sack 
of  which  it  occupied  ;  another  similar  occurrence  was  noticed  in  a  Bitch. 
Franck  insists  on  this  complication  being  always  looked  for  in  the  Mare, 
and  he  recommends  that  this  animal  be  always  either  narcotized  by  mor- 
phia or  chloroform,  so  as  to  get  rid  of  the  violent  straining  to  which  it 
yields  itself. 

An  exploratory  incision  may  then  be  made  in  the  body  of  the  uterus, 
and  if  any  intestine  is  found  in  its  interior,  this  must  be  returned  to  the 
abdomen  before  amputation  is  ventured  upon. 

From  among  the  many  recorded  cases,  we  select  the  following  as  ex^ 
amples : 

1.  Barker  in  1841  (  Veterinarian,  vol.  xiv.,  p.  444),  gives  one  of  the  earliest  instances 
of  this  operation  in  England.  The  patient  was  a  Sow,  which,  after  producing  nine 
young  ones,  had  the  uterus  inverted.  No  attempt  was  made  to  replace  it,  and  a  ligature 
being  tied  tightly  round  its  pedicle,  the  organ  was  cut  away,  leaving  a  small  portion  of 
it  protruding.  No  haemorrhage  followed.  It  soon  after  took  some  gruel  and  then 
ordinary  food,  suckled  its  young,  and  was  recovering  rapidly  when  it  was  attacked  by 
aphthous  fever.     It  ultimately  did  well,  and  became  very  fat. 

2.  Gregory  [Ibid.,  vol.  xvii.,  p.  422)  amputated  the  uterus  of  a  Sow,  the  organ  being  so 
torn  after  complete  inversion,  and  the  animal  being  so  prostrate,  that  no  other  course 
was  open.  A  ligature  was  applied  to  the  "  uterine  vessels,"  and  the  uterus  excised.  An 
opiate  dose  was  administered,  and  laxative  medicine,  and  recovery  soon  took  place. 

3.  Gardner  [Ibid.,  p.  485)  amputated  the  inverted  uterus  of  a  Ewe,  as  the  organ  was 
always  extruded  when  returned.  "  I  commenced  as  high  as  I  could,  tying  the  uterine 
arteries  as  I  came  to  them,  and  stitched  the  cut  edges  together  in  order  to  prevent  an 
effusion  of  the  intestines.  No  more  care  was  taken  with  her  than  usual,  and  in  ten 
days'  time  she  was  caught  for  me  to  look  at  her,  when  I  found  that  adhesion  had  taken 
place,  and  she  was  as  well  as  ever." 

4.  This  veterinarian  {loc.  cit.)  had  to  operate  in  the  same  manner  on  a  Cow,  whose 
inverted  uterus  had  been  injured  by  rough  handling,  and  the  labia  of  the  vulva  torn  by 
sutures.     The  animal  recovered  and  fattened  well. 

5  Cleveland  [Ibid.,  vol.  xx.,  p.  378)  attended  a  Sow  which  had  farrowed  four  days 
previously.  The  entire  uterus  was  inverted  and  the  mucous  membrane  lacerated.  "  A 
ligature  was  applied  as  far  forward  within  the  vagina  as  convenient,  including  the 
ovaries  ;  and  then,  with  a  sharp  knife,  the  whole  of  the  protruded  uterus  was  removed. 
The  animal  sickened  for  a  few  days  ;  then  her  appetite  returned."  Recovery  was  com- 
plete. 

6.  Dickens  {Ibid.,  xxviii.,  p.  130)  records  the  case  of  a  fine  sow  which  brought  forth 
a  litter  of  twelve,  and  inversion  of  the  uterus  soon  ensued.  The  organ  had  been  twice 
returned,  and  the  labia  sutured,  but  without  avail,  and  it  was  rapidly  becoming  gan- 
grenous. Two  strong  ligatures  were  placed  round  the  cervix  uteri,  and  then  the  organ 
was  excised.  The  creature  was  kept  warm  and  carefully  nursed.  It  soon  partook  of 
some  milk  and  peas,  and  the  mammary  secretion  gradually  returned,  so  that  the  young 
family  were  all  suckled.     Afterwards  the  Sow  arrived  at  great  "bacon  weight." 

7.  Leech  {Ibid.,  vol.  xxxix.,  p.  790)  attended  a  pointer  Bitch  which  had  pupped  several 
days  previously,  and  the  uterus  had  become  inverted.  It  had  been  returned  several  times 
before  he  was  called  in,  and  the  organ  was  so  swollen  that  he  could  not  replace  it. 
"  Upon  careful  examination,  and  after  passing  the  catheter.  I  found  that  the  bladder 
was  included  in  the  mass;  therefore  I  made  •'an  incision  in  the  body  of  the  uterus,  and 


INVERSION  OF  THE  UTERUS.  609 

found  that  therein  was  also  a  knuckle  of  intestine  as  well  as  the  bladder.  I  returned  the 
bladder  and  intestine  into  the  cavity  of  the  abdomen,  and  raised  the  hind  jiarts  of  the 
Bitch,  so  as  to  keep  them  there  whilst  the  operation  was  performed.  This  was  done  in 
the  following  manner  :  A  needle  armed  with  a  strong  ligature  was  passed  through  the 
neck  of  the  uterus,  behind  the  meatus  urinarius,  including  one-fourth  of  its  substance, 
which  being  tightly  tied,  the  needle  was  again  passed  through  another  fourth  and  tied 
in  the  same  manner ;  then  again  through  another  fourth  in  the  same  way,  leaving  one- 
fourth  up  to  this  time  fre^.  The  whole  of  the  neck  of  the  uterus  was  then  included  in 
one  strong  ligature,  which  closed  the  aperture  ittto  the  abdomen?''  The  parts  behind 
the  ligatures  were  then  removed  by  the  scalpel,  and  the  remainder  returned  in  the 
vagina.  The  haemorrhage  was  very  trifling  ;  the  parts  were  sponged  with  cold  water ; 
a  dose  of  opium  was  administered,  and  a  good  dry  bed  allowed.  Next  morning  more 
opium  was  given,  and  the  animal  partook  freely  of  bread  and  milk.  No  untoward 
symptoms  intervened,  and  in  about  a  fortnight  the  Bitch  had  quite  recovered.  This 
case  demonstrates  the  necessity  for  a  careful  examination  of  the  tumor  before  excision 
is  ventured  upon,  as  the  inverted  uterus  contained  both  bladder  and  intestine,  and  if 
these  had  been  included  death  was  certain  in  a  brief  period. 

8.  Brown  [Ibid.,  vol.  xl.,  p.  845)  partially  amputated  the  uterus  of  a  setter  Bitch.  The 
organ  had  a  tumor  upon  it,  and  a  ligature  was  passed  round  it  near  this  tumor^nd  the 
latter,  with  the  distal  portion  of  the  uterus,  cut  away.  There  was  considerable  haemor- 
rhage, and  the  uterus  was  returned  with  some  dilificulty.  The  ligature  came  away  on 
the  third  day,  and  recovery  was  rapid.  Before  the  operation  the  Bitch  was  in  a  very 
sorry  condition  ;  after  recovery  there  was  a  wonderful  improvement.  The  case  was 
complicated  by  a  fracture  of  the  ilium. 

9.  Barnes  [Ibid.,  vol.  xliv.,  p.  656)  amputated  the  uterus  of  a  Ewe  which  had  lambed, 
and  the  inversion  had  occurred  four  hours  before  his  arrival.  The  organ  was  so  much 
torn  and  swollen,  that  it  was  impossible  to  effect  its  return.  A  ligature  was  firmly  tied 
round  the  cervix,  and  the  mass  removed  by  a  sharp  bistoury,  the  arteries  being  ligatured 
as  a  further  precaution  against  haemorrhage  ;  the  vulva  was  likewise  sutured,  to  prevent 
a  protrusion  of  the  remaining  parts..  When  the  operation  was  finished  the  Ewe  was  in 
a  sinking  condition;  but  stimulants  were  given,  and,  with  attention,  in  a  week  it  was 
convalescent. 

10.  Olver  {Ibid.,  vol.  xlv.,  p.  98)  removed  the  uterus  of  a  Bitch  by  a  ligature  placed 
close  to  the  vulva,  and  excising  the  body  of  the  organ  by  the  knife.  There  was  little 
bleeding,  and  the  remaining  portion  of  the  organ  was  returned.  A  stimulant  was  given, 
and  good  food,  and  recovery  was  rapid. 

If.  Broad  {Ibid.,  xlviii.,  p.  175)  removed  the  inverted  uterus  of  a  Bitch  by  means  of 
clams  and  the  hot  iron.  "  Bitches  appear  to  suffer  very  little  from  the  operation.  .  .  In  • 
all  cases  where  it  is  possible  to  use  the  clams  and  hot  iron  I  do  so,  as  I  find  that  liga- 
tures cause  the  animals  much  suffering ;  besides  which,  there  is  a  greater  danger  of 
blood-poisoning  from  absorption  of  the  morbid  products  during  the  sloughing  process." 
In  all  cases  of  cauterizing  it  is  better  to  use  the  iron  at  a  black  heat. 

12.  Goffi  (//  Medico  Veterittario,  1876)  had  to  attend  a  Cow — primipara— for  inversion 
of  the  uterus.  The  organ  had  been  greatly  contused  and  lacerated  through  the  attempts 
of  the  owner  and  his  friends  to  return  it,  and  reposition  was  hopeless.  After  assuring 
himself  that  the  extruded  sac  did  not  contain  any  viscera,  he  tied  a  strong  ligature 
round  it,  near  the  vulva,  then  ampirtated  it  about  two  inches  beyond  the  ligature.  There 
was  a  slight  haemorrhage,  and  when  this  was  subdued  the  remaining  portion  was  put 
back  into  the  pelvis.  Soon  after,  the  Cow  was  very  restless,  and  strained  severely.  It 
was  bled  and  sedatives  were  given.  On  the  fourth  day  there  was  acute  traumatic 
fever,  and  inappetence  ;  small  doses  of  carbolic  acid  were  administered,  and  improve- 
ment took  place  ;  but  on  the  eighth  day  superficial  oedema  manifested  itself.  This  was 
combated  bv  oil  of  turpentine  itttus  and  extra.  Gradually  recovery  took  place,  and 
about  the  thirteenth  day  there  was  so  little  amiss  that  the  Cow  was  turned  out  to 
pasture.     It  never  went  off  its  milk,  though  the  calf  died  on  the  fourth  day. 

13.  Lorretta  {Ibid.,  1876)  returned  the  inverted  uterus  of  a  Cow,  and  every  thing  ap- 
peared to  be  well  until  the  fourth  day,  when  the  accident  again  occurred.  During  the 
owner's  journey  to  request  the  attendance  of  Lorretta,  a  large  Saint  Bernard  dog  in  the 
cow-shed  devoured  a  large  portion  of  the  protruded  uterus.  On  the  arrival  of  the 
owner  and  veterinary  surgeon,  the  Cow  was  lying  on  the  floor  inundated  with  blood, 
and  apparently  about  to  die.  A  knuckle  of  intestine  protruded  through  a  rent  in  the 
uterus.  Nothing  could  be  done  but  to  amputate  the  organ.  This  was  ligatured  close 
to  the  vulva — after  the  intestine  had  been  returned — by  a  well  waxed  and  soaped  cord, 
which  Avas  passed  round  it  several  times,  being  tied  each  time.  Then  by  means  of  a 
convex  bistoury,  he  cut  through  the  mass  about  two  inches  below  the  ligature,  applied 
an  astringent  lotion  to  the  ligatured  end,  and  Replaced  it  in  the  pelvic  cavity.     From 

39 


6io  ACCIDENTS  INCIDENTAL   TO  PARTURITION. 

the  fourth  day  the  Cow  appeared  to  be  quite  well,  seeking  food  and  ruminating,  and  on 
the  twelfth  day  it  was  cured. 

14.  Ledru  [Recueil  de  Med.  Veterinaire,  1866,  p.  115)  returned  the  inverted  uterus  of 
a  Cow,  and  applied  a  truss.  The  owner  removed  the  latter  too  soon,  and  inversion 
again  occurred ;  but  this  time  reposition  was  impossible.  Amputation  being  decided 
upon,  a  whipcord  ligature  was  applied  round  the  pedicle  of  the  tumor,  about  two  and  a 
half  inches  from  the  vulva ;  there  was  some  haemorrhage  when  the  uterus  was  cut  away 
four  or  five  minutes  afterwards.  For  an  hour  the  Cow  was  \'1*ry  uneasy,  but  next  morn- 
ing it  was  tranquil,  and  in  a  few  days  gave  its  usual  quantity  of  milk  and  quite  recovered. 

15.  Claverie  [Journal  des  Vet.  du  Midi,  i860,  p.  535)  reduced  the  inverted  uterus  of  a 
three-year-old  Cow  with  great  difficulty,  and  attempted  to  retain  it  by  sutures  in  the- 
vulva  and  a  truss.  All  appeared  to  be  going  on  favorably  until  the  fourth  day,  when 
the  organ  was  again  prolapsed,  tearing  away  the  sutures  and  the  truss.  Excision  of  the 
uterus  was  considered  the  only  means  of  saving  the  animal,  and  this  was  performed  by 
double  ligature — the  needle  being  passed  through  the  middle  of  the  pedicle  ;  the  body 
of  the  organ  being  amputated,  the  remainder  was  returned  to  the  vagina.  Much  bleed- 
ing ensued,  and  the  part  had  to  be  withdrawn,  another  circular  ligature  applied,  and  the 
hot  iron  used  to  close  the  bleeding  vessels.  Cooling  lotions  and  charcoal  were  after- 
wards CTnployed  ;  for  ten  days  the  animal  was  dull,  and  the  secretion  of  milk  and 
appetite  were  diminished  ;  soon  after  this,  however,  it  improved  rapidly  and  completely 
recovered. 

16.  Turquet  {Recueil  de  Med.  Veterinaire,  1868,  p.  20)  relates  a  case  of  inversion  in 
which,  from  the  great  infiltration  and  gangrenous  condition  of  the  uterus,  reduction  was 
impracticable  ;  so  it  was  decided  to  amputate.  The  operation  was  performed  by  pass- 
ing a  cord  about  two  yards  in  length,  and  with  a  piece  of  wood  at  each  end,  around  the 
uterus  about  two  inches  from  the  vulva — the  Cow  being  held  by  two  strong  men  ;  while 
two  other  assistants  pulled  at  the  ends  of  the  cord,  so  as  to  tighten  it  gradually  around 
the  tumor.  Turquet  kept^his  finger  on  the  knot,  so  as  to  judge  of  the  amount  of  con- 
striction, and  finding  after  a  minute  or  two  that  it  was  sufficient  to  stop  the  circulation, 
the  cord  was  firmly  tied. 

There  was  scarcely  any  bleeding  when  the  uterus  was  removed  about  two  inches  from 
the  ligature,  and  the  latter  disappeared  within  the  vagina.  The  animal  was  extremely 
uneasy,  threw  itself  down,  groaned  and  bellowed,  and  otherwise  exhibited  indications  of 
pain  for  about  ten  minutes.  Next  morning  it  was  ruminating  ;  the  ligature  came  away 
in  due  course,  the  Cow  suckled  its  calf  and  gave  the  usual  quantity  of  milk,  and  in  five 
months  afterwards  was  fatted. 

17.  Schiiller  {CEsterreich.  Vierteljahress.  fiir  Wissenschaftliche  Veierin&rknnde,  1858, 
p.  17)  appears  to  be  one  of  the  few  veterinarians  who  has  attempted  amputation  of  the 
uterus  in  the  Mare.  He  was  called  to  attend  a  seven-year-old  Mare,  which  eight  days 
previously  had  given  birth  to  a  dead  foal,  and  soon  after  suddenly  inverted  the  uterus. 
For  eight  days  (!)  was  the  swollen,  gangrenous  organ  protruded,  and  when  he  saw  it,  the 
mucous  membrane  was  greatly  infiltrated  and  sodden,  and  covered  by  a  yellowish 
exudation.  The  animal  stood  with  its  hind-legs  wide  apart,  and  looked  dull  and  heavy  ; 
the  pulse  was  65  per  minute,  the  respirations  25  to  30.  It  still  fed,  except  during  the 
paroxysms  of  straining.  No  attempt  was  of  course  made  to  replace  the  uterus,  and  with 
the  owner's  consent  amputation  was  resolved  on.  A  twitch  was  placed  on  the  Mare's 
nose,  and  a  man  placed  at  the  head,  while  two  others  stood  on  each  side  to  keep  the 
animal  steady  and  to  assist  in  the  operation  when  necessary.  The  upper  part  of  the 
uterus,  near  to  the  vagina,  was  then  freed  from  the  discharge  and  exudation  by  means 
of  the  finger  and  tepid  water,  and  the  mucous  membrane  exposed.  A  strong,  well- 
waxed  ligature  was  tied  round  the  pedicle,  about  two  inches  from  the  vulva,  and  the 
uterus  excised  by  a  sharp  bistoury  about  half  an  inch  from  this  part.  The  haemorrhage 
was  unimportant,  and  the  remains  of  the  uterus  disappeared  in  the  vagina.  A  few  sutures 
were  passed  through  the  vulva,  and  a  pledget  of  tow  put  over  it  and  retained 
by  a  bandage.  Internal  treatment  was  also  resorted  to.  Next  day  the  pulse  was  y^^ 
and  the  respirations  increased ;  micturition  and  defecation  were  normal.  The  vulva 
was  greatly  swollen,  injected  and  hot.  The  straining  was  feeble,  and  only  occurred  at 
long  intervals.  On  the  succeeding  two  days  the  Mare  was  livelier,  the  appetite  was 
better,  and  the  straining  had  almost  disappeared.  The  vulvar  sutures  had  given  way, 
and  the  bandage  was  removed.  A  small  quantity  of  unhealthy,  dirty-brown  colored 
fluid  escaped  from  the  vulva.  This  was  corrected  by  injections,  and  in  three  days  the 
discharge  was  healthy.  In  fourteen  days  after  the  operation  the  Mare  was  discharged 
cured. 

18.  Moens  (Annales  de  Med.  Veterinaire  de  Britxelles,  1866,  p.  591)  was  less  fortunate 
with  a  Mare,  six  years  old,  which  had  the  uterus  inverted  and  hanging  as  low  as  its 
hocks.  The  organ  had  a  large  rent  in  it,  and  a  jet  of  arterial  blood  flowed  in  such 
quantity  that  it  was  evident  death  must  soon  take  place  from  haemorrhage.     A  ligature 


INVERSION  OF  THE  VAGINA.  6ii 

was  therefore  at  once  applied  around  the  cervix,  and  with  the  aid  of  several  persons  abla- 
tion was  effected.     The  Mare  died  two  days  afterwards. 

19.  The  same  authority  {Ibid.)  practised  the  operation  on  a  Cow  soon  after  this  un- 
fortunate case,  and  with  the  greatest  success.  In  all,  he  had  operated  on  eighteen  Cows, 
without  a  fatal  case  ;  and  he  is  of  opinion  that  total  ablation  of  the  uterus  in  this  animal 
is  incontestably  more  benignant  than  reposition.  He  remarks  on  the  ease  with  which 
it  can  be  executed,  and  that  it  requires  no  special  dexterity  :  all  that  is  needed  is  a  strong 
ligature  applied  as  close  as  possible  to  the  vulva,  and  firmly  tied  round  the  part ;  the 
organ  being  cut  off  about  two  fingers'  breadth  from  the  ligature.  A  little  straining 
often  occurs  afterwards,  but  rarely  any  thing  more  serious. 

20.  De  Ceuster  [Ibid.,  p.  588),  in  attempting  to  reduce  the  inverted  uterus  of  a  Cow, 
ruptured  the  organ  almost  unconsciously — its  texture  was  so  soft  and  friable.  Ampu- 
tation was  decided  upon.  The  opening  was  enlarged  to  discover  if  the  sac  contained 
intestines.  A  strong  suture  {forte  suture)  was  placed  at  the  base  of  the  organ,  close  to 
the  vulva,  and  in  half-an-hour,  when  the  uterus  had  become  cold,  it  was  amputated 
about  two  inches  from  the  vulva,  and  the  ligatured  end  returned.  The  following  day 
there  were  a  few  expulsive  efforts,  and  for  twelve  days  a  foul-smelling  fluid  was  dis- 
charged from  the  vulva.  Tar-water  was  injected.  The  animal  fed  well  immediately 
after  the  operation,  and  gave  an  abundance  of  milk. 

De  Ceuster  is  of  opinion  that  the  obstetrist  should  not  hesitate  in  resorting  to  ampu- 
tation of  the  inverted  uterus  when  he  cannot  return  it,  or  when  it  is  so  damaged  that,  if 
returned,  the   animal's  life  may  be  endangered. 

Van-Hacken  [Ibid.,  1863,  p.  259),  Sulmon,  and  De  Meester  {Ibid.,  1877,  p.  158)  record 
successful  cases  of  ablation  of  the  uterus  in  the  Cow. 


CHAPTER   IV. 

Inversion  of  the  Vagina — Inversio  Vaginae. 

Inversion.,  procidence,  prolapsus,  or  fall  of  the  vagina.,  is  a  hernia  of  this 
part  through  the  vulvar  opening,  analogous  to  that  of  the  uterus,  and  with 
which  it  may  be  complicated  when  inversion  of  the  latter  is  extreme  ; 
though  in  this  case  it  does  not  add  to  the  symptomatology  or  gravity  of 
the  accident. 

The  accident  may  occur  in  other  than  pregnant  or  parturient  animals, 
though  rarely;  it  may  also  take  place  during  gestation,  particularly 
towards  the  termination  of  that  condition,  when  the  gravid  uterus  pushes 
it  outwards.  Most  frequently,  however,  it  is  witnessed  after  parturition, 
and  particularly  when  delivery  has  been  difficult  and  protracted,  and 
especially  when  force  has  been  necessary  to  extract  the  foetus,  and  Uie 
expulsive  efforts  were  severe. 

It  often  occurs  when  the  "  waters  "  have  escaped  for  some  time,  and 
the  young  creature,  lodged  in  the  genital  canal,  is  extracted  without  the 
precaution  of  lubrication.  Its  progress  through  the  dry,  tenacious 
passage  causes  the  mucous  membrane  of  the  vagina  to  gather  in  ridges 
and  folds  ;  the  connective  tissue  beneath  is  torn,  and  this  leads  to  inver- 
sion, which  may  occur  immediately,  along  with  the  exit  of  the  foetus,  or 
when  the  animal  afterwards  strains — sometimes  so  long  as  four,  six,  or 
eight  days  subsequent  to  parturition. 

Fatigue,  such  as  that  induced  by  travelling,  or  severe  exertion,  imme- 
diately or  soon  after  calving,  or  keeping  the  animal  in  a  stall,  the  floor 
of  which  slopes  too  much  backwards,  are  also  likely  to  produce  the  acci- 
dent.    It  may  also  take  place  after  abortion,  and  retention  of  the  placenta. 

When  inversion  of  the  vagina  occurs  without  that  of  the  uterus,  the 
latter  is  propelled  backwards  by  the  contractions  of  the  abdominal 
muscles,  pushing  before  it  the  walls  of  that  canal  until  it  has  extruded 


6i2  ACCIDENTS  INCIDENTAL   TO  PARTURITION. 

them  beyond  the  vulva,  and  itself  occupies  the  cavity  of  the  pelvis. 
During  this  extrusion,  the  connective  tissue  which  attaches  the  vaginal 
mucous  membrane  to  the  pelvis  is  more  or  less  lacerated  ;  and  it  is 
this  laceration  which,  as  Saint-Cyr  justly  remarks,  constitutes,  the  serious 
character  of  the  accident,  and  differentiates  it  from  simple  prolapse  due 
to  relaxation  of  the  connective  tissue,  which  is  of  no  great  moment,  but 
which  may  precede  it.  The  latter  condition  is  not  very  rare  towards  the 
end  of  pregnancy,  and  under  certain  circumstances  it  may  lead  to  com- 
plete inversion,  Rainard  mentions  having  seen  a  Goat  which  had 
inversion  of  the  vagina  fifteen  days  before  parturition,  and  to  such  an 
extent  that  the  mouth  and  nostrils  of  the  foetus  protruded  through  the 
half-open  os  uteri,  so  that  it  could  breathe  and  lick  the  hand. 

But,  as  has  been  said,  inversion  of  the  vagina  occurs  far  more  frequently 
after  abortion  and  parturition,  though  not  so  often  as  inversion  of  the 
uterus. 

Symptoms. 

Of  course,  the  chief  symptom  of  this  accident  is  the  presence  of  a  tumor 
between  the  labia  of  the  vulva,  and  which  may  hang  for  some  distance 
below  that  opening.  In  this  respect  it  resembles  inversion  of  the  uterus, 
though  the  difference  is  otherwise  very  marked.  In  the  majority  of  cases 
the  tumor  is  most  voluminous  when  the  animal  is  lying,  and  can  then  be 
best  examined.  It  is  circular  in  form,  varies  in  size  from  that  of  an  apple 
to  a  large  melon,  and  is  not  unlike  a  thick  sausage  ;  the  surface  is  smooth, 
more  or  less  of  a  deep  red  color  streaked  with  darker  patches,  and  covered 
by  a  thick  white  mucus,  or  a  fibrinous  exudate  ;  in  other  cases  it  is 
inflamed,  excoriated  by  the  tail  or  litter,  and  covered  with  foreign  mat- 
ters. There  are  fio  traces  of  cotyledons  or  placental  follicles.  On  the  under 
surface  of  the  tumor  is  observed  a  longitudinal  depression,  or  furrow, 
which  leads  to  the  urethra.  At  its  end  is  a  round  opening,  into  which 
the  finger  can  be  passed  as  far  as  the  os  uteri,  which  will  be  found  either 
completely  closed  or  partially  open.  At  the  vulva  the  tumor  is  narrow, 
and  exhibits  longitudinal  folds  or  ridges,  due  to  the  constriction  caused 
by  the  vulva.  Passing  the  finger  between  the  tumor  and  the  vulva,  there 
is  found  a  depression,  or  cul-de-sac,  formed  by  its  direct  continuity  with 
the  vulvar  mucous  membrane.  In  certain  cases,  the  cervix  uteri  can  be 
seen  in  the  middle  of  the  tumor.  Not  unfrequently  the  tumor  is  not 
visible  when  the  animal  is  standing  ;  though  it  may  show  itself  when  it 
lies  down,  riiicturates,  defecates,  or  strains.  When,  however,  the  inver- 
sion has  occurred  to  a  considerable  extent,  or  the  case  is  chronic,  the 
tumor  often  remains  external  to  the  vulva. 

There  is  generally  more  or  less  difficulty  in  micturating,  arising  from 
the  pressure  on  the  urethra  ;  and  instances  are  recorded  in  which  extreme 
distention  of  the  bladder,  from  retention  of  urine,  had  occasioned  serious 
symptoms,  and  led  to  paralysis,  and  even  rupture,  of  that  viscus.  There 
may  also  be  more  or  less  straining — indeed,  this  symptom  is  nearly  always 
present  ;  febrile  symptoms  may  likewise  be  noted  in  some  cases. 

When  the  mucous  membrane  has  been  long  exposed  to  the  air  it  becomes 
thickened  and  indurated,  from  the  constant  irritation  giving  rise  to  effusion 
and  exudation  ;  it  assumes  a  greyish  tint,  and  is  covered  with  a  coriaceous 
epithelium,  which  gives  it  a  leathery  appearance. 

The  local  symptoms  which  we  have  indicated  should  sufficiently  distin- 
guish between  this  accident  and  the  presence  of  tumors  in   the  genital 


INVERSION  OF  THE  VAGINA.  613 

canal.  In  the  Bitch,  inversion  of  the  vagina  has  been  sometimes  mis- 
taken for  a  condylomatous  tumor ;  and  cases  are  recorded  in  which 
tumors  of  this  kind,  protruding  beyond  the  vulva,  through  insufficient 
examination  have  been  mistaken  for  inversion.  Inversion  of  the  bladder 
has  also  b6en  confounded  with  that  of  the  vagina.  The  pyriform  kysts 
which  sometimes  form  in  that  canal,  and  contain  a  citron-colored  fluid, 
have  likewise  been  sometimes  confounded  with  inversion  of  the  vagina. 

To  avoid  errors  which  might  have  a  serious  tendency,  a  careful  examina- 
tion must  be  made,  and  nothing  should  be  attempted  in  the  way  of  opera- 
tion until  the  state  of  affairs  is  exactly  determined. 

Prognosis. 

Inversion  of  the  vagina  is  not  nearly  so  serious  an  accident  as  inver- 
sion of  the  uterus  ;  and  Cows,  Mares,  and  Bitches  may  often  suffer  from 
this  condition  for  months  without  showing  much  apparent  inconvenience. 
This  is  the  kind  of  inversion  that  is  liable  to  recur  ;  reposition  may  be 
readily  effected,  but  no  sooner  is  it  accomplished  than  inversion  again 
takes  place  through  the  animal  straining. 

In  other  instances,  however,  the  accident  is  much  more  serious.  The 
mucous  membrane  of  the  vagina,  exposed  to  contact  with  the  urine,  faeces, 
and  litter,  in  addition  to  friction  from  the  tail  and  other  objects,  as  well 
as  the  attacks  of  flies,  etc.,  becomes  irritated,  excoriated,  abraded,  and 
indurated,  while  it  is  greatly  thickened  from  exudation  ;  a  more  or  less 
foetid  muco-purulent  secretion  covers  its  surface  ;  cicatrization  of  the  torn 
sub-mucous  connective  tissue  ensues  ;  new  adhesions  are  formed  which 
fix  the  part  in  its  abnormal  situation,  and  offer  what  is  sometimes  an 
insurmountable  obstacle,  if  not  to  reduction,  at  least  to  retention,  after 
that  has  been  effected.  If  assistance  is  not  afforded,  the  animal  gradually 
loses  condition  and  becomes  emaciated  ;  hectic  fever  sets  in,  and  it  falls 
into  a  state  of  marasmus.  At  other  times  the  extruded  part  becomes 
acutely  inflamed,  intense  fever  supervenes,  and  the  creature  succumbs  to 
the  effects  of  vaginitis — either  simple  or  complicated  with  metritis— "-and 
almost  as  rapidly  as  from  inversion  of  the  uterus. 

Treat77ie?it. 

The  more  speedily  treatment  is  resorted  to  after  inversion  has  occurred, 
the  more  easily  is  reduction  effected  and  likely  to  prove  permanent,  while 
the  risks  from  injury  are  greatly  diminished. 

The  treatment  is  somewhat  similar  to  that  recommended  for  inversion 
of  the  uterus,  the  preli^ninary  steps  being  the  same  in  both  accidents,  and 
reduction  accomplished  according  to  the  same  rules.  The  part  of  the 
vaginal  membrane  nearest  the  vulva  is  to  be  carefully  and  gradually 
returned  should  the  tumor  be  large  ;  if  comparatively  small,  then  it  may 
be  reduced  en  masse,  by  applying  the  closed  fist  to  the  centre  of  the  most 
dependent  part,  and  pushing  it  into  the  canal.  When  reduction  has  been 
effected,  it  is  particularly  necessary  to  observe  that  every  part  has  assumed 
its  normal  shape  and  position  ;  as  it  often  happens  that  the  mucous 
membrane,  particularly  towards  the  bottom  of  the  canal,  forms  a  thick 
fold,  which  must  be  effaced  if  it  is  desired  to  obviate  renewed  straining 
and  a  recurrence  of  the  inversion.  All  the  folds  and  inequalities  from 
one  end  of  the  canal  to  the  other,  as  far  as  the  cervix,  should  be  smoothed 
carefully  down  by  the  hand  or  a  soft  damp  cloth.     If,  after  reduction,  the 


6 1 4  A  CC IDE  NTS  INC  IDE  NT  A  L  TO  PAR  TURITION. 

straining  continues,  it  may  be  inferred  that  tlie  mucous  membrane  is 
irritated  by  the  existence  of  wrinkles  or  folds  on  its  surface.  The  hand 
must  then  be  introduced  again  into  the  vagina,  and  the  ridges  effaced 
either  by  passing  the  hand  over  them  so  as  to  carry  the  membrane  onwards, 
or  by  gentle  pressure  entirely  obliterating  them. 

If  the  membrane  is  irritable  and  inflamed,  astringents — such  as  acetate 
of  lead,  and  anodynes — such  as  opjum,  may  be  applied  to  it  \  and  as  a 
matter  of  precaution,  a  truss  may  used  for  a  few  hours. 

When  the  foetal  membranes  are  still  in  the  uterus,  some  obstetrists 
recommend  that  they  should  be  removed  before  reduction  of  the  inversion 
is  attempted  ;  but  others — and  among  them  Saint-Cyr — are  of  opinion 
that  reduction  should  be  accomplished  first,  and  removal  of  the  mem- 
branes afterwards,  unless  the  latter  are  so  lightly  attached  that  they  can 
be  pulled  away  without  introducing  the  hand  into  the  uterus.  In  any 
case  the  membranes  must  be  removed,  as  their  presence  is  certain  to  cause 
expulsive  efforts  which  will  inevitably  lead  to  protrusion  of  the  vagina  again. 

For  the  retention  of  the  reduced  organ,  sutures  are  often  passed  through 
the  labia  of  the  vulva,  and  Harms  and  Schleg  {Magazm  von  Gurlt  und 
Hertwig,  1869,  p.  13)  have  rings  (ringehts)  with  this  object.  Schleg's 
ring  is  a  thin  flat  band  of  steel,  pointed  at  one  end,  and  with  a  round  hole 
and  slot  a  little  above  the  point :  at  the  other  end  is  a  kind  of  button 
raised  on  the  surface.  The  point  is  passed  through  the  labia,  and  the 
band  bent  round  so  as  to  meet  and  button  at  the  ends.  This  ring  has 
been  worn,  according  to  Schleg,  from  a  few  days  to  more  than  five  months. 
But  in  general,  it  will  be  preferable  to  employ  a  truss  for  the  retention  of 
the  vagina,  if  the  accident  is  recent. 

When  the  submucous  connective  tissue  of  the  vagina  has  been  much 
lacerated,  and  abnormal  adhesions  have  taken  place,  then  a  recurrence  of 
the  inversion  is  to  be  apprehended.  This  recurrence  is,  of  course,  most 
likely  to  take  place  in  chronic  inversion,  and  all  the  skill  and  patience  of 
the  veterinary  surgeon  will  be  required  in  dealing  with  such  a  case.  At 
times  the  accident  has  proved  so  troublesome,  and  retention  has  so  baffled 
every  attempt  after  reduction  was  effected,  that  amputation  of  the  pro- 
truded portion  has  been  practised,  and  with  success. 

Rainard  appears  to  have  been  the  first  to  venture  on  this  bold  measure, 
and  he  practised  the  operation  several  times  on  Bitches.  He  ligatured 
the  entire  inverted  mass  close  to  the  vulva,  in  one  case  ;  but  as  this  gave 
rise  to  intense  fever,  and,  when  cured,  the  animal  suffered  from  inconti- 
nence of  urine,  he  adopted  another  procedure.  Instead  of  including  the 
whole  of  the  tumor  in  one  ligature,  he  divided  the  pedicle  into  three  por- 
tions, which  he  tied  separately,  so  that  each  ligature  only  enclosed  one- 
third  of  the  mass.  After  tightening  the  ligatures,  the  Bitch  was  allowed 
to  run  at  large,  the  only  attention  it  received  being  the  injection  of  emol- 
lient fluids  into  the  vagina,  and  a  smaller  allowance  of  food.  The  pain 
was  much  less  in  intensity  and  duration  than  in  the  first  case,  and  the 
tumor  came  away  in  five  or  six  days,  when  recovery  took  place.  Rainard, 
however,  advises  immediate  excision  of  the  portion  of  the  mass  beyond 
the  ligatures,  when  these  have  been  drawn  tight. 

Daprey  operated  on  a  two-year-old  filly  in  a  somewhat  different  man- 
ner. Inversion  of  the  vagina  had  been  present  for  fifteen  days,  and  the 
tumor  was  as  large  as  a  man's  head  ;  it  was  cold,  of  a  dark  brown  color, 
and  the  animal  was  greatly  agitated  and  feverish.  As  gangrene  was 
apprehended,  it  was  decided  to  remove  the  whole  mass.     This  was  done 


INVERSION  OF  THE  BLADDER. 


615 


by  practising  a  kind  of  saddler's  stitch  around  it,  by  means  of  two  needles 
armed  with  a  waxed  thread  ;  and  when  sewn  round,  the  two  ends  of  the 
ligature  were  drawn  so  tight  as  to  raise  the  enclosed  sides  of  the  tumor 
into  plaits  like  the  mouth  of  a  tied  sack  ;  they  were  then  firmly  joined. 
The  filly  was  kept  standing  with  the  hinder  part  of  the  body  raised,  and 
the  tumor  was  dressed  with  chlorinated  water  and  vinegar.  Between  the 
seventh  and  eighth  days  the  mass  came  away  ;  the  discharge  diminished 
in  quantity  and  foetidness,  and  on  the  tenth  day  the  animal  was  nearly 
well. 

Saint-Cyr  mentions  that  Bernard  operated  upon  a  female  Ass,  which 
had  the  vagina  inverted  for  more  than  a  month,  and  every  means-  of 
retention  had  failed.  Amputatipn  was  practised,  by  a  circular  incision 
around  the  base  of  the  tumor.  At  the  first  cut  of  the  bistoury,  it  was 
observ^ed  that  the  mucous  membrane  was  very  much  thickened,  and  easily 
detached  from  the  other  parts  ;  so  that,  instead  of  making  a  total  ampu- 
tation, it  was  considered  better  to  make  it  only  partial,  by  dissecting 
away  all  that  fissue  to  the  extent  of  four  or  five  inches.  This  was  done, 
and  the  haemorrhage  was  inconsiderable  ;  but  it  persisted  so  long  after- 
wards that  the  animal  was  seized  with  symptoms  of  syncope.  However, 
these  symptoms  passed  away,  and  the  creature  began  to  eat.  A  rope 
truss  was  applied,  and  for  eight  days  there  was  a  discharge  of  pus.  At 
the  end  of  that  time,  when  the  truss  was  removed,  recovery  was  found  to 
be  complete.  On  exploring  the  vagina  some  time  afterwards,  a  thick  but 
dilatable  ring,  about  the  middle  of  the  vagina,  was  found,  through  which 
first  one  finger,  than  two  and  three,  could  be  passed.  Beyond  this  ring 
the  canal  was  normal  in  width. 

There  can  be  no  doubt,  then,  that  the  inverted  vagina  may  be  ampu- 
tated without  much  risk,  when  reduction  is  impossible  or  incomplete  ;  but 
whether  an  animal  which  has  undergone  this  operation  can  be  utilized 
for  breeding  purposes  after\vards,  we  have  no  evidence  to.  prove.  It 
is  possible  that  the  cicatricial  tissue  uniting  the  wound  maybe  sufficiently 
yielding  to  allow  of  gradual  dilatation  by  manual  or  mechanical  means, 
and  thus  not  offer  much  impediment  to  impregnation  or  parturition. 


CHAPTER  V. 
Inversion  of  the  Bladder — Prolapsus  Vesicae. 

At  page  337,  we  have  alluded  to  inversion  of  the  bladder  as  occurring 
before  parturition,  and  described  the  symptoms  and  treatment  of  this 
accident.  The  remarks  we  there  made  are  applicable  to  the  accident 
when  it  follows  delivery.  It  is  of  somewhat  rare  occurrence,  and  is  per- 
haps more  frequently  met  with  in  the  Mare  than  the  Cow. 

We  have  jDarticularly  insisted  upon  the  necessity  for  a  careful  examina- 
tion of  these  vulvar  tumors  before  adopting  any  surgical  measures ;  and 
this  precaution  is  above  all  things  necessary  in  this  accident,  as  an  inci- 
sion in  this  viscus  is  certain  to  lead  to  a  fatal  termination  :  of  this  we 
have  given  an  illustration  in  page  339. 

Reduction  must  be  attempted  according  to  the  directions  given  at  page 
338,  and  care,  must  be  taken  not  to  lacerate  the  organ,  as  this  also  will 


6i6  ACCIDENTS  INCIDENTAL  TO  PARTURITION. 

prove  fatal.  Elmue  (Canstatt's  yahresbericht,  1859)  relates  an  occurrence 
of  this  description. 

In  desperate  cases,  when  reduction  cannot  be  effected,  or  when  the 
organ  is  so  much  injured  that  reposition  is  almost  certain  to  be  followed 
by  death,  amputation  may  be  ventured  upon  with  some  prospect  of  suc- 
cess. 

With  regard  to  the  operation,  Cartwright  remarks :  "  It  is  to  be 
observed  that  the  ureters  enter  the  substance  of  the  neck  of  the  bladder 
obliquely  towards  its  sides,  but  their  orifices  are  to  be  seen  when  the 
bladder  is  inverted,  and  the  Cow  or  Mare  is  standing  up,  at  the  upper 
surface  of  the  viscus,  about  half  an  inch  apart.  To  detect  them,  we 
must  draw  the  bladder  sufficiently  down,  so  that  we  may  be  able  to  in- 
spect the  parts.  Where  they  enter,  the  inner  membrane  (now  the  ureter) 
will  have  a  soft  and  jelly-like  protuberant  appearance,  in  the  middle  of 
which  will  be  detected  two  very  small  openings  of  a  nipple-like  shape. 
To  be  certain  that  we  have  hit  upon  them,  we  may  introduce  a  probe, 
and  pass  it  down  towards  the  suspended  fundus.  Having  discovered  the 
orifice  of  the  ureters,  and  passed  a  ligature  around  the  neck  of  the  blad- 
der below  them,  we  have  nothing  more  to  do  than  occasionally  tighten 
it,  so  as  to  effect  complete  strangulation  and  sloughing  of  the  body  of 
the  bladder ;  though,  as  soon  as  we  find  it  dead,  we  may,  to  save  time, 
cut  it  away  with  a  scalpel.  We  should  also,  after  having  applied  the 
ligature,  puncture  the  distended  fundus  ;  since  its  great  weight  may  cause 
a  dragging  and  inflammation  about  its  cervix,  or  may  force  the  ligature 
over  the  mouth  of  the  ureters,  which  would  occasion  the  death  of  the  an- 
imal. After  the  separation  has  taken  place,  the  remaining  portion  will 
contract  within  the  vagina,  and  the  cavity  will  be  closed  by  the  vulva. 
The  urine  will  generally  ever  after  run  down  the  thighs,  excoriating 
them  ;  though  in  other  cases  the  fluid  will  accumulate  within  the  vulva, 
and  be  from  time  to  time  ejected  in  large  quantities." 

When  excision  is  not  resorted  to,  spontaneous  amputation  may  take 
place. 

When  the  inversion  or  prolapsus  is  complicated  by  rupture  of  the  floor 
of  the  vagina,  then  the  accident  is  of  the  most  serious  character,  though 
not  invariably  fatal  in  its  results.  » 

1.  Riviere  {Journal  de  Med.  Veterinaire  de  Lyon,  1867,  p.  236)  reports  the  case  of  a 
Cow  which  had  a  laborious  delivery,  in  consequence  of  lateral  deviation  of  the  head  of 
the  foetus,  and  manual  aid  was  necessary.  The  foetus  was  very  large.,  and  soon  after  it 
was  extracted  the  envelopes  came  away  ;  but  in  about  a  quarter  of  an  hour  very  violent 
straining  ensued,  and  almost  immediately  a  quantity  of  reddish  fluid  flowed  from  the 
vulva,  followed  by  a  tumor  as  large  as  a  child's  head.  A  careful  inspection  proved  this 
tumor  to  be  formed  by  the  fundus  of  the  bladder,  and  a  manual  exploration  discovered, 
on  the  floor  of  the  vagina,  a  long  slit  through  which  the  organ  had  passed.  When  this 
laceration  took  place,  was  not  known  ;  but  the  owner  of  the.  Cow  had  attempted  to  de- 
liver it  the  previous  evening,  and  had,  as  he  thought,  pierced  the  "water  bag."  The 
bladder  was  full  of  urine,  so  it  could  not  be  returned,  nor  yet  could  it  be  emptied  by 
pressure  on  its  surface. 

The  contents  were  removed  by  a  hastily-devised  catheter,  made  of  a  piece  of  elder- 
tree  deprived  of  its  pith.  When  the  urine  was  abstracted,  reduction  was  easy,  and  the 
Cow  recovered  in  less  than  twenty  days. 

2.  Canu  {Mem.  de  la  Societe  VetSrinaire  dit  Calvados,  1835)  was  requested  to  see  a 
Mare  that  half  an  hour  previously,  had  given  birth  to  a  foal  without  any  difficulty.  He 
found  the  animal  lying  on  its  left  side,  straining  violently,  covered  with  perspiration, 
and  a  membranous-looking  substance  hanging  from  the  vulva,  which  led  to  the  suspi- 
cion that  inversion  of  the  uterus  or  vagina  had  taken  place.  The  owner  said  that  he 
had  been  for  a  long  time  attempting  to  return  this  membrane,  but  had  failed.     Canu 


INVERSION  OF  THE  BLADDER.  617 

carefully  examined  it,  but  was  unable  to  satisfy  himself  as  to  what  it  really  was.  He 
therefore  caused  the  Mare  to  rise,  which  was  done  with  difficulty,  owing  to  weakness. 
The  creature  made  repeated  efforts  to  void  its  urine,  from  time  to  time  ejecting  it  to  a 
considerable  distance.  Canu  did  not  even  suspect  inversion  of  the  bladder,  as  he  had 
never  seen  or  read  of  such  an  accident.  The  tumor  was  red,  thickened,  and  bloody, 
and  an  examination  by  means  of  a  candle  proved  the  vagina  to  be  all  right.  P'oUowing 
the  floor  of  that  canal,  however,  the  meatus  urinarius  could  not  be  found,  and  the  tumor 
commenced  where  that  conduit  should  be  ;  at  the  same  time  the  Mare  violently  expelled 
some  urine,  and  it  was  now  surmised  that  it  was  really  the  bladder  that  was  depending 
from  the  vulva.  A  close  scrutiny  led  to  the  discovery  that  the  organ  was  torn  at  the 
fundus,  through  the  owner's  efforts  to  replace  it ;  he  had  used  all  his  force,  and  the 
Mare  at  the  same  time  struggled  violently.  After  considerable  deliberation,  nothing 
was  done,  except  abstracting  a  quantity  of  blood  and  reducing  the  diet.  At  the  end  of 
three  days,  the  mammary  secretion  proving  troublesome,  the  foal  was  restored  to  the 
Mare.  The  bladder  was  then  swollen  and  black,  and  the  thighs  were  excoriated  from 
the  constant  flowing  of  urine.  On  the  fourth  day,  in  consultation  with  another  veter- 
inary surgeon,  it  was  decided  to  pass  a  ligature  around  the  organ,  behind  the  orifice  of 
the  ureter.  This  was  done,  and  the  owner  was  entrusted  with  the  task  of  tightening 
the  ligature  every  day.  Next  day  the  Mare  showed  symptoms  of  colic,  and  it  was  found 
that  the  ligature  had  slipped  upwards  for  more  than  an  inch,  and  closed  the  ureters — 
thus  causing  uneasiness  from  retention  of  urine  in  these  ducts.  The  bladder  being  py- 
riform — the  pedicle  next  the  vulva — it  was  difficult  to  keep  the  ligature  in  its  place. 
This  was  ultimately  accomplished,  however,  by  passing  two  small  pieces  of  wood 
through  the  tumor  behind  the  ligature,  and  attaching  the  latter  to  them.  Every  day  the 
constriction  was  increased  until  the  whole  mass — weighing  nearly  six  pounds,  and  very 
foetid — was  held  only  by  a  narrow  band  ;  this  was  divided  without  any  haemorrhage. 
The  remaining  portion  was  immediately  retracted  as  far  as  the  meatus  urina?-ius,  when 
the  lips  of  the  vulva  closed,  leaving  nothing  to  be  seen.  The  urine,  however,  continually 
flowing  through  the  ureters,  accumulated  in  the  vulva,  whence  it  was  frequently  ejected, 
and  running  down  the  thighs  excoriated  them  still  more. 

Canu  {hen  determined  to  have  a  little  projecting  spout  of  tin  made,  with  brass  wires 
to  attach  it  to  the  vulva.  This  was  fitted  below  the  inferior  commissure  of  that  open- 
ing the  wires  serving  to  fasten  it  to  a  crupper  worn  by  the  animal ;  the  hair  of  the  tail 
was  tied  up  so  that  it  might  not  disarrange  the  apparatus.  By  this  means  the  urine  was 
thrown  beyond  the  hocks,  and  a  few  emollient  lotions  healed  the  excoriations.  The 
Mare  was  put  to  work  six" weeks  after  the  accident,  and  in  three  months  it  was  sold  at  a 
fair. 

3.  Lecoq  [Ibid.,  1837,  p.  252)  mentions  that  a  draught  Mare,  after  difficult  parturi- 
tion, and  expulsion  of  the  foetal  membranes,  without  the  slightest  warning  protruded  a 
round  dull-colored  body  as  large  as  a  fist,  from  the  vulva.  Next  morning  this  had  a 
fleshy  appearance,  was  pyriform  in  shape,  as  large  as  a  three-pint  bottle,  and  eight  or 
nine  inches  in  length.  It  was  soft,  and  only  some  small  transverse  rugae  were  apparent 
on  its  surface.  On  the  hand  being  introduced  into  the  vagina,  it  was  evident  that  this 
body  was  continuous  with  it;  and  on  separating  the  labia  of  the  vulva,  on  the  upper 
surface  of  the  part,  at  a  short  distance  from  each  other  were  two  nipple-shaped  bodies, 
the  size  of  a  pea,  from  the  centre  of  which,  at  every  effort  made  by  the  Mare,  a  faintly- 
tinged  fluid  was  projected.  It  was  therefore  evident  that  the  tumor  was  the  inverted 
bladder.  Reposition  could  not  be  effected,  owing  to  the  struggles  of  the  Mare,  the  con- 
striction and  engorgement  of  the  sphincter,  and  the  thickening  of  the  parietes  of  the 
bladder  ;  so  to  save  the  animal,  amputation  was  resolved  upon.  "  Having  prepared  a 
strong  waxed  thread,  many  times  doubled,  and  to  the  extremities  of  which  we  had  at- 
tached two  small  pieces  of  wood  to  facilitate  tightening  the  ligature,  we  passed  it  round 
the  body  of  the  bladder,  an  inch  and  a  half  below  the  orifices  of  the  ureters,  and  drew 
the  knot  as  tightly  as  possible.  In  exploring  the  bladder,  we  perceived  that  it  con- 
tained some  fluid,  and  on  cutting  into  its  fundus  about  a  pint  of  light-red  odorless  liquid 
— the  product  of  the  exhalation  from  the  utero-vesical  portion  of  the  peritoneum — es- 
caped." 

The  Mare's  health  appeared  to  be  scarcely  affected  by  the  operation.  Three  days 
afterwards  the  efforts  to  micturate  were  less  violent;  the  bladder  below  the  ligature 
was  flaccid,  livid,  and  like  macerated  flesh  ;  the  parts  above,  and  in  immediate  pro.ximity 
to  the  ligature,  were  red  and  inflamed.  Every  time  the  animal  strained,  a  jet  of  urine 
escaped  from  the  ureters,  and  in  the  intervals  between  these  efforts  it  ran  continually 
from  the  vulva,  though  without  causing  any  apparent  inconvenience.  A  new  ligature, 
tightly  drawn,  was  placed  above  the  other,  at  which  the  parts  were  becoming  gangren- 
ous. Six  days  subsequentlv,  the  t^ini or  was  excised  an  inch  below  the  ligature,  and  the 
remaining  part  was  well  washed  with  camphorated  spirit  of  wine.  Suppuration  speedily 
set  in,  and  in  another  fifteen  days  the  part  had  healed.     The  Mare  was  put  to  work  in 


6i8  ACCIDENTS  INCIDENTAL  TO  PARTURITIOA 

a  month,  and  did  well ;  inside  the  thighs  was  slightly  excoriated  for  some  months  after- 
wards, and  the  salts  of  the  urine  had  become  deposited  on  the  hair  and  skin.  The 
urine  trickled  down  these  parts  almost  continuously. 

Nine  months  after  the  operation,  the  condition  of  the  Mare  was  as  follows  :  "The 
thighs  are  a  little  excoriated,  the  vulva  somewhat  swollen,. the  urine  runs  only  at  inter- 
vals, but  oftener  than  in  a  healthy  state,  and  in  a  small  quantity  at  a  time.  The  Mare 
assumes  the  natural  attitude  in  order  to  micturate,  and  discharges  about  half  a  pint  of 
urine  at  each  attempt.  The  hair  below  the  vulva  is  thin  and  easily  removed,  on  account 
of  the  flow  of  urine  over  the  part." 

4.  Devaux  [Ibid.,  p.  219)  relates  the  case  of  a  Mare  which  had  eversion  of  the  blad- 
der fifteen  days  after  abortion.  When  he  attempted  to  examine  it,  the  animal  struggled 
violently  and  threw  itself  down,  and  there  ensued  a  violent  distention  and  bruising  of 
the  tumor ;  so  that  in  the  course  of  a  few  minutes  five  or  six  pints  of  blood  escaped 
from  it.  Washing  with  pure  vinegar  checked  the  haemorrhage.  The  Mare  being  raised 
and  tranquillized,  reduction  was  affected  by  causing  the  mass  to  be  supported  by  an  as- 
sistant, and  gently  pressing  on  its  sides  with  the  fingers  and  hand  ;  it  returned  readily, 
and  the  hand  was  kept  pressing  on  it  for  neaily  half  an  hour.  The  animal  was  tied  up 
during  four  days  and  completely  recovered. 

5.  Baudson  [Annales  de  Med.  Veterinaire  de  Bruxelles,  1877,  p.  153)  refers'tothe  case 
of  a  three-year- old  Mare,  which  had  inversion  of  the  bladder  for  six  weeks.  Reposi- 
tion had  been  effected  by  an  empiric,  but  inversion  recurred  almost  immediately.  The 
tumor  presented  the  characteristic  appearances,  though  it  was  greatly  inflamed,  owing 
to  the  rough  manipulation  to  which  it  had  been  subjected,  as  well  as  the  exposure. 
The  animal  was  in  much  pain  and  strained  violently.  Reduction  being  deemed  impos- 
sible, an  iron  clam  was  fixed  behind  the  ureters,  and  gradually  tightened  until  the 
eighteenth  day,  when  the  fundus  and  body  of  the  organ  came  away.  The  remainder 
was  spontaneously  retracted,  and  the  Mare  went  to  work. 

6.  Decleene  {Ibid.,  1876,  p.  147)  furnishes  an  interesting  case  of  retroversion  or  retro- 
flexion of  the  bladder  against  the  floor  of  the  vagina,  which  was  inverted  by  the  dis- 
placed organ.  The  amateurs  who  had  tried  to  relieve  the  animal — a  Cow  which  had  just 
calved — thought  the  mass  was  the  thickened  foetal  envelopes  of  a  second  foetus  ;  com- 
mencement of  inversion  of  the  uterus  ;  inversion  of  the  bladder  ;  or  hernia  of  the  intes- 
tine. The  animal  was  lying  when  Decleene  examined  it,  and  it  was  breathing  quickly, 
as  well  as  making  violent  expulsive  efforts  ;  during  which  a  round  tumor,  the  size  of  a 
man's  head,  appeared  at  the  vulva,  and  diminished  in  size  when  the  straining  ceased. 
The  temperature  of  the  tumor  was  low ;  it  was  rather  hard,  and  almost  stony  in  consist- 
ence during  straining  ;  when  there  was  not  straining,  fluctuation  could  be  detected.  The 
surface  was  smooth  and  regular,  except  at  its  posterior  part,  where  were  some  abrasions, 
due  to  the  owner's  attempts  to  tear  through  it,  from  an  idea  that  it  was  the  "  water  bag  " 
of  a  second  foetus.  A  vaginal  exploration  proved  that  the  upper  and  lateral  surfaces  of 
the  tumor  were  directly  continuous  with  the  vaginal  mucous  membrane ;  and  that  the  os 
uteri  was  partially  dilated,  but  normal.  Internally  the  hand  could  not  advance  far  into 
the  vagina,  as  at  the  meatus  urinarius  the  mucous  membrane  was  reflected  on  itself  at  a 
very  acute  angle.  In  order  to  pass  the  finger  into  the  meatus  it  had  to  be  bent,  and 
even  then  it  could  only  be  advanced  a  short  distance,  in  consequence  of  the  inflexion  of 
the  neck  of  the  bladder. 

Moderate  pressure  for  more  than  five  minutes  was  unavailing  in  replacing  the  organ, 
in  consequence  of  the  continuous  straining  of  the  Cow.  The  animal  was  incited  to  get 
up,  and  at  the  moment  when  its  hind  quarters  were  raised,  the  knees  being  bent,  the 
pressure  forward  and  a  little  upward  caused  the  bladder  to  suddenly  resume  its  normal 
position  and  relations.     The  animal  quickly  recovered. 

7.  Neale  [Veterinarian,  vol.  xi.,  p.  410)  states  that  a  Sow  had  inversion  of  the  bladder 
after  bringing  forth  a  litter  of  ten  pigs.  A  butcher  thought  it  was  the  uterus,  and  return- 
ing it  into  the  vagina,  put  stitches  through  the  lips  of  the  vulva  to  retain  it.  It  again 
protruded,  however,  and  nothing  more  was  done  to  it.  It  sloughed  away,  and  the  Sow 
did  not  suffer  much  ;  indeed,  in  six  months  after  the  accident,  it  was  killed  for  bacon. 
The  bladder  was  found  to  have  completely  disappeared,  and  the  ureters  passed  directly 
from  the  kidneys  to  a  mass  about  the  size  of  a  lemon,  lying  in  the  vulva — the  remains 
of  the  organ. 

8.  Leech  {Ibid.,  vol.  xx.,  p.  425)  attended  an  aged  Cart  Mare  which  had  foaled  a  few 
days  previously,  and  was  suffering  from  inversion  of  the  bladder.  On  the  supposition 
that  it  was  the  uterus  which  protruded,  the  owner  had  tried  to  return  it,  and  had  passed 
sutures  through  the  labia  of  the  vulva.  On  these  being  removed,  it  was  ascertained 
that  the  bladder,  which  filled  the  vagina,  was  extensively  and  severely  inflamed  ;  urine 
was  ejected  at  intervals  from  the  ureters.  Attempts  at  reduction  were  made,  but  with- 
out success.  The  organ  was  then  ligatured  behind  the  ureters,  and  the  ligature  tight- 
ened every  day.     The  animal  received  general  depletive   treatment.     On  the  sixth  day 


TRAUMATIC  LESIONS  OF  THE  GENITAL  ORGANS,  ETC.  619 

the  tumor  was  removed  by  the  knife ;  it  weighed  seven  pounds.  The  Mare  died  three 
days  subsequently,  from  inflammation  of  the  vagina,  neck  of  the  bladder,  and  the  ureters. 
Leech  was  of  opinion  that  the  inflammation  was  chiefly  due  to  the  weight  of  the  mass 
after  the  ligature  was  applied,  and  he  recommends  immediate  amputation. 

9.  Tailby  {Ibid.,  vol.  xliii.,  p.  23)  attended  a  six-year-old  Mare  which  had  foaled  three 
days  previously,  and  soon  after  was  observed  to  have  a  large  mass  protruding  from  the 
vulva.  The  animal  was  in  great  pain,  pulse  and  res'piration  much  increased,  tremors  in 
the  hind  quarters,  great  difficulty  in  moving  from  side  to  side,  and  occasionally  lying 
down  and  getting  up  again.  The  protruded  viscus,  supposed  to  be  the  uterus,  was 
evidently  the  bladder  :  urine  trickling  from  the  orifice  of  the  ureters,  ana  the  hand  could 
be  readily  passed  into  the  vagina.  The  organ  appeared  to  be  in  a  gangrenous  condition. 
Reduction  was  attempted  without  casting  the  animal,  but  it  strained  so  violently  that  it 
had  to  be  thrown  down.  The  fundus  and  as  much  of  the  body  as  could  be  grasped, 
were  seized,  and  gentle  pressure  was  steadily  applied  with  three  fingers  upon  the 
entrance  to  the  urethra  ;  during  a  struggle  made  by  the  animal,  a  large  portion  of  the 
mass  receded,  and  the  hand  of  an  assistant  completed  the  reduction.  The  uterus,  vagina, 
and  bladder  were  then  injected  with  solution  of  carbolic  acid  (i  to  60).  Anodynes  and 
stimulants  were  subsequently  administered,  and  the  Mare  recovered. 

10.  Robinson  (Ibid.,  p.  78 1)  relates  a  case  of  inversion  of  the  bladder  in  a  Mare,  a 
sequel  of  parturition.  It  was  attended  with  so  much  general  prostration,  as  well  as 
congestion  of  the  bladder,  that  he  thought  it  inadvisable  to  attempt  reduction.  The  urine 
conveyed  by  the  ureters  filled  tlie  vagina,  and  was  frequently  ejected.  The  Mare  was 
ultimately  able  to  partially  retract  the  organ  within  the  vagina ! 


CHAPTER  VI. 

Traumatic  Lesions  of  the  Genital  and  Neighboring  Organs. 

Either  during  or  after  parturition,  the  genital  and  neighboring  organs 
are  exposed  to  injuries  of  a  more  or  less  serious  character,  according  to 
their  situation  and  extent.  These  we  will  now  consider  in  the  following 
order  :  i.  Laceration  and  rupture  of  the  uterus  ;  2.  Laceration  and  rupture 
of  the  vagina  ;  3.  Thro?nbus  of  the  vulva  and  vagina  ;  4.  Relaxation  of  the 
pelvic  symphyses  ;  5.  Rupture  of  the  bladder  ;  6.  Rupture  of  the  intestines  ; 
7.  Rupture  of  the  diaphragm  ;  8,  Rupture  of  the  abdominal  muscles  ;  9,  Rup- 
ture of  the  sacro-sciatic  ligament. 

Section  i. — Laceration  and  Rupture  of  the  Uterus. 

Laceration  and  rupture  of  the  soft  parturient  passages  are  very  far 
from  being  unusual  during  parturition  in  the  domestic  animals,  and  par- 
ticularly in  the  Mare  and  Cow ;  and  of  these  the  uterus  and  vagina  are 
most  frequently  involved. 

Solutions  of  continuity  of  the  uterus  are  often  met  with  by  the  veteri- 
nary obstetrist,  and  they  are  either  incomplete — when  the  organ  is  only 
partially  torn  or  lacerated,  or  complete — when  they  penetrate  through  the 
entire  thickness  of  the  uterine  wall,  and  perforate  into  the  abdominal 
cavity.  These  solutions  may  occur  either  during  pregnancy,  during  par- 
turition, or  at  a  variable  period  after  the  fcetus  has  been  removed  from 
the  uterus — when  it  is  generally  a  complication  of  inversion  of  this  organ. 
Antepartum  rupture  has  been  already  fully  alluded  to  at  page  184,  and 
we  have  now  to  study  its  occurrence  during  and  after  birth. 

Rupture  during  Birth. — Rupture  of  the  uterus  may  occur  spontaneously 
in  a  complete  or  incomplete  form  during  parturition  ;  and  though  the  ac- 
cident is  perhaps  not  so  frequent  in  animals  as  in  woman,  yet  there  are 
many  cases  on  record  in  which  it  has  undoubtedly  occurred  in  them,  and 


62 o  ACCIDENTS  INCIDENTAL   TO  PARTURITION. 

it  has  been  affirmed  by  highly  competent  authorities  that  it  has  been 
observed  in  Cows  which  had  not  received  any  assistance  during  parturi- 
tion. 

It  can  easily  be  understood  why,  if  there  is  any  material  obstacle  to  the 
passage  of  the  fcetus — such  as  induration  or  torsion  of  the  cervix,  or  a 
malposition  or  deformity  of  the  young  creature — the  violent  contractions 
of  the  powerful  muscular  layer  of  the  organ  should  overcome  the  resist- 
ance of  some  portion  of  its  own  fibres,  and  thus  lead  to  a  more  or  less 
extensive  solution  of  continuity,  which  may  involve  the  other  tunics  and 
produce  complete  perforation.  Non-penetrating,  or  incomplete  lacera- 
tions, in  the  majority  of  instances  occur  towards  the  cervix,  and  are 
usually  longitudinal.  Complete  rupture  may  take  place  at  any  part  of 
the  organ. 

This  accident  is  more  likely  to  occur  spontaneously  when  there 
chances  to  be  an  alteration  in  the  texture,  wholly  or  partially,  of  the 
uterus  wall ;  though  this  predisposing  cause  does  not  appear  to  be  so 
often  present  in  animals  as  in  the  human  female,  in  which  sudden  per- 
forating ruptures  never  take  place  when  the  uterine  tissue  is  healthy. 
Nevertheless,  there  can  be  no  reason  to  doubt  that  in  animals  alterations 
in  the  tissue  of  this  organ  may  and  do  occur  ;  and,  as  in  woman,  this  may 
assume  the  form  of  anomalous  development ;  interruption  of  the  normal 
tissue  by  interstitial  fibroids  or  cicatrices  ;  separation  of  the  muscular 
fibres  by  submucous  fibroids,  or  by  projecting  thin  parts  of  the  foetus  ; 
inflammatory  softening  of  some  portions  of  the  parenchyma  during  preg- 
nancy ;  or  thinning  of  the  wall  at  some  part  by  pressiire.  This  pressure 
may  arise  from  contact  with  the  brim  of  the  pelvis,  or  exostoses  in  or 
upon  the  bony  canal. 

The  exciting  cause,  however,  proceeds  from  considerable  mipediments 
to  the  progress  of  labor,  and  the  accident  is  due  to  the  energetic  contrac- 
tions of  the  uterine  walls  and  abdominal  muscles,  as  well  as  to  the  pres- 
sure, direct  or  indirect,  of  the  diaphragm  through  the  fully  dilated  chest 
cavity. 

In  such  cases  the  rent  may  be  so  great,  that  the  fcetus  passes  entirely 
through  it  into  the  abdominal  cavity,  enveloped  or  not  in  its  membranes  ; 
or  only  a  portion  of  it  has  escaped  through  the  tear,  and  it  may  be 
extracted  therefrom  with  more  or  less  dA^oxAiy per  vias  naturales,  and  in 
some  recorded  cases  birth  has  taken  place  by  the  natural  efforts,  the 
existence  of  rupture  only  becoming  evident  when  the  uterus  was  acci- 
dentally extruded  after  birth. 

More  frequently,  however,  the  accident  arises  from  artificial  mechani- 
cal causes,  brought  into  operation  in  the  course  of  manoeuvres  for 
effecting  the  extraction  of  the  fcetus.  The  various  instruments  employed 
may  either  tear  or  incise  the  uterus  ;  or  the  organ  may  be  lacerated  dur- 
ing traction  on  the  foetus  when  the  "  waters  "  have  escaped,  and  its  walls 
closely  envelop  the  young  creature  ;  or  during  retropulsion  or  version. 
The  tenuity  of  the  uterine  parietes  at  this  period,  renders  such  an  acci- 
dent as  laceration  one  of  easy  occurrence  ;  and,  however  large  the  tear 
maybe  during  life,  after  death  it  usually  appears  much  smaller,  because 
of  the  contraction  of  the  muscular  tissue. 

In  all  these  cases,  when  the  organ  remains  /;/  situ,  the  diagnosis  is  diffi- 
cult, and  generally  it  is  only  on  post-mortem  examination  that  the  lesion 
is  discovered.  Nevertheless,  certain  clinical  symptoms  are  often 
observed  during  life,  which,  if  they  were  constant,  might  lead  to  a  sus- 


TRAUMATIC  LESIONS  OF  THE  GENITAL  ORGANS,  ETC.  621 

picioii  of  the  existence  of  rupture.  Thus,  the  expulsive  efforts  are  very 
energetic  and  regular  up  to  a  certain  period,  when  all  at  once  they  cease  ; 
the  animal  begins  to  manifest  symptoms  of  abdominal  pain — lying  down 
and  getting  up,  stamping  and  pawing,  looking  towards  its  flanks,  moving 
about  uneasily,  moaning,  bellowing,  neighing,  or  even  screaming,  when 
the  rupture  occurs. 

Non-penetrating  lacerations  do  not,  as  a  rule,  give  rise  to  very 
marked  symptoms  immediately  ;  though  subsequently  they  may  produce 
metritis  or  metro-peritonitis,  or  induce  septic  infection.  Their  presence 
is  not  easily  diagnosed  during  life. 

In  some  few  instances,  the  existedice  of  complete  rupture  has  been 
ascertained  by  manual  exploration  of  the  uterus  ;  in  others  it  has  been 
discovered  de  visu  in  inversion  of  the  organ.  The  pulse  soon  becomes 
feeble  if  there  is  much  haemorrhage,  and  exhaustion  quickly  supeivenes. 
If  death  does  not  occur  promptly,  acute  fever  ensues,  and  symptoms  of 
peritonitis  or  septic  infection. 

The  complications  attending  this  accident  are  always  serious,  and  ren- 
der the  prognosis  unfavorable  in  nearly  every  case.  When,  however,  the 
laceration  occurs  at  the  upper  part  or  sides  of  the  uterus,  the  accident  is 
not  so  grave  as  when  the  floor  of  the  organ  is  involved  ;  if  the  os  remains 
closed,  so  as 'to  prevent  the  admission  of  air,  the  circumstance  is  still 
more  favorable,  though  this  can- rarely  indeed  be  the  case. 

The  chief  cojnplications  are  hcEmorrhage,  hernia  of  the  intestines,  2LXiA  peri- 
tonitis. 

Death  from  direct  hcemorrhage  is  less  frequent  than  might  be  antici- 
pated, knowing  the  great  vascularity  of  the  uterus  at  parturition.  This 
unfrequency  is  explained  by  the  fact,  that  bleeding  from  such  a  laceration 
is  less  profuse  than  from  an  incised  wound  of  the  same  dimensions. 
Nearly  always,  too,  the  foetus  is  partially  or  entirely  expelled  from  the 
uterus  into  the  abdominal  cavity,  or  is  born  immediately  after  the  acci- 
dent, and  the  organ  then  may  firmly  contract. 

Nevertheless,  in  some  instances,  the  haemorrhage  is  so  great  that  a 
fatal  termination  soon  takes  place,  with  all  the  symptoms  already 
described  at  page  577. 

Hernia  of  the  intestines  ozcxxx^  when  the  rent  is  somewhat  large,  and 
the  uterus,  flaccid  and  uncontracted,  allows  these  viscera  to  enter  its 
cavity — they  being  propelled  therein  by  the  action  of  the  abdominal 
muscles.  In  some  instances  the  intestinal  mass  received  into  the  uterus 
has  been  so  large  that  they  have  passed  through  the  vagina  and  vulva, 
reached  the  ground,  and  the  animal  has  trodden  upon  them — thus  has- 
tening death  ;  while  in  others,  the  hernia  has  been  reduced  and  the  crea- 
ture survived. 

Peritonitis  may  be  primary  or  secondary.  ^\\&n  primary,  it  is  due  to 
the  escape  of  blood,  the  foetal  fluids  or  envelopes,  or  the  foetus  itself. 
When  secondary,  or  consecutive,  it  may  result  either  from  the  extension  of 
the  inflammation  to  the  peritoneum,  or  the  discharge  of  the  lochia,  pus, 
etc.,  from  the  interior  of  the  organ. 

The  escape  of  fluids  from  the  uterus  is,  of  course,  more  likely  to  take 
place  when  the  rupture  is  inferior  than  when  lateral  or  superior.  Death 
is  nearly  always  the  result  of  peritonitis  or  metro-peritonitis. 

Treatment. 

The  treatment  of  rupture  of  the  uterus  during  parturition  is  generally 


622  ACCIDENTS  INCIDENTAL   TO  PARTURITION. 

very  unsatisfactory.  Very  little  can  be  done  to  check  the  haemorrhage,  if 
it  is  great,  and  consecutive  peritonitis  is  always  a  most  serious  complica- 
tion. 

If  the  fcetus  remains  within  the  peritoneal  sac,  a  favorable  termination 
can  scarcely  be  hoped  for  ;  though  in  some  rare  instances,  if  air  does  not 
obtain  access  to  the  cavity  of  the  uterus  or  abdomen,  it  is  possible  that  it 
may  terminate  in  all  the  various  ways  of  extra-uterine  pregnancy.  If  the 
fcetus  is  extracted,  the  rent  may  heal  up  ;  though  this  is  very  unlikely  if 
the  edges  are  much  contused,  and  the  animal  will,  in  all  probability, 
perish  from  consecutive  purulent  peritonitis. 

If  the  fcetus  is  still  wholly  or  partially  in  the  uterus,  it  and  its 
envelopes  must  be  extracted  without  delay,  and  as  gently  as  possible  ;  as 
haemorrhage  will  probably  only  cease  with  the  contraction  of  the  organ. 
If  the  uterus  does  not  contract,  but  remains  flaccid  after  removal  of  the 
placenta,  then  it  maybe  stimulated  to  do  so  by  introducing  the  hand 
into  the  interior  for  some  time,  after  removing  the  coagula.  If  this  fails, 
and  the  rupture  is  not  in  the  floor  of  the  uterus,  small  pieces  of  ice,  cold 
water,  or  astringents  may  be  introduced,  and  ergot  of  rye  administered  ; 
a  jet  of  cold  water  should  be  allowed  to  play  upon  the  loins,  wherever 
the  rupture  may  be.  If  there  is  hernia  of  the  intestines,  these,  of  course, 
must  be  promptly  returned  into  the  abdominal  cavity,  before  any  thing  is 
done  to  the  uterus. 

Some  authorities  advise  that  the  uterus  should  be  gently  inverted  and 
brought  outside  the  vulva,  in  order  that  the  rent  maybe  closed  by  suture, 
and  then  return  it.  But  this  course  is  not  to  be  recommended,  as  it  is 
very  dangerous,  and  the  wound  will  unite  without  sutures  if  the  organ 
contracts  and  no  complications  follow. 

The  cavity  of  the  uterus  should  be  swabbed  with  a  weak  solution  of 
carbolic  acid  (i  to  loo,  up  to  250)  ;  and  to  prevent  septic  infection  by 
admission  of  air,  a  pledget  of  carbolized  lint  or  tow  should  be  placed  in 
the  OS  or  vagina,  and  changed  nov»^  and  again. 

Straining  must  be  subdued  by  doses  of  opium  or  chloral,  or  the  subcu- 
taneous injection  of  morphia  ;  and  the  diet  must  be  carefully  attended 
to.  If  there  is  constipation,  mild  laxatives  and  enemas  may  be  admin- 
istered. Consecutive  fever  and  peritonitis  must  be  treated  by  cold,  and 
large  doses  of  anodynes — such  as  opium,  as  well  as  counter-irritants. 
Metritis  must  be  treated  in  the  same  manner,  by  the  gentle  injection  of 
cold  water  ;  or  the  introduction  of  small  pieces  of  ice  into  the  genital 
canal  will  be  beneficial.  Should  symptoms  of  septic  infection  appear, 
stimulants,  with  small  doses  of  carbolic  acid  and  sulphite  of  soda,  must 
be  given. 

When  the  foetus  has  passed  through  the  rent  into  the  abdominal 
cavity,  d^Mv^ry  per  vias  natur ales  is  then  impossible,  and  the  Caesarean 
section  must  be  resorted  to  ;  unless  it  be  decided  to  allow  the  animal  to 
take  its  chance,  and  get  rid  of  the  fcetus  as  in  extra-uterine  foetation, 
should  it  survive  the  accident. 

Rupture  of  the  Uterus  after  Parturition. 

Rupture  of  the  uterus  after  parturition  generally  complicates  inversion 
of  the  organ  and  is  due  to  mechanical  injury  either  on  the  part  of 
amateurs,  or  even  of  the  veterinary  surgeon,  when  endeavoring  to  re- 
place  it  j  sometimes   it   is  produced  by  the  animal   itself,  or  by  other 


TRAUMATIC  LESIONS  OF  THE  GENITAL  ORGANS,  ETC.  623 

animals  when  the  prolapsed  organ  gets  in  their  way.  In  some  instances 
it  has  been  caused  by  jagged  bones  of  the  fcEtus  in  embryotomy,  and  in 
others  by  pessaries  introduced  into  the  genital  canal  to  retain  the  inverted 
organ. 

In  such  instances  the  diagnosis  is  easy  ;  for  if  the  uterus  is  still  inverted 
the  rent  is  visible,  and  its  dimensions,  situation,  and  gravity  can  be  taken 
into  account. 

It  is  somewhat  remarkable  that  laceration  or  rupture  of  the  extruded 
organ  is  much  less  serious  than  the  same  amount  of  injury  to  the  uterus 
in  situ,  and  it  would  appear  that  in  inversion  there  is  the  greatest  toler- 
ance of  the  most  serious  lesions.  Why  this  should  be  has  not  been  ex- 
plained ;  but  the  fact  is  nevertheless  patent,  that  in  very  many  instances, 
when  reposition  of  the  uterus  has  been  effected,  the  rupture  has  readily 
cicatrized,  and  union  has  been  so  complete  and  substantial,  that  the 
animals  have  afterwards  been  successfully  bred  from. 

Some  authorities  have  closed  the  rent  by  suture  ;  but  very  many  have 
not,  and  the  termination  has  been  as  favorable  in  the  one  series  of  cases 
as  the  other.  Unless  the  rupture  is  in  the  lower  wall  of  the  uterus, 
sutures  are  at  least  superfluous. 

Beyond  the  measures  for  reduction  of  the  inversion,  and  the  neces- 
sary antiseptic  after-treatment,  little  more  has  to  be  observed.  When 
the  rupture  is  serious  in  inversion,  and  grave  results  are  to  be  appre- 
hended should  the  uterus  be  returned,  then  it  may  be  advisable  to  ampu- 
tate the  organ.  This  may  be  accomplished  in  the  manner  already  indi- 
cated. 

We  shall  notice  a  few  of  the  recorded  cases  of  rupture   of  the  uterus. 

1.  Louis  {Reaieil  de  Mid.  Vetermaire,  i?>6i)  attended  a  Mare — a  primipara — which  had 
aborted,  and  soon  afterwards  the  uterus  was  inverted,  with  the  placenta  adhering  to  it ; 
the  organ  was  ruptured  in  the  two-thirds  of  its  antero-posterior  diameter,  i.e.,  laterally. 
It  was  the  left  side — probably  the  left  cornu.  The  Mare  was  straining  violently.  The 
inverted  portion  was  replaced,  a  cord  truss  was  applied,  and  the  animal  had  recovered  in 
twenty  days. 

2.  Darquie  (Gelle',  Pathologie  Bovine,  vol.  iii.)  was  called  in  to  reduce  the  inverted  uterus 
of  a  four-year-old  Cow,  three  days  after  parturition.  Reduction  was  accomplished,  and 
a  truss  applied.  The  straining  continued,  however,  and  on  the  fourth  day  after  reduc- 
tion, one  of  the  strands  of  the  truss  having  been  torn,  inversion  again  occurred.  On  the 
arrival  of  Darquie,  the  uterus  was  found  to  be  enormously  swollen,  and  the  mucous 
membrane  hanging  about  it  in  shreds.  He  went  for  assistance,  but  forgot  to  close  the 
door  of  the  shed,  and  during  his  absence  two  large  dogs  had  got  in,  and  commenced  de- 
vouring the  organ.  When  he  returned  half  an  hour  afterwards,  the  Cow  was  lying  and 
covered  with  blood,  and  the  uterus  was  destroyed  nearly  as  high  as  the  vulva.  Fearing  the 
results  of  the  haemorrhage,  Darquie  was  about  to  ligature  en  wajj^what  remained  of  the 
uterus,  when  the  animal  suddenly  jumped  up,  and  all  that  was  left  disappeared  in  the 
pelvis.  Nothing  was  done  except  to  prescribe  some  acidulated  injections  into  the  vagina, 
low  diet,  and  a  few  hygienic  measures;  in  about  fifteen  days  the  Cow  appeared  to  be 
quite  well. 

3.  Eleout  [Rec.  de  Med.  Veterinaire,  1841)  had  to  treat  a  Cow  which  produced  a  dead 
calf,  and  soon  after  showed  complete  inversion  of  the  uterus.  The  latter  was  of  a  deep 
red  color,  and  soiled.  Reposition  was  attempted.  "  I  commenced  with  the  left  cornu, 
which  I  readily  returned,  holding  it  by  its  base,  and  pushing  it  with  my  left  hand  until  it 
disappeared.  I  proceeded  in  the  same  manner  with  the  right  cornu,  which  was  likewise 
replaced.  There  was  only  a  small  portion  that  was  not  returned,  when  the  Cow  backed 
upon  me  with  such  force  that  the  termination  of  the  right  cornu  was  ruptured,  and  my 
hand  and  arm  penetrated  into  the  abdomen.  The  uterus,  finding  nothing  to  resist  it, 
was  again  expelled.  My  first  thought  was  to  unite  the  edges  of  the  wound  by  suture  ; 
but  seeing  that  the  animal  was  greatly  debilitated,  that  the  mucous  membrane  of 
the  ut  rus  had  been  too  long  exposed  to  irritating  contact  with  the  air,  that  by  this  pro- 
ceeding I  would  protract  the  operation,  and  that  in  similar  cases  others  had  obtained  a 
radical  cure  by  excising  a  portion  of  the  organ,  I  set  about  a  second  reduction  of  the 


624  ACCIDENTS  INCIDENTAL  TO  PARTURITION. 

uterus,  which  was  returned  into  the  abdominal  cavity  without  difficulty."  A  pessary  was 
introduced  into  the  vagina,  and  the  hind-quarters  of  the  Cow  elevated;  emollient  injec- 
tions were  employed,  and  stimulating  draughts  administered.  On  the  following  day 
there  was  much  fever  and  general  disturbance.  Blood  was  abstracted,  febrifuge  medi- 
cine given,  and  a  poultice  applied  to  the  loins.  On  the  fourth  day  the  pessary  was  with- 
drawn, and  a  sanious  fetid  fluid  escaped  from  the  vulva.  Vaginal  injections  were  fre- 
quently resorted  to.  In  twelve  days  the  Cow  was  turned  out  to  graze,  evidently  re- 
covered. 

4.  Franyois  {Annales  de  Med.  Veterinaire  de  Bruxelles,  1877,  p.  157)  describes  a  case 
of  inversion  of  the  uterus  in  a  Cow,  which  was  complicated  by  a  rupture  in  the  wall  of 
the  organ,  about  eight  inches  in  length.  This  rent  was  closed  by  suture,  the  uterus  was 
returned,  and  retained  by  a  truss.     The  case  did  well.  * 

5.  Obich  (  Wocheiischrift  fi'tr  'Ihierheilkwtde  jmd  Viehzucht,  1869,  p.  349)  describes  the 
case  of  a  Cow  which,  suffering  from  torsion  of  the  uterus,  had,  during  detorsion,  a  rent 
made  in  the  upper  wall  of  the  organ ;  this  rent  was  so  large  that  the  outspread  hand 
could  be  passed  through  it  into  the  abdominal  cavity.  The  animal  was  very  ill  for  eight 
days,  but  it  gradually  recovered  without  any  treatment. 

0.  Adam  {Ibid.,  1870,  p. .411)  mentions  that  a  four-year-old  Cow  had  a  calf,  and  ap- 
peared to  be  quite  Well  until  ten  days  afterwards,  when  haemorrhage  from  the  vulva  was 
observed;  and  on  the  following  day  there  was  loss  of  appetite,  high  fever,  and  greatly 
accelerated  pulse  and  respiration,  and  the  animal  showed  such  serious  symptoms  that 
it  was  killed.  On  examination  the  uterus  was  found  to  be  tolerably  healthy,  but  in  the 
right  cornu,  which  had  contained  the  calf,  was  found  a  quantity  of  partially  coagulated 
blood,  while  the  mucous  and  muscular  coats  were  lacerated  to  the  extent  of  nearly  two 
inches — the  laceration  commencing  at  the  base  of  a  cotyledon.  In  the  pericardial  sac 
was  some  dark-red  fluid,  and  the  right  endocardium  was  marked  by  large  ecchymoses; 
while  the  fourth  compartment  of  the  stomach,  as  well  as  the  small  intestine,  had  their 
mucous  membrane  tumefied  and  very  red,  and  that  of  the  gall-bladder  was  ecchymosed. 
All  this  pointed  to  a  sudden  attack  of  septikaemia,  resulting  from  the  laceration. 

7.  Copeman  (  Veterinary  Record  and  Tra7tsactions,-\d\.  v.,  p.  1 54)  relates  a  case  of  rup- 
ture of  the  uterus  in  a  Cow,  occurring  after  protracted  labor.  The  rent  was  nearly  eight 
inches  long,  and  about  a  foot  from  the  os  ;  the  small  intestine  passed  through  it  into 
the  uterus.  These  were  replaced,  and  Copeman  held  the  edges  of  the  laceration  to- 
gether for  a  quarter  of  an  hour.  No  other  treatment  was  adopted,  and  the  animal  re- 
covered. 

8.  Higginson  {Veterinarian,  vol.  xiii.,  p.  395)  was  summoned  to  attend  a  Cow  which 
had  calved  five  hours  previously.  He  found  complete  inversion  of  the  uterus,  and  the 
fundus  of  the  organ  so  lacerated  as  to  allow  a  large  portion  of  the  small  intestine  to  pass 
through.  This  rupture  was  probably  produced  by  an  amateur  who  had  tried  to  reduce 
the  inversion,  but  failed.  The  intestine  was  fir.st  returned,  and  then  the  uterus,  a  truss 
being  applied.  Stimulants,  opiates,  and  febrifuge  medicines  were  administered,  and  in 
nine  days  the  Cow  was  convalescent.  This  Veterinarian  does  not  approve  of  sutures  in 
the  uterus. 

9.  At  page  345  we  have  given  an  instance  in  which  a  rent  in  the  uterus  and  vagina  was 
discovered  to  have  cicatrized  perfectly. 

10.  Cartwright  (  Veterinarian,  vol.  xv.,  p.  429)  relates  the  case  of  a  Cow  from  which  a 
calf  had  been  forcibly  extracted  by  an  amateur  on  the  previous  day.  On  examination, 
the  uterus  was  found  to  be  ruptured,  and  as  the  animal  was  evidently  sinking  it  was 
killed.  At  the  neck  of  the  uterus  was  a  rent  sufficiently  large  to  admit  a  man's  head. 
The  rectum  was  also  torn. 

11.  The  same  authority  {Ibid.)  states  that  he  was  called  to  a  Cow,  from  which  the 
head,  fore-limbs,  and  body  of  a  calf  had  been  removed.  It  was  intended  to  extract  the 
hind  extremities  by  the  application  of  greater  force,  but  on  the  amateur  introducing  his 
arm  they  could  not  be  found.  Cartwright  soon  discovered  that  the  uterus  was  ruptured 
to  a  very  great  extent,  and  through  the  opening  the  limbs  had  receded.  The  Cow  lived 
for  several  hours  after  the  accident,  without  evincing  any  pain  or  debility,  and  was  ulti- 
mately destroyed. 

12.  This  authority  {Ibid.,  vol.  xviii.)  gives  an  account  of  a  Cow  which  was  most  cruelly 
dealt  with  by  amateurs,  while  trying  to  deliver  it  of  a  calf  in  malposition.  The  extrac- 
tion occupied  two  or  three  hours,  during  which  time  it  was  observed  that  the  animal 
breathed  quicker  than  usual,  and  groaned  very  much;  it  also  strained  violently,  though 
this  ceased  immediately  before  delivery.  It  soon  began  to  "  breathe  short,  threw  the 
head  about,  moaned,  and  was  restless."  Death  took  place  in  about  twenty-four  hours. 
The  uterus  was  observed  to  be  ruptured  on  its  lower  surface,  to  the  extent  of  eicrhteen 
inches  in  a  straight  line  from  the  cervix  towards  the  fundus.  The  abdomen  contained 
about  two  gallons  of  bloody  serum,  and  the  peritoneum  was  inflamed. 

13.  Cartwright  {Ibid.)  gives  another  fatal  case  of  rupture  of  the  uterus,  due  to  attempts 


TRAUMATIC  LESIONS  OF  THE  GENITAL  ORGANS,  ETC.  625 

to  extract  a  calf  in  a  false  presentation.  The  Cow  died.  The  peritoneum  was  inflamed, 
about  two  quarts  of  coagulated  blood  was  contained  in  the  uterus,  and  the  floor  of  the 
latter,  towards  the  fundus,  was  lacerated  and  ruptured  in  two  places.  One  rupture  was 
towards  the  posterior  part  of  the  fundus,  extending  in  a  circular  manner  nearly  around 
it.     The  organ  had  contracted  very  much. 

14.  Younghusband  {Ibid.,  vol.  xxvi.,  p.  382)  was  sent  for  in  haste  to  see  a  Cow  which, 
three  days  previously,  had  calved,  and  was  apparently  quite  well  until  that  morning, 
when  inversion  of  the  uterus  was  discovered.  He  found  the  placental  membranes  ad- 
herent to  the  surface  of  the  organ,  which  was  greatly  soiled.  The  hind-quarters  were 
well  elevated,  the  placenta  detached,  and  the  uterus  cleansed  by  weak  spirit  and  water  ; 
on  proceeding  to  return  it,  a  large  rent  was  found  through  which  the  hand  could  be 
passed,  and  which  was  supposed  to  have  been  caused  by  the  next  Cow  having  trodden 
upon  the  extruded  mass.  Reposition  was  attempted.  "  Judging  I  had  got  all  the  part 
into  a  right  position,  I  made  an  attempt  to  withdraw  my  arm  ;  but  in  doing  this  the  Cow 
immediately  began  to  strain  with  such  violence  that  it  was  with  the  greatest  difficulty  I 
could  retain  the  part.  But  by  a  fortunate  slip,  her  anterior  parts  were  brought  so  near 
the  ground  that  I  now  easily  accomplished  that  which  for  a  length  of  time  I  had  found 
the  gre'atest  difficulty  in  attempting  to  do — getting  the  part  into  a  right  position,  retain- 
ing it  there,  and  withdrawing  my  arm  without  difficulty."  The  usual  measures  were 
adopted  to  prevent  a  recurrence  of  the  inversion,  an  anodyne  was  given,  and  recovery 
soon  ensued.     The  Cow  had  two  calves  afterwards. 

15.  The  same  veterinary  surgeon  (//^/^.)  refers  to  the  case  of  a  Cow  which  calved 
without  difficulty,  and  soon  after  had  inversion  of  the  uterus,  the  placen'.a  remaining  ad- 
herent. The  owner  took  precautions  against  injury  to  the  organ,  and  hurriedly  sent  for 
Younghusband,  who  on  arrival  detached  the  placenta,  and  readily  replaced  the  uterus. 
Immediately,  however,  a  portion  of  the  small  intestine  appeared  through  the  vulva,  and 
a  rent  was  soon  discovered  towards  the  fundus  of  the  organ.  The  intestine  was  returned 
without  much  difficulty,  and  contraction  of  the  uterus  was  brought  about  by  applying 
tincture  of  opium  and  camphor.     No  truss  was  employed,  and  the  Cow  recovered. 

SECTION    II. — LACERATION    AND    RUPTURE    OF    THE  VAGINA 

Lacerations  and  rupture  of  the  vagina  are  not  at  all  unfrequent  in  the 
larger  domesticated  animals,  and  they  are  generally  as  serious  as  those  of 
the  uterus.  These  accidents  may  occur  during  copulation,  as  well  as  in 
parturition  ;  but  they  are  more  common  in  the  latter.  Trifling  laceration 
of  the  vagina  and  vulva  is  often  observed  in  primiparae,  or  those  animals 
in  which  the  soft  parturient  passages  are  narrow  or  rigid. 

The  injury  may  be  either  spontaneous  or  accidental.  The  accidental  in- 
juries are  those  produced  artificially  during  assisted  labor,  and  are  due 
either  to  the  instruments  employed — hooks,  forceps,  knives,  etc.  ;  the 
hand  or  the  nails  of  the  fingers  of  the  obstetrist — the  sharp  exposed  bones 
of  the  foetus  when  embryotomy  has  been  practised,  or  from  some  salient 
part  of  the  young  creature  during  the  uterine  contractions.  In  the  latter 
case,  the  feet  generally  cause  the  laceration  or  rupture.  Deformity  of  the 
pelvis,  or  roughened  nodules  of  bone  in  the  vicinity  of  the  genital  canal, 
may  also  lead  to  serious  lesions  of  the  vagina. 

When  the  lesion  occurs  in  what  we  may  call  a  "spontaneous  manner," 
it  happens  either  that  the  vagina  is  lacerated  along  with  the  uterus,  during 
natural  labor  and  from  continuity  of  texture,  or  when  the  os  is  amply 
dilated,  but  the  vagina  is  overstretched  by  the  foetus. 

In  some  instances  such  an  accident  as  rupture  of  the  vagina  may  be 
secondary :  as  when  the  textures  which  form  its  walls  are  much  bruised 
and  contused  during  the  passage  of  the  foetus.  Then  gangrene  may 
supervene,  and  the  mortified  tissue  be  thrown  off  in  a  gradual  manner, 
until  complete  perforation  has  taken  place. 

The  lesions  arising  from  these  different  causes  are  extremely  varied — 
from  removal  of  the  epithelium  or  simple  abrasion,  to  laceration  of  the 
mucous  membrane,  or  even  thorough  perforation  of  the  vagina  ;  and  they 

40 


626  ACCIDENTS  INCIDENTAL  TO  PARTURITION. 

may  be  situated  either  towards  the  vutva  or  cervix  uteri,  on  the  sides, 
floor,  or  roof  of  the  canal  ;  while  they  may  only  concern  the  vagina,  or 
involve,  at  the  same  time,  the  neighboring  organs  and  textures.  Conse- 
quently, the  gravity,  as  well  as  the  symptoms  of  such  lesions,  vary  con- 
siderably, according  to  their  simplicity  or  complexity.  Nevertheless,  as 
we  shall  have  to  note  hereafter,  a  very  trifling  abrasion  may  bring  about 
very  serious  consequences  ;  while  an  apparently  formidable  injury  maybe 
followed  by  no  unfavorable  indications. 

With  regard  to  rupture  of  the  vagina,  and  particularly  with  that  which 
may  be  designated  "  spontaneous,"  it  may  be  remarked  that  when  the 
lesion  occurs  towards  the  cervix  uteri,  it  is  nearly  always  transversal,  and, 
as  has  been  before  noted,  the  vagina  may  be  completely  separated  from 
the  uterus.  In  other  instances,  the  form  and  direction  of  the  rupture  will 
differ  considerably.  Longitudinal  rents  often  extend  into  the  cervix  uteri 
and  body  of  the  uterus. 

Of  all  the  domesticated  animals,  the  Mare  appears  to  suffer  most  fre- 
quently from  lesions  of  the  vagina  produced  during  parturition.  The 
reasons  for  this  liability  we  have  already  alluded  to,  and  they  may  be 
chiefly  referred  to  the  length  of  the  limbs  of  the  foetus,  and  the  energetic 
and  rapid  contractions  of  the  uterus  ;  as  \vell  as  the  greater  susceptibility 
of  this  animal  to  morbid  influences — such  as  septikasmia.  Nevertheless, 
in  all  animals  these  injuries  are  notoriously  serious,  and  if  the  laceration 
occurs  when  the  tissues  of  this  part  are  bruised,  chafed,  and  irritated  by 
manipulations  during  a  laborious  delivery,  they  are  all  the  more  grave, 
^ainard  justly  remarks  that  Bitches  and  Cats  in  which  such  a  condition 
of  the  tissues  exist,  all  succumb  if  there  is  the  most  trifling  rupture  of  the 
vagina,  even  if  there  is  no  hernia. 

If  the  laceration  is  extensive  towards  the  bottom  of  the  vagina,  the  ab- 
dominal cavity  will  be  opened,  and  the  foetus,  if  it  has  not  been  expelled, 
may  have  partly  passed  through  the  rupture  ;  and  in  consequence  of  the 
walls  of  the  passage  being  much  less  contractile  than  those  of  the  uterus, 
the  accidental  opening  is  more  pervious  in  the  former  than  the  latter, 
and  thus  all  the  more  readily  allows  the  intestines  or  bladder  to  pass 
through. 

Laceration  or  rupture  of  the  vagina  is  more  easily  diagnosed  than  when 
this  accident  occurs  in  the  uterus,  as  the  vagina  is  much  more  accessible 
to  the  eye  and  hand  ;  though  in  some  cases  it  is  difficult  to  arrive  at  an 
exact  knowledge  of  the  situation  or  extent  of  the  injury. 

With  regard  to  progtiosis^  this  will  much  depend  upon  circumstances, 
and  the  complications  met  with.  Sometimes  a  mere  abrasion  of  the  mu- 
cous membrane,  which  produces  a  raw  surface,  or  a  laceration  extending 
to  the  submucous  connective  tissue,  may  lead  to  septic  infection.  This  is 
particularly  to  be  apprehended  should  the  foetus  or  membranes  have 
undergone  decomposition,  or  any  putrid  matter — as  the  lochia — allowed 
to  remain  in  the  genital  canal,  especially  during  hot  weather.  Wounds 
or  lacerations  on  the  floor  of  the  vagina  are  generally  more  serious  than 
those  on  the  roof  or  sides,  for  the  reasons  mentioned  with  regard  to  rup- 
ture of  the  uterus.  And  even  wounds  or  rupture  of  the  sides  or  roof  of 
the  vagina  are  much  more  serious  than  the  incisions  made  through  its 
walls  in  ovariotomy,  owing  to  the  presence,  during  parturition  and  the 
puerperal  state,  of  .fluids  which  may  quickly  become,  or  are  already, 
putrescent. 

Hcemorrhage  is  generally  not  so  much  to  be   dreaded  as  in  lacerations 


TRAUMATIC  LESIONS  OF  THE  GENITAL  ORGANS,  ETC.  627 

of  the  uterus ;  though  occasionally  it  may  be  so  serious  as  to  endanger 
the  life  of  the  animal. 

Hernia  of  the  intestine  occurs  when  perforation  of  the  vaginal  wall,  near 
the  cervix,  is  complete,  and  the  peritoneal  cavity  is  opened.  This  is  a 
serious  complication,  as  is  also  hernia  of  the  bladder,  which  may  happen 
when  the  rent  is  adjacent  to  that  viscus  ;  though  in  the  case  alluded  to 
by  Riviere  (page  616)  it  was  deemed  a  fortunate  circumstance  that  cysto- 
cele  was  present,  as  the  bladder  effectually  closed  the  rupture  in  the 
vagina,  and  thus  prevented  the  escape  of  the  lochial  and  other  fluids  into 
the  abdominal  cavity. 

Peritonitis  and  pelvic  cellulitis  are  also  very  serious  complications  suc- 
ceeding laceration,  and  are  a  consequence  either  of  the  extension  of 
vaginal  inflammation  to  the  neighboring  tissues,  or  the  escape  of  septic 
matters  or  inflammatory  products  into  the  pelvic  connective  tissue  or  the 
peritoneal  cavity. 

So  that  if  extensive  laceration  of  the  vagina  does  not  produce  rapid 
death,  there  are  other  grave  dangers  to  be  apprehended  from  either  present 
or  subsequent  complications.  The  inflammation  of  the  vagina  and  sub- 
mucous tissues,  with  suppuration  and  partial  gangrene,  may  lead  to  the 
formation  of  fistula,  or  even  of  wide-spread  destruction  of  the  soft  parts 
in  the  pelvic  cavity,  which  sooner  or  later  induce  a  fatal  termination. 
Should  this  not  occur,  and  some  of  the  neighboring  organs  have  been 
injured  at  the  same  time  as  the  vagina,  then  we  may  have  such  important 
damage  as  to  render  the  animal  nearly  valueless.  We  will  refer  to  some 
of  these  injuries  presently. 

The  symptoms  of  injury  to  the  vagina  and  neighboring  organs  will,  of 
course,  vary  with  their  nature  and  extent. 

Much  constitutional  disturbance  is  generally  only  manifested  when  the 
lesions  are  serious,  or  when  septic  infection  has  taken  place.  Small 
rents  may  not  give  rise  to  any  perceptible  derangement,  except,  perhaps, 
a  little  fever  and  tumefaction  \  but  if  they  extend  deeply  into  the  con- 
nective tissue,  then  acute  fever,  infiltration,  and  other  grave  symptoms 
may  supervene. 

With  regard  to  treatment.     This  also  must  depend  upon  circumstances. 

When  rupture  of  the  vagina  is  recognized  during  parturition,  delivery 
should  be  eftected  as  speedily  as  possible,  and  with  every  care,  in  order 
to  prevent  the  laceration  extending  and  the  foetus  passing  into  it.  If,  un- 
fortunately, some  part  of  the  latter  has  lodged  in  the  rent,  it  must  be  re- 
moved therefrom  with  the  utmost  precaution,  so  as  not  to  injure  other 
viscera.  The  foetal  membranes  should  also  be  extracted  as  soon  as  pos- 
sible. If  there  is  heemorrhage  from  the  vagina,  this  may  be  suppressed 
by  ice  or  injections  of  cold  water  if  the  rent  is  superior  or  lateral  ;  if  it  is 
inferior,  then  a  sponge  or  a  cloth  soaked  in  cold  water  should  be  placed 
in  the  canal.  Should  there  be  hernia  of  the  bladder  or  intestines,  these 
must  be  replaced  at  once. 

In  all  cases  of  wounds,  abrasions,  or  rupture  of  the  vagina,  every  pre- 
caution should  be  observed  with  a  view  to  the  prevention  of  septic  infec- 
tion. With  this  object  the  greatest  cleanliness  must  be  observed,  all 
decomposing  matters,  or  matters  likely  to  decompose,  should,  if  possible, 
be  scrupulously  removed,  and  injections  or  "  swabbings  "  with  weak  solu- 
tions of  carbolic  acid  or  other  disinfectants,  practised.  If  there  is  much 
danger  of  haemorrhage,  a  suitable  tampon  of  lint  or  fine  tow,  saturated 
in  these  fluids,  may  be  allowed  to  remain  in  the  vagina  for  some  time. 


fc 


628  ACCIDENTS  INCIDENTAL   TO  PARTURITION. 

1.  Petzold  {Sachsen  Jahresbericht,  1865,  p.  73)  relates  that  a  Cow  was  delivered  of  its 
calf  by  manual  force,  though  without  much  difficulty  ;  nevertheless,  there  ensued  much 
swelling  of  the  vulva,  which  extended  to  the  right  hock.  On  a  close  inspection  being 
made,  there  was  found  on  the  right  side  of  the  vagina,  about  four  inches  from  the  vulva. 
a  rent  nearly  three  inches  in  length ;  while  the  whole  of  the  vagina  itself  was  swollen, 
hard,  and  of  a  bluish-red  hue.  Fzeces  and  urine  were  voided  with  difficulty  ;  the  animal 
was  feverish,  had  lost  its  appetite,  the  respiration  was  hurried,  etc.  Injections  of  tepid 
aromatic  infusions,  with  acetate  of  lead,  were  resorted  to.  From  the  third  day  all  the 
more  serious  symptoms  disappeared,  and  on  the  tenth  day  the  wound  had  healed. 

2.  Field  (  Veterinarian,  vol.  xxxi.,  p.  i)  communicates  the  case  of  a  young  Mare  which, 
being  expected  soon  to  foal,  was  put  into  one  of  the  bays  of  a  barn  with  that  view  ;  at 
the  same  time  another  Mare,  due  to  foal  two  months  later,  was  put  into  the  opposite 
bay.  Both  were  fenced  off  from  contact  with  each  other,  and  the  breadth  of  the  floor 
intervened.  The  Mares  were  visited  by  the  carter  at  night,  and  there  was  nothing  to 
attract  his  particular  attention.  When  he  looked  in  upon  them  early  next  morning,  he 
found  the  Mare  which  had  been  expected  to  foal  was  dead,  and  that  the  other  had 
aborted.  The  first  had  evidently  been  dead  some  hours,  and  on  a  closer  inspection,  its 
bowels  were  observed  to  be  lying  about  its  feet,  bruised  and  lacerated,  but  there  was  no 
foal.  An  autopsy  was  made,  and  the  foetus,  full-grown,  was  found  with  its  head  bent  on 
the  chest  and  the  fore-legs  under  the  body.  In  the  violent  efforts  made  by  the  Mare  to 
expel  the  foal,  the  intestines  had  been  forced  through  a  wide  rupture  between  the  vagina 
and  rectum.     The  other  Mare  had  aborted  through  fear  or  sympathy,  or  both. 

3.  Shipley  {Ibid.,  vol.  xxx.,  p.  383)  attended  a  Mare  which  required  assistance  in  par- 
turition. The  animal  was  lying  down  and  getting  up  frequently,  straining,  etc  A  very 
small  portion  of  the  foetal  membrane  was  hanging  from  the  vagina,  the  calibre  of  which 
was  contracted,  and  the  general  appearance  of  the  parts  was  not  that  of  the  parturient 
period.  The  liquor  a?nnii  had  escaped.  The  foal  was  large  and  alive  ;  the  fore-limbs 
were  in  the  vagina,  but  the  head  was  bent  round  to  the  right  side.  Attempts  were 
made  to  adjust  the  latter,  during  which  the  hand  came  in  contact  with  something,  the 
character  of  which  could  not  be  detected  from  its  being  covered  with  the  membranes. 
The  Mare  was  very  much  exhausted,  and  threw  itself  down  violently  onCe  or  twice. 
Traction  by  means  of  cords  was  exercised  on  the  foetus,  during  which  the  Mare  sud- 
denly fell  on  the  left  side  and  violently  strained,  forcing  from  the  vagina  what  appeared 
to  be  a  portion  of  the  single  colon,  covered  by  part  of  the  cTiorion.  The  case  being 
deemed  hopeless  for  the  Mare,  even  if  the  foetus  was  removed  by  embryotomy,  it 
was  shot,  and  a  longitudinal  incision  being  at  once  made  along  the  li7tea  alba,  the  uterus 
was  exposed,  opened  anteriorly,  and  a  fine  healthy  filly  extracted.  The  young  creature 
lived  and  did  well.  The  wall  of  the  uterus  was  found  to  be  ruptured  to  the  left  of  the 
upper  part,  and  anterior  to  the  os  ;  the  rent  was  about  five  inches  in  length,  and  some- 
what oblique,  a  considerable  portion  of  the  single  colon  and  rectum  protruding  through 
it.     The  meso-colon  and  meso-rectum  were  also  ruptured  to  the  extent  of  six  inches. 

4.  Meyrick  [Ibid.,  p.  503)  alludes  to  a  Mare  he  was  called  upon  to  attend  which 
could  not  foal.  The  labor-pains  had  only  commenced  two  or  three  hours  previously, 
but  there  was  no  appearance  of  the  foal.  On  introducing  the  hand  into  the  uterus,  the 
foetus  was  found  to  be  so  placed  that  there  was  no  diffiulty  in  adjusting  it.  While,  how- 
ever, attempts  were  being  made  to  bring  one  of  the  fore-feet  through  the  os,  the  Mare 
strained  very  violently.  "This  led  to  an  immediate  protrusion  of  a  portion  of  the 
vagina  in  the  form  of  a  large  bladder,  close  to  my  shoulder.  Immediately  afterwards 
the  vagina  burst,  and  a  quantity  o£  the  intestines  gushed  out  through  the  rent,  the  Mare 
falling  down  at  the  same  instant.  The  mucous  membranes  of  the  mouth  and  nose  be- 
came blanched  almost  immediately,  and  the  pulse  so  tremulous  and  weak  as  scarcely  to 
be  felt."  In  about  fifteen  minutes  death  took  place  ;  and  on  opening  the  abdomen  a 
large  quantity  of  blood  was  found  in  it,  and  which  had  escaped  from  a  rupture,  two  or 
three  inches  in  length,  in  one  of  the  common  iliac  veins.  Much  blood  had  also  poured 
from  the  rent  in  the  vagina.     The  foal  was  dead.  ^' 

5.  Galtier  [Recueil  de  Med.  Veterinaire,  1875,  P-  47)  '*^^^  summoned  in  the  afternoon  to 
aid  a  Mare  which  had  been  attempting  to  foal  since  the  morning.  It  had  lain  on  its 
side,  making  violent  expulsive  efforts,  and  Galtier  was  only  sent  for  when  it  was  noticed 
that  the  intestines  were  protruding  from  the  vulva ;  on  his  arrival  the  Mare  was  dead. 
The  small  intestine  and  floating  colon,  pushed  through  a  rent  in  the  vagina,  were  fully 
exposed  externally,  but  not  torn,  and  notwithstanding  their  expulsion,  the  abdomen  was 
still  considerably  distended.  As  soon  as  the  abdominal  walls  were  incised,  a  large 
quantity  of  uncoagulated  blood  escaped  from  the  cavity — the  result  of  haemorrhage  from 
the  ruptured  vagina.  The  foetus  was  in  the  anterior  presentation,  vertebro-sacral  posi- 
tion, the  lower  part  of  the  head  pressed  against  the  brim  of  the  pubis  and  slightly  in- 
clined to  the  right,  although  the  Mare  died  when  lying  on  the  left  side.  The  uterus  and 
its  contents  occupied  the  right  flank,  and  the  small  intestine  and  floating  colon,  more  free 


TRAUMATIC  LESIONS  OF  THE  GENITAL  ORGANS,  ETC.  629 

than  the  large  intestine,  puslied  by  the  other  portions  of  the  intestinal  mass  by  the  efforts 
of  the  mother,  had  passed  through  a  rent  on  the  left  side  of  the  vagina,  close  to  the 
cervix  uteri  which  remained  intact.  The  rent  was  irregular,  and  sufficiently  large  to 
admit  the  fist ;  it  extended  lengthways,  and  its  borders  were  ragged,  ecchymosed,  red, 
and  thickened,  with  considerable  extravasation  of  blood  in  the  connective  tissue.  The 
stomach  and  large  intestine  contained  a  great  quantity  of  alimentary  matters,  and 
Galtier  is  inclined  to  attribute  the  rupture  to  this  condition,  together  with  the  faulty 
position  of  the  foal  and  the  .ecumbent  attitude  of  the  Mare.  He  points  out  that  a 
trifling  amount  of  manual  skill  in  raising  the  head  of  the  foetus  would  probably  have 
prevented  the  accident;  that  the  full  condition  and  exaggerated  volume  of  the  first 
portions  of  the  digestive  tube  may  have  contributed  to  bring  about  the  misdirection  of 
the  foetus  ;  that  when  parturition  is  near,  animals  should  not  receive  food  in  too  great 
bulk  ;  that  assistance  should  be  sought  for  immediately  the  discovery  is  made  that  birth 
is  delayed ;  and  that  when  the  life  of  the  mother  is  compromised,  the  Caesarear  section 
should  be  practised  without  delay,  in  order  to  preserve  the  offspring. 

Complications  of  Ruptured  Vagina. 

We  have  mentioned  some  serious  complications  of  ruptured  vagina,  in 
which  adjacent  organs  and  tissues  were  involved.  These  are  chiefly  the 
rectum,  bladder,  and  the  perinaeum,  one  or  more  of  which  may  be  per- 
forated and  torn,  along  with  the  vagina.  These  ruptures  vary  in  extent 
and  gravity,  and  while  some  of  them  are  necessarily  fatal,  others  are  not 
so  ;  though  they  may  lead  to  serious  deformity  and  inconvenience,  such 
as  accompany  chronic  fistulae  in  important  regions.  We  will  follow  the 
example  of  Saint-Cyr,  and  consider  them  under  the  head  of  recto-vaginal 
fistula,  rupture  of  the  perinaum,  and  vesico-vaginal fistula. 

Recto- Vaginal  Fistula. — Injuries  to  the  rectum  are  generally  pro- 
duced through  the  wall  of  the  vagina,  during  the  passage  of  the  fcetus. 
When  the  salient  parts  of  the  latter,  and  more  especially  the  feet,  are 
misdirected  and  pressed  up  towards  the  sacrum  of  the  mother,  and  if 
the  rectum  chances  to  be  distended  with  fasces,  not  only  will  the  vagina, 
but  this  viscus  also  may  be  perforated,  and  some  portion  of  the  foetus 
will  soon  appear  at  the  anus.  If  this  accident  is  discovered  in  time,  it 
may  be  possible  to  push  back  the  parts  thus  misdirected  into  their 
natural  outlet,  and  complete  delivery  by  the  vagina  ;  but,  notwithstand- 
ing this  happy  termination,  the  communication  between  the  vagina  and 
rectum  very  often  remains  permanent,  and  we  have  a  recto-vaginal 
fistula. 

The  treatment  of  these  cases  is  not  always  satisfactory,  so  far  as  a 
perfect  cure  is  concerned.  Sutures  have  sometimes  been  employed  to 
close  the  wound  in  the  rectum,  when  it  was  sufficiently  accessible.  But 
this  surgical  operation  can  rarely  be  resorted  to,  and  all  that  can  be  done 
is  to  keep  the  lacerated  parts  clean,  by  frequent  injections  per  vaginam 
and  rectum,  prevent  constipation,  and  treat  the  injury  on  ordinary  prin- 
ciples— not  forgetting  the  free  employment  of  antiseptics. 

If  sutures  are  employed  to  close  the  fistula,  they  may  be  supported  by 
a  pessary  or  tampon  placed  in  the  vagina  beneath  the  fistula. 

When  the  limbs,  or  other  parts  of  the  foetus,  protrude  through  the 
anu^  it  is  nearly  always  advisable  to  amputate  them,  in  order  to  effect 
the  replacement  of  the  remainder  more  easily  in  the  vagina,  and  with 
less  risk  of  further  injury  to  the  parent.  Once  in  the  genital  canal,  then 
the  foetus  can  be  extracted  in  the  ordinary  manner.  Opiates  should  be 
largely  administered. 

I.  Cruzel  {Journal  de  Med.  Veterinaire,  1832,  p.  153)  l-.ad  his  attention  directed  to  a  Cow, 
which,  after  aborting,  had  a  fistulous  opening  between   the  vagina  and  rectum,  through 


630  ACCIDENTS  INCIDENTAL  TO  PARTURITION. 

which  a  portion  of  the  faeces  escaped.     These  caused  a  great  and  constant  irritation  in 
the  vagina.     The  animal  was  in  a  state  of  marasmus,  and  was  therefore  killed. 

2.  Favre  {Le  Veterinaire  Campagnard,  p.  300)  was  shown  a  Mare,  which  the  groom 
found  with  some  pellets  of  faeces  in  the  vulva.  Removing  these,  others  followed.  There 
was  no  external  lesion  apparent,  but,  on  examination,  Favre  discovered  in  the  floor  of 
the  rectum,  about  five  fingers'  breadth  from  the  anus,  a  longitudinal  fissure  from  five  to 
six  inches  in  length,  the  borders  of  which  were  cicatrized,  and  came  together  when  the 
rectum  was  empty.  The  roof  of  the  vagina  was  fissured  in  the  same  direction,  and  the 
corresponding  borders  of  the  two  fissures  were  adherent ;  so  that  a  free  and  direct  com- 
munication existed  between  the  rectum  and  vagina.  The  cause  of  the  fistula  was  not 
known,  and  no  treatment  was  adopted.        t 

3.  Mongau  {Annates  de  Med.  Veterinaire^  1856,  p.  406)  was  called  to  assist  a  Mare  in 
labor,^and  found  the  foetus  in  a  wrong  position.  The  head,  neck,  and  a  fore-limb  of  the 
young  creature  had  passed  through  the  wall  of  the  vagina  into  the  rectum,  while  the 
other  fore-limb  protruded  from  the  vulva.  The  parts  in  the  rectum  were  pushed  back 
through  the  rent,  and  the  foetus  was  placed  in  its  normal  position,  and  extracted.  In  a 
short  time  the  Mare  was  sufficiently  well  to  be  sold.  Mongau  adds  that  this  was  not 
the  first  time  he  had  to  treat  such  a  case,  and  he  remarks  that  when  the  parent  lives,  the 
tear  in  the  rectum  does  not  entirely  close — there  always  remains  an  opening  by  which 
faecal  matters  pass  into  the  vagina. 

4.  Dupont  [Recueit  de  Med.  Veterinaire,  1858,  p.  105)  was  consulted  about  a  Mare 
which  the  stud-groom  at  the  stallion-station  of  ^Bordeaux  declined  to  put  again  to  the 
horse  ;  as  at  each  attempt  the  latter  had  the  penis  covered  with  fasces  when  it  was  with- 
drawn from  the  vagina.  Externally,  there  was  nothing  wrong  noticed  with  the  Mare  ; 
but,  on  the  hand  being  introduced  into  the  vagina,  there  was  found  in  the  roof  of  that 
canal  an  opening  into  which  the  fingers  could  be  easily  passed.  At  that  moment  the 
animal  passed  f?eces,  and,  on  the  hand  being  withdrawn,  it  was  soiled  by  excrementitious 
matters.  The  fistula  was  in  the  middle  part  of  the  canal,  and  was  between  two  and 
three  inches  in  length.  When  the  rectum  was  empty,  its  borders  were  in  apposition  ; 
these  were  thick  and  irregular,  from  the  presence  of  large,  soft  granulations,  which  bled 
readily.     Dupont  did  not  see  the  animal  again  after  this  examination. 

5.  Griois  {Ibid.,  1859,  p.  411)  relates  that  a  farmer,  in  the  vicinity  of  Amiens,  was 
aroused  during  the  night,  owing  to  one  of  his  Mares  which  was  in  labor.  The  foal  was 
apparent,  and  he  set  himself  to  pull  it  away.  The  task  was  a  long  and  difficult  one  ; 
but,  aided  by  two  neighbors,  it  was  at  length  accomplished — the  foetus  being  extracted, 
and  the  envelopes  soon  followed.  It  was  not  until  late  next  day  that  it  was  discovered 
that  the  foal  had  been  removed /^r  rectum.  Griois  being  then  called  in,  made  the  fol- 
lowing observations :  The  anus,  from  which  the  debris  of  the  foetal  envelopes  still 
hung,  was  much  lacerated  in  every  direction,  but  especially  at  its  lower  part ;  it  was 
also  considerably  swollen.  The  vulva,  on  the  contrary,  did  not  offer  any  thing  unusual 
— not  even  the  slightest  infiltration.  The  hand,  on  being  iTitroduced  into  the  rectum, 
perceived,  at  about  six  inches  from  the  anus,  a  rupture,  eight  inches  long  at  least,  with 
ragged  margins,  and  corresponding  to  a  similar  rent  in  the  uterus  (vagina?).  Through 
openings  the  hand  could  not  only  be  passed  into  one  or  other  of  the  canals,  but  also 
into  the  abdominal  cavity,  where  the  faces  -which  had  escaped  fr  0771  the  recttmt  cotdd  be  al- 
ready felt.  The  fissure  in  the  rectum  was  sutured,  and  appropriate  treatment  adopted. 
In  eleven  days  the  wound  in  the  intestine  was  cicatrized,  and  some  months  afterwards 
the  animal  was  sold  for  a  good  sum. 

6.  Lecouturier  {A7t7iales  de  Med.  Vet.  de  Bruxelles,  1867,  p.  268)  was  called  upon  to 
examine  a  Mare,  which,  two  months  after  parturition,  exhibited  unsteady  gait,  rigidity 
of  the  loins,  difficulty  in  rising,  and  pain  in  defecation,  discovered,  on  rectal  exploration, 
a  tumor  on  the  anterior  part  of  the  left  side  of  the  pelvis.  An  examination /^rz/a^/««z« 
led  also  to  the  discovery  of  a  solution  of  continuity  of  the  vaginal  wall,  at  a  point  cor- 
responding to  the  tumor.  From  the  bottom  of  this  wound  was  removed  the  remains  of 
a  fibrinous  clot,  the  whole  of  which  could  not  be  brought  away,  even  after  the  opening 
was  enlarged.  It  was  then  found  that  the  recto-vaginal  septum  was  perforated.  Green 
food  was  prescribed,  as  well  as  emollient  enemas,  and  slightly  stimulant  injections  into 
the  vagina.     In  six  weeks  the  fistula  was  cicatrized. 

7.  Andre  [Ibid.,  1864,  p.  175)  reports  that  a  Mare,  four  years  old,  strained  very  much 
during  parturition  when,  all  at  once,  the  fore -limbs  of  the  foal  appeared — one  by  the 
vulva,  the  other  by  the  anus.  The  owner,  who  was  with  the  Mare,  at  once  endeavored 
to  push  back  the  two  limbs,  and  bring  that  which  had  entered  the  rectum  into  the  va- 
gina ;  having  accomplished  this,  birth  soon  took  place.  Andre  prescribed  a  soft  diet, 
and  the  application  of  lard  three  times  a  day  to  the  vagina.  Cicatrization,  without  fis- 
tula, was  complete  by  the  seventeenth  day. 

8.  Ory  (Saint-Cyr,  Op.  cit.,  p.  662)  had  to  give  his  attention  to  a  Mare,  five  years  old, 
which  had  foaled  on  the  previous  evening.     For  three  weeks  previously  the  animal 


TRAUMATIC  LESIONS  OF  THE  GENITAL  ORGANS,  ETC.  631 

had  exhibited,  from  time  to  time,  and  chiefly  during  the  night,  symptoms  of  colic,  which 
gradually  became  more  marked  and  frequent,  until  on  the  day  of  foaling  it  had  seven 
actacks.  On  the  evening  of  that  day  appeared  the  expulsive  efforts,  and  soon  the  anus 
began  to  dilate  in  an  extraordinary  manner,  until  the  two  fore-limbs  of  the  foetus  ap- 
peared at  the  opening,  and  then  the  head  showed  itself.  At  last,  under  the  influence  of 
a  violent  effort,  the  anus,  which  seemed  to  have  attained  its  extreme  limit  of  dilatation, 
tore,  and  gave  exit  to  a  well-formed  and  lively  foal. 

When  Ory  arrived,  the  poor  Mare  was  in  a  state  of  great  prostration.  The  sphincter 
^z;// was  lacerated  to  the  extent  of  four  inches;  the  rupture  extending  obliquely  down- 
wards and  outwards,  and  from  right  to  left,  passing  through  the  skin,  and  exposing  a 
portion  of  the  left  semimembranosus  muscle,  though  the  perinaeum  was  uninjured.  On 
introducing  the  hand  into  the  vagina,  it  was  noted  that  this  and  the  rectum  formed  to- 
gether one  vast  cavity,  containing  a  certain  quantity  of  well-moulded  faecal  pellets.  The 
anus,  which  had  been  so  violently  dilated,  remained  wide  and  flaccid.  Ory  did  not  at- 
tempt to  repair  thes«  enormous  lacerations,  but  limited  his  treatment  to  removing,  three 
times  a  day,  and  by  hand,  the  faecal  pellets  which  fell  into  the  vagina  ;  to  cleansing  the 
cavity  as  thoroughly  as  possible,  and  to  injecting  a  mixture  of  oil,  carbolic  acid,  and  an 
infusion  of  elder-flowers  ;  while  the  external  wound  was  dressed  with  a  decoction  of 
oak  bark,  to  which  acetate  of  lead  was  added.  This  treatment  was  continued  for  fifteen 
days,  and  in  about  three  weeks  the  external  laceration  was  almost  cicatrized  ;  the  ani- 
mal's health  was  good ;  but  the  vagina  and  rectum  remained  as  a  single  cavity,  and 
forming  a  kind  of  cloaca,  where  the  faeces  accumulated. 

The  owner  stated  that,  since  the  accident,  the  Mare  could  only  be  worked  at  a  slow 
pace  on  the  farm.  As  soon  as  it  began  to  trot,  a  noise  was  heard,  due  to  the  air  rush- 
ing out  and  in  to  the  fistula.  Then  the  animal  became  tympanitic,  and  evinced  symp- 
toms of  colic.  Then,  also,  the  urine  and  faeces  were  sometimes  ejected  simultaneously 
from  the  anus,  which  was  always  dilated ;  but  these  i^assed  by  their  natural  channel 
when  the  Mare  was  at  rest. 

9.  Schrader  {Magazin  fiir  die  Gesamtnte  Thierheilkunde,  1837,  p.  261)  was  requested 
to  examine  a  six-year-old  Mare,  which  had  been  purchased  a  few  divs  previously. 
When  the  animal  micturated,  faecal  pellets  came  away  at  the  same  lime.  A  rectal  ex- 
ploration, as  far  as  the  arm  could  be  inserted,  did  not  discover  any  thmj  amiss,  until,  on 
withdrawing  it  with  the  fingers  downwards,  an  opening  has  encountered,  wliich  led  in 
an  oblique  direction  from  the  rectum  to  the  upper  part  of  the  vagina.  A  finger  could 
be  easily  passed  from  the  vagina  into  the  rectum.  The  opening  was  about  an  inch  in  di- 
ameter, but  it  could  be  readily  dilated ;  its  borders  were  even  and  smooth,  and  the  ani- 
mal did  not  evince  any  pain  when  they  were  touched.  The  Mare  had  produced  one  foal. 
The  fasces  were  tolerably  well  retained  in  the  rectum,  but  flatus  always  passed  through 
the  vagina. 

10.  Hawthorn  (  Veterinarian,  vol.  vii.,  p.  28)  was  sent  for  to  see  a  Mare  which  was  re- 
ported to  have  the  foal  "  coming  the  wrong  way."  Hawthorn  was  struck  with  the  sin- 
gularity of  the  case.  "  The  foal  was  protruded  as  far  as  the  middle  of  the  chest,  and 
the  fore-legs  were  almost  a  yard  asunder — one  hanging  down  towards  the  thighs,  and 
the  other  standing  up  above  the  tail.  The  body  of  the  foal  was  lying  on  its  off-side : 
of  course  it  was  dead.  The  left  leg  had,  in  the  act  of  foaling,  been  forced  through  the 
rectum,  and  then  through  the  anus."  The  Mare  was  cold  and  feeble ;  the  pulse  was 
scarcely  perceptible,  and  the  animal  appeared  to  be  sinking  rapidly.  It  was  decided  to 
extract  the  foetus  by  embryotomy.  "  The  nearest  place  which  was  suitable  for  the  opera- 
tion, was  a  barn  a  quarter  of  a  mile  distant,  to  which  ^he  was  immediately  walked ;  and 
as  I  followed  her,  and  witnessed  her  staggering  gait,  I  felt  as  if  she  was  going  to  execu- 
tion. She  was  thrown,  and  pulleyed  up  to  a  joist.  The  near  leg  of  the  foal  was  dis- 
sected off  at  the  knee,  and,  by  the  right  hand,  forced  back  into  the  vagina,  where  it  was 
received  by  my  left  hand,  and  drawn  a  little  forward.  As  the  only  obstacle  to  the  foal- 
ing was  now  removed,  the  remaining  part  of  the  operation  was  soon  accomplished,  and 
the  Mare  got  on  her  legs.  The  wound  through  the  rectum  was  terrific,  as  I  had  easily 
passed  my  arm  through  it.  She  was  then  walked  home,  and  seemed  much  better." 
The  animal  was  dieted  on  wet  bran  and  clover  for  a  week.  The  rectum  was  emptied 
manually  two  or  three  times  a  day,  and  the  vagina  washed  out.  "  The  faeces  which  es- 
caped through  the  wound  into  the  vagina  were  not  wholly  expelled ;  it  was  therefore 
necessary  to  cleanse  the  vaginal  passage.  The  wound  in  the  rectum  healed  very  rap- 
idly, and' the  Mare  never  exhibited  any  unfavorable  symptoms  after  the  extraction  of 
the  foal."     The  animal,  soon  after,  was  put  to  work,  as  if  nothing  had  happened. 

ir.  Morgan  {Ibid.,  vol.  xxviii.,  p.  397)  was  hastily  sent  for  to  see  a  Mare  which  was 
foaling,  but  the  foal  was  "coming  the  wrong  way."  When  he  arrived  he  found  the  ani- 
mal lying  down,  groaning,  and  straining  violently,  and  the  head,  neck,  and  one  fore-leg  of 
the  foal  through  "the  rectum,  and  the  other  fore-leg  through  the  vulva.  The  Mare  was 
induced  to  get  up,  hobbles  were  applied,  and  then  the  parts  of  the  foetus  protruding  be* 


632  ACCIDENTS  INCIDENTAL  TO  PARTURITION. 

yond  the  anus  were  excised  as  close  as  possible.  The  sphincter  ani  was  dilated,  the 
parts  in  the  rectum  pushed  through  the  rent  in  that  viscus  into  the  vagina,  and  with  a 
little  assistance  the  remains  of  the  foal  were  extracted  by  the  vulva.  The  Mare  received 
opiate  and  laxative  draughts,  and  soft  diet.  "  Without  entering  into  further  details,  the 
animal  was  under  my  care  for  about  a  fortnight,  when  she  was  sold  to  a  builder  for 
;i^i8,  and  is  at  present  working  in  a  brick-cart,  perfectly  well." 

12.  Hudson  {Ibid.,  vol.  xlv.,  p.  409),  called  to  attend  a  case  of  difficult  parturition  in  a 
five-year-old  Mare,  with  the  first  foal,  found,  on  arrival,  that  the  persons  in  attendance 
had  delivered  the  animal,  and  that  during  labor  the  head  and  neck  of  the  foal  had  pro- 
truded from  the  anus  of  the  mother  nearly  as  low  as  the  hocks  of  the  latter.  When 
first  observed,  one  foot  of  the  foal  was  protruding  from  the  vagina,  "  with  the  other  foot 
pointing  upwards  towards  the  spine,  and  after  pulling  it  downwards  into  position,  the 
next  pain  sent  the  head  into  the  place  which  the  foot  had  previously  occupied,  and  a  sec- 
ond pain  forced  the  head  through  the  passage  and  out  at  the  anus."  The  foal  was  alive, 
but  to  effect  delivery  the  head  was  cut  off,  which  allowed  the  neck  to  be  pushed  back 
into  the  vagina,  and  delivery  to  be  accomplished.  "  The  Mare  looked  anxious  and  un- 
settled. Her  head  was  held  high,  and  she  was  paddling  with  the  hind-legs,  and  whisk- 
ing the  tail  occasionallv.  The  pulse  and  respiration  were  both  somewhat  quickened. 
On  an  examination  being  made/^^r  vaginam,  I  was  enabled  to  pass  my  hand  through  a 
large  rent,  and  to  touch  the  forefinger  of  the  other  hand,  which  I  had  passed  into  the 
rectum."  An  anodyne  and  aperient  bolus  was  administered,  the  animal  ordered  to  be 
kept  quiet,  the  parts  to  be  fomented  and  dressed  with  lard,  and  the  fasces  to  be  removed 
if  they  accumulated.  Next  day  the  rectum  was  emptied,  and  an  enema  of  warm  water 
administered.  The  injured  parts  were  dressed  with  tincture  of  myrrh,  and  the  mucous 
membrane  lubricated  with  lard.  The  appetite  remained  good.  Next  day  there  were 
indications  of  congestion  of  the  fore-feet,  for  which  treatment  was  prescribed,  and  the 
rectum  was  emptied  and  cleansed  as  before.  Two  days  afterwards  a  small  quantity  of 
fasces  had  passed  into  the  vagina,  and  the  following  day  there  was  much  discharge,  and 
a  piece  of  dead  tissue  hanging  out  of  the  vulva.  Thirteen  days  after  the  accident,  some 
fascal  pellets  still  dropped  into  the  vagina,  and  this  appeared  to  be  the  only  incon- 
venience. "  The  rent  in  the  rectum  has  contracted  considerably,  and  seems  to  be  partly 
arched  over  by  a  portion  of  the  lining  membrane  projecting  from  the  antero-inferior 
part  of  the  laceration.  Posteriorly,  the  edge  of  the  lesion  feels  now  only  just  within  the 
anus,  but  there  is  not  the  slightest  indication  of  union  by  healing."  Soon  afterwards  the 
Mare  went  to  regular  work. 

Rupture  of   the  PERiNiEUM. 

Laceration  of  the  vagina  is  not  at  all  unfrequently  complicated  with 
more  or  less  extensive  rupture  of  the  perinaeum,  and  occasionally  we  may 
meet  with  rupture  of  the  vagina,  rectum  and  perinasum  in  the  same  ani- 
mal. Sometimes  it  is  only  the  fourchette  and  superior  commissure  of  the 
vulva  which  are  involved  ;  in  others  the  entire  extent  of  the  perinseum  is 
lacerated,  and  the  lesion  only  ends  at  the  anal  sphincter ;  while  in  others, 
again,  the  sphincter  and  part  of  the  rectum  are  included. 

If,  in  malposition  of  the  foetus,  assistance  is  not  timely  afforded — and 
particularly  in  the  Mare — so  as  to  correct  the  deviation,  the  young  crea- 
ture is  pushed  outwards  by  the  violent  uterine  contractions,  and  if  it  en- 
ters the  rectum  the  anus  is  dilated  ;  while,  if  the  expulsive  efforts  are  con- 
tinued, the  sphincter  and  all  the  tissues  between  it  and  the  vulva  are 
greatly  stretched  and  strained  until  they  tear.  Then  the  foetus  is  finally 
expelled — sometimes  dead,  at  other  times  alive — and  there  remain  the 
most  startling  and  immense  lacerations  which  convert  the  rectum  and 
vagina  into  one  vast  opening,  into  whose  cavity,  as  Saint-Cyr  observes, 
the  termination  of  the  digestive  and  genito-urinary  organs  open  in  com- 
mon. 

These  ruptures,  immediately  after  birth,  appear  two  or  three  times 
larger  than  they  are  some  days  afterwards,  when  the  distended  textures 
have  contracted  somewhat ;  the  borders  of  the  laceration  are  sometimes 
even,  in  other  cases  uneven,  ragged  and  shreddy. 


TRAUMATIC  LESIONS  OF  THE  GENITAL  ORGANS,  ETC.     633 

The  consequences  are  variable,  according  to  the  extent  of  tlie  injury. 
Moderate  laceration  does  not  usually  prove  very  prejudicial  j  but  if 
severe,  serious  inflammation  of  the  perinasum,  extending  sometimes  to 
neighboring  tissues  and  organs,  sets  in.  If  the  tear  involves  the  anus  and 
its  sphincter,  there  will  be  involuntary  escape  of  fcecal  matters  and  flatus ; 
and  in  the  most  formidable  cases — those  in  which  the  vagina  and  rectum 
form  one  wide  gaping  cavity — the  mucous  membrane  is  irritated  by  the 
free  admission  of  air  and  excreta,  inflammation  and  suppuration  ensue, 
fistulas  are  formed,  and  the  poor  animal  only  too  often  presents  a  painful 
and  repulsive  spectacle. 

In  other  instances,  partial  recovery  takes  place,  and  the  animals  do  not 
appear  to  be  much  affected  or  inconvenienced.  They  maintain  good  health, 
rear  their  progeny,  if  it  chances  to  be  born  alive,  and  may  even  bring 
forth  young  again,  though  the  laceration  has  not  cicatrized. 

The  treatment  will  vary,  according  to  circumstances.  If  there  is  much 
hsemorrhage,  styptics  must  be  employed  ;  if  the  bleeding  is  slight,  cold 
may  check  it ;  but  if  severe,  perchloride  of  iron  must  be  used. 

The  lacerated  margins,  if  much  torn,  must  be  freed  from  shreds,  which 
are  likely  to  lose,  or  have  already  lost,  their  vitality.  They  must  then  be 
brought  together  by  sutures — either  of  metal,  or  carbolized  silk  or  catgut. 
Cold  water  dressings  may  then  be  applied;  or  styptic  colloid,  collodion, 
or  carbolized  glycerine  may  be  employed.  The  parts  must  be  kept  as 
clean  as  possible,  and  the  animal  not  disturbed  or  allowed  to  lie  down 
until  union  has  been  effected.  With  this  object  a  narrow  stall  is  to  be 
preferred.  The  sutured  septum  should  be  supported  from  the  vagina  by 
a  tampon  placed  therein.  This  will  tend  to  prevent  the  pressure  of  faeces 
tearing  away  the  sutures  in  the  floor  of  the  rectum,  and  this  result  will 
also  be  greatly  obviated  by  administering  enemas  frequently,  and  cover- 
ing the  mucous  membrane  with  lard.  Sloppy  food  should  be  given  as 
diet.  Fever  and  other  unfavorable  complications  must  be  treated  accord- 
ing to  their  indications.  Opiates  will  prove  of  great  service  ;  and  if  there 
is  much  local  disturbance  or  straining,  suppositories  of  opium  are  to  be 
recommended. 

There  are  not,  so  far  as  I  can  ascertain,  any  instances  of  this  accident  recorded  in 
English  veterinary  literature.  We  shall  therefore  give  a  few  derived  from  foreign 
sources. 

1.  Cruzel  (Journal  de  Med.  Veterhtaire,  1832)  mentions  that  a  Mare,  ten  months  preg- 
nant, aborted  a  living  Mule,  one  of  whose  limbs,  during  parturition,  had  passed  through 
the  rectum.  A  veterinary  surgeon  attempted  to  extract  it,  but  not  succeeding  owing  to 
the  obstacle  this  limb  presented,  he  prolonged  the  rupture  to  the  anus.  The  Mare  died 
next  day. 

2.  The  same  authority  saw  a  she-Ass  which  had  the  posterior  third  of  the  rectum 
ruptured,  as  well  as  the  anus.     It  was  not  much  inconvenienced. 

3.  Dupont  [Recueil  de  Med.  Veterinarire,  1858)  relates  that  an  empiric  being  called 
upon  to  deliver  a  Mare  in  parturition,  seeing  the  feet  of  the  foal  protruding  from  the 
anus,  knew  nothing  better  than  to  pull  at  them,  and  thus  extract  the  young  creature 
through  the  rectum.  Four  days  afterwards  Dupont  was  sent  for,  and  he  found  that  de- 
fecation had  not  taken  place  for  three  days ;  there  was  considerable  tumefaction  in  the 
ano-vulvar  region:  from  the  anus  to  the  vulva  all  the  textures  were  torn  and  bleeding, 
and  the  external  borders  of  the  rupture  overlapped  each  other  in  large  swollen  masses ; 
the  inferior  parts  of  the  vulva  were  covered  by  the  continual  escape  of  the  vagino-intes- 
tinal  excretions.  The  injury-exhaled  a  very  fetid  odor.  The  rectum  and  vagina  were 
emptied  of  the  faecal  pellets  which  encumbered  the  vast  cloaca,  and  then  the  injury  was 
seen  to  its  full  extent.  From  the  cervix  uteri  to  the  roof  of  the  intestine,  the  vagina  and 
rectum  formed  one  vasf  cavity.  The  flica  p.xhnata  of  the  cervix  were  visible  as  thick 
dark-colored  ridges,  between  which  excrementitial  debris  was  incrusted.  Superiorly, 
the  rectum  appeared  gaping,  and  aspiring  the  air  like  the  piston  of  a  steam  engine. 


634  ACCIDENTS  INCIDENTAL  TO  PARTURITION 

The  line  representing  the  recto-vaginal  septum  divided  the  cavity,  in  the  form  of  a  small, 
red  and  irregular  ring.  The  mucous  membrane  was  ecchymosed  and  very  congested ; 
the  cervix  was  seriously  inflamed.  For  fifteen  days  nothing  was  done  but  merely  keep- 
ing the  parts  clean.  At  this  time  the  inflammation  in  the  borders  of  the  external  wound 
had  disappeared,  and  repair  was  going  on  along  the  perineal  rupture ;  internally,  the 
mucous  membrane  had  nearly  assumed  its  normal  appearance,  and  scarcely  any  thing 
remained  of  the  vagino-rectal  diaphragm  ;  there  was  no  suppuration  or  ulceration. 
Dupont  then  decided  to  resort  to  autoplasty  to  repair  the  serious  damage,  and  fixed  on 
the  Indian  method.  "I  slowly  introduced  my  left  hand  into  the  vagina,  and  extended 
the  canal  by  pressing  strongly  on  its  sides.  The  right  hand,  armed  with  long  fine  scissors, 
pared  to  the  blood  the  edges  of  what  remained  of  the  septum.  Then  with  a  needle  armed 
with  a  waxed  thread,  I  commenced  to  bring  these  edges  together  by  suture,  the  sutures 
being  eight  in  number  ...  I  then  passed  to  the  perineal  laceration.  With  the 
scissors,  I  destroyed  all  the  granulations  as  low  as  the  skin.  I  then  applied  sutures,  se- 
curing each  by  a  distinct  knot  .  ,  .  covering  the  whole  externally  with  a  thick  layer  of 
collodion." 

Every  care  was  taken  to  ensure  success,  and  for  eight  days  every  thing  appeared  to  be 
going  on  favorably ;  but  on  the  ninth  day  it  was  observed  that  some  of  the  recto-vaginal 
sutures  had  given  way,  and  that  the  wound  had  not  united ;  and  in  two  days  afterwards 
all  the  sutures  had  sloughed  through,  without  the  least  union  having  been  effected. 
Nothing  discouraged  by  this  failure,  Dupont  again  resorted  to  sutures,  and  when  the 
edges  were  once  more  brought  into  apposition  by  them,  with  a  curved  bistoury  he  cut 
through  the  vaginal  mucous  membrane  parallel  to  the  sutures,  but  at  a  few  lines  from 
the  roof,  in  order  to  diminish  the  tension.  For  fifteen  days  all  went  on  satisfactorily, 
and  success  appeared  to  be  certain,  when  the  same  result  ensued.  Dupont  then  gave 
up  the  case,  and  the  Mare,  which  had  been  in  excellent  health  during  the  seventh 
month's  trial,  was  set  to  work. 

4.  Andre  [AnnalSs  de  Med.  Vitirinaire  de  Bruxellcs,  1864)  was  summoned  to  aid  in  the 
delivery  of  a  Mare,  ten  years  old,  whose  foal  was  being  expelled  through  the  anus. 
"When  he  arrived  it  had  been  delivered,  and  did  not  appear  indisposed;  the  foal  was 
well  and  lively.  The  birth,  which  was  spontaneous,  appeared  to  have  been  very  rapid  ; 
for  the  servant,  as  soon  as  he  saw  the  feet  of  the  foal  appear  at  the  anus,  ran  for  his 
master,  and  when  he  returned  the  foal  was  born.  On  examining  the  Mare,  Andre  found 
a  complete  rupture  of  the  perinasum,  and,  consequently,  a  total  absence  of  any  septum 
between  the  annus  and  vulva — the  rectum  and  vagina  being  merely  one  large  open- 
ing. It  was  also, observed  that  this  lesion  involved  the  contiguous  walls  of  these  parts 
to  some  extent ;  and  on  separating  the  labia  of  the  vulva  the  cervix  uteri  could  be  seen. 
The  faeces  were  passed  by  the  vulva. 

No  attempt  at  repair  was  made,  and  treatment  was  merely  directed  towards  subduing 
inflammation.  A  month  afterwards  the  wounds  were  cicatrized,  but  not  united.  The 
general  heUlth  was  good,  but  defecation  took  place  by  the  vulva  more  frequently  than 
usual,  and  involuntarily. 

5.  Jouet  {Rec.  de  Med.  Veterinaire,  1873,  p.  56)  gives  the  detailed  history  of  a  Mare 
belonging  to  Prince  Ney,  of  Moscow,  and  with  which,  during  parturition,  the  foal  could 
not  pass  through  the  vagina,  in  consequence  of  the  narrowness  of  that  canal ;  it  there- 
fore passed  into  the  rectum,  and  was  born  through  the  anus.  About  eighteen  months 
after  this  accident,  the  rupture,  which  established  a  communication  between  the  rectum 
and  vagina,  was  ten  inches  in  length,  and  formed  an  infundibulum  in  which  the  faeces 
accumulated  before  being  expelled  by  the  vulva.  The  anus  appeared  to  be  inert,  and 
did  not  act.  The  clitoris  was  hypertrophied.  Notwithstanding  this  infirmity,  the  Mare 
lived  for  many  years,  and  neither  suffered  in  health  or  vigor.  It  was  even  fecundated 
without  accident,  and  brought  forth  a  foal  with  ease.  When  put  to  the  stallion  a  second 
time,  however,  it  received  serious  injury,  lost  condition,  fell  into  a  state  of  marasmus, 
and  died. 

6.  Saint-Cyr  {Op.  Cit.,  p.  665)  states  that  the  internal  clinic  of  the  Lyons  Veterinary 
School  received  a  Mare,  five  years  old,  and  a  primipara,  which  had  brought  forth  its 
ioz\per  anum,  under  the  following  circumstances.  Six  days  previously  it  exhibited  the 
first  signs  of  parturition.  Soon  the  two  fore-feet  of  the  foetus  appeared  at  the  vulva, 
and  quickly  after  the  nose  appeared,  but  at  the  anus.  While  the  proprietor  was  in 
search  of  a  veterinary  surgeon,  the  foal  was  born  without  any  assistance.  It  soon  died, 
and  when  the  surgeon  came  he  saw  an  immen.se  rupture  in  the  Mare,  comprising  the 
perinasum  and  the  whole  of  the  recto-vaginal  septum.  Otherwise  the  Mare  did  not  ap- 
pear to  be  much  disturbed,  but  ate  and  drank  heartily.  The  veterinary  surgeon  declared 
that  he  could  do  nothing  for  the  animal ;  consequently  it  was  sent  to  the  Veterinary 
School.  When  it  reached  there,  nothing  particular  was  observed  except  a  slight  swel- 
ling of  the  left  hind-leg,  which  caused  marked  lameness.  On  raising  the  tail  there  was 
immediately  observed  a  considerable  tumefaction  of  the  vulva  and  anus,  then  a  complete 


TRAUMATIC  LESIONS  OF  THE  GENITAL  ORGANS,  ETC.  635 

rupture  of  the  perinasum — an  irregular  laceration  rather  to  the  right  side,  and  which 
made  the  anus  and  vulva  one  long  slit.  When  the  great  cavity  was  freed  from  the  mass 
of  faeces  it  contained,  the  half-open  os  uteri  could  be  seen  at  the  far  end,  while  above 
were  the  remains  of  the  recto-vaginal  septum.  The  latter  was  destroyed  throughout  its 
entire  length,  so  that  the  rectum  and  vagina  communicated  freely  with  each  other  for  at 
least  five  inches,  and  their  union  formed  a  vast  cloaca,  in  which  the  faeces  gradually  col- 
lected. The  borders  of  the  rupture  had  commenced  to  granulate.  On  the  floor  of  the 
vagina,  not  far  from  the  bulb,  there  were  two  other  wounds  of  some  length,  which  in- 
volved the  mucous  membrane  throughout  its  thickness — one  to  the  right,  the  other  to 
the  left — from  which  escaped  a  quantity  of  pus. 

Rather  for  the  instruction  of  the  pupils  than  in  the  hope  of  effecting  a  cure,  the  auto- 
plastic procedure  adopted  by  Dupont  was  resorted  to.  The  remains  of  the  recto- 
vaginal septum  were  made  raw,  and  united  by  the  interrupted  suture  :  six  sutures  being 
made  without  nmch  difficulty ;  so  that,  when  the  operation  was  completed,  the  margins 
of  the  rupture  were  in  exact  apposition  and  the  septum  re-established.  This  was  the 
most  difficult  part  of  the  operation,  as  the  perineal  sutures  were  easily  placed.  The 
rectal  and  vaginal  cavities  were  thus  once  agam  separated,  as  in  the  normal  condition. 
During  the  day  of  the  operation,  the  anfmal  appeared  to  suffer  and  was  restless  ;  it  was 
unable  to  defecate  spontaneously,  and  the  rectum  had  to  be  emptied  several  times,  dur- 
ing which  manceuvre  the  sutures  were  interfered  with,  the  tissues  strained,  and  next 
morning  it  was  discovered  that  several  of  the  stitches  had  given  way;  so  that  the  edges 
were  not  exactly  in  contact,  excrement  had  passed  between  them,  and  it  was  necessary 
to  again  attempt  the  task  of  restoration  This,  however,  was  not  ventured  upon,  and 
nothing  was  done  but  to  keep  the  parts  clean  Cicatrization  occurred  without  any  note- 
worthy circumstance  except  the  formation  of  an  intermuscular  abscess,  which  developed 
towards  the  middle  of  the  right  thigh,  discharged  a  large  quantity  of  pus,  and  healed 
slowly.  In  a  month  the  animal  had  recovered,  so  far  as  general  health  was  concerned, 
but  the  infirmity  still  existed,  and  rendered  the  creature  almost  valueless. 

Vesico-Vaginal  Fistula. 

When  the  floor  of  the  vagina  is  ruptured,  it  may  happen  that  the  neck 
or  walls  of  the  bladder  are  involved  in  the  lesion,  just  as  that  viscus  may, 
as  we  have  seen,  become  prolapsed  or  hernied  through  the  vaginal  rent. 
When  rupture  of  the  bladder  occurs  in  this  manner,  the  case  is  indeed 
serious.  The  urine  is  no  longer  confined  to  its  receptacle,  but  escapes 
through  the  laceration  and  becomes  infiltrated  in  the  pelvic  connective 
tissue.  Hence  arises  most  serious  complications  :  pelvic  cellulitis  and 
urine-ahscess,  which  rapidly  lead  to  a  fatal  termination.  In  less,  formid- 
able cases,  the  urine  may  escape  by  the  vagina,  but  involuntarily  ;  so  that 
the  incontinence  of  urine  not  only  proves  a  troublesome  infirmity,  but  the 
constant  passage  of  this  fluid  over  the  membrane  lining  the  vagina  gives 
rise  to  intense  inflammation  of  the  canal,  and  leads  to  the  formation  of  a 
vesico-vaginal  fistula.  This  fistula  may  also  be  produced  by  usure  or 
bruising.  When  the  foetus  is  very  large  it  occasions  over-stretching  of  the 
vagina,  and  if  it  remains  for  any  length  of  time  in  the  passage,  this  dis- 
tention weakens  the  vitality  of  the  soft  tissues ;  so  that  the  compression 
to  which  they  are  submitted  between  the  fcetus  and  the  floor  of  the  pelvis 
will  produce  mortification,  which  may  extend  to  the  neck  of  the  bladder. 
The  resulting  sloughing,  should  the  animal  survive,  will  establish  a  direct- 
communication  between  the  vagina  and  bladder. 

An  animal  may  live  with  a  fistula  of  this  description,  provided  urine- 
abscess,  uraemia,  or  other  serious  complications  do  not  result. 

The  symptoms  need  not  be  specified.  The  chief  is  incontinence  of 
urine.  When  this  fluid  is  observed  to  be  constantly  dribbling  from  the 
vulva  after  parturition,  the  existence  of  the  accident  may  be  suspected, 
and  an  examination /^r  vaginam  will  confirm  the  suspicion. 

Treattnent  must  be  mainly  palliative. 


636  ACCIDENTS  INCIDENTAL  TO  PARTURITION. 

bupont  [Rec.  de  Med.  Veterinaire,  1858,  p.  1057)  examijied  a  fine,  well-bred,  four-year- 
old  Cow,  which  was  in  good  condition.  The  animal  emitted  a  very  penetrating  acid 
odor,  which  extended  to  some  distance  around  it.  The  tail  was  entirely  denuded  of 
hair  ;  a  vast  ulcer  occupied  all  the  posterior  regions,  from  the  inferior  commissure  of 
the  vulva  down  to  the  claws  of  the  hind  feet.  After  washing  the  parts  well  with  chlori- 
nated water,  the  hand  was  passed  into  the  vagina,  and  a  large  wound  was  discovered  in 
the  middle  of  the  lower  and  posterior  part  of  that  canal,  but  it  was  partly  concealed  by 
large,  ragged,  and  irregular  vegetations.  Pus,  thick  and  plastic  secretions,  and  a  thin 
layer  of  salts,  gave  to  the  touch  the  sensation  of  a  calcareous  powder  occupying  the  bot- 
tom of  the  wound,  which  was  bathed  by  a  permanent  "  sweating  "  of  urine.  When  this 
part  of  the  vagina  had  been  well  cleansed,  it  was  observed  that  there  was  a  considerable 
loss  of  substance,  and  that  about  three  inches  of  the  ischial  symphysis  was  denuded. 
The  irregular  borders  of  what  remained  of  the  vagina,  stood  nearly  an  inch  above  the 
bony  surface ;  great  movable,  and  spongy  granulations  partly  covered  the  symphysis, 
and  appeared  to  be  the  seat  of  an  abundant  suppuration.  Beyond  this  the  retracted 
bladder  could  be  felt.  The  vaginal  mucous  membrane  was  of  a  bright-red  color,  and  the 
whole  of  its  inferior  surface  was  ulcerated.  The  place  where  the  hind-feet  of  the  animal 
had  stood  during  the  few  minutes'  exploration  was  saturated  with  urine. 

No  information  as  to  the  date  or  origin  of  the  lesion  could  be  procured. 

SECTION  III. THROMBUS    OF    THE    VAGINA    AND    VULVA. 

Thrombus  or  hcematoma  of  the  vagina  and  vulva  is  sometimes  observed 
after  parturition,  and  is  due  to  an  infiltration  of  blood  into  the  connective 
tissue  of  these  parts,  from  the  almost  inevitable  injury  they  sustain  during 
laborious  parturition. 

In  such  cases,  when  the  foetus  is  very  large,  or  in  a  wrong  position, 
considerable  manipulation  and  traction  are  often  necessary  to  adjust  and 
remove  it  ;  and  this  leads  to  bruising  of  the  soft  parts  against  the  pelvis, 
ana  laceration  and  rupture  of  the  blood-vessels  and  connective  tissue. 
The  blood-vessels  are  larger,  and  probably  more  numerous,  during  preg- 
nancy than  at  other  times  ;  consequently,  there  results  extravasation  of 
blood,  and  considerable  tumefaction  of  the  genital  canal,  particularly  in 
the  vagina  and  vulva.  Sometimes  this  tumefaction  appears  during  par- 
turition, when  it  may  form  an  obstacle  to  birth. 

The  mucous  membrane  is  raised  into  irregular  masses,  perceptible  to 
the  eye,  and  still  more  marked  to  the  touch.  The  membrane  itself  has  a 
blue,  violet,  or  black  tint ;  the  labia  of  the  vulva  are  considerably  swollen, 
and  the  engorgement  may  extend  to  the  thighs  and  croup. 

If  there  is  not  much  extravasation,  the  eflfused  blood  may  be  absorbed 
in  a  few  days  \  but  if  the  thrombus  is  extensive,  the  blood  becomes  de- 
composed, gives  rise  to  inflammation,  may  run  on  to  gangrene,  and  septic 
infection  may  consequently  ensue. 

As  to  treatment,  scarifications  are  above  all  things  to  be  recommended. 

wSamson,  who  has  had  much  experience  of  such  cases,  says  that  the  labia 
of  the  vulva  should  be  well  separated,  and  a  bistour}'-  plunged  into  the 
right  and  left  walls  of  the  vagina,  as  if  to  open  an  abscess,  and  the  incis- 
ion should  be  large,  in  proportion  to  the  quantity  and  situation  of  the 
clots  ;  pressure  must  then  be  made,  so  as  to  remove  the  latter. 

The  operation  appears  to  be  quite  innocuous  ;  though  a  case  is  re- 
corded by  Cartvvright  ( Veteritiarian,  vol.  xix.,  p.  386)  in  which  a  great 
stream  of  blood  issued  from  one  of  the  punctures,  in  consequence  of  a 
large  vein  being  wounded. 

When  all  the  extravasated  blood  has  been  removed  from  beneath  the 
mucous  membrane  or  skin,  cold  water  injections  and  sponging,  and  weak 
solutions  of  carbolic  acid,  permanganate  of  potash,  or  other  detersive  and 
disinfecting  fluids,  should  be  resorted  to.     The  same  treatment  is  to  be 


TRAUMATIC  LESIONS  OF  THE  GENITAL  ORGANS,  ETC.  637 

adopted  when  suppuration   has  set  in,  only  more  attention  must  be  paid 
to  the  disinfective  treatment. 

SECTION    IV. RELAXATION    OF    THE    PELVIC  SYMPHYSES. 

This  accident,  which  is  far  from  common  in  woman,  is  still  more  rare 
in  animals  j  and  there  appears  to  be  only  one  case  recorded — that  by 
Gilis. 

Gilis  {Journal  des  Veterinaires  dii  Midi,  1858)  alludes  to  the  case  of  a  Cow,  eight 
years  of  age,  which,  nineteen  clays  beyond  its  time  for  calving,  commenced  to  strain 
very  much.  All  at  once  it  ceased,  bellowed,  flexed  its  fore-limbs,  lay  down,  and  began 
to  strain  again.  In  a  short  time  it  brought  forth  a  calf  in  a  natural  manner.  From  this 
time  it  lay  almost  constantly,  and  could  only  rise  with  great  difficulty.  Then  it  could 
scarcely  move,  and  its  hind-quarters  swayed  from  side  to  side  :  the  ilium  of  either  side 
rising  or  falling,  as  the  corresponding  limb  sustained  weight  or  was  raised  from  the 
ground.  The  hand  passed  into  the  rectum,  found  the  sacro-iliac  articulation  painful  on 
])ressure.  There  was  no  abnormal  sensibility  in  the  ischio-pubic  symphysis;  but  when 
ihe  animal  walked,  the  index-finger  placed  on  one  pubic  bone  and  the  medius  on  the 
other,  felt  an  alternate  movement  of  these  bone.s,  in  harmony  with  that  of  each  ilium. 
The  sacro-pubic  diameter  of  the  pelvis  appeared  to  be  diminished,  while  the  bi-iliac  was 
slightly  increased.  The  internal  angle  of  the  iliums  forming  the  summit  of  the  croup, 
projected  more  than  four  inches  above  the  spines  of  the  sacrum,  which  appeared  to  be 
as  much  buried  between  these  angles. 

From  these  symptoms,  Gilis  diagnosed  a  partial  disjunction  between  the  pubic  and 
sacro-iliac  bones.  Deeming  the  case  incurable,  he  recommended  that  the  animal 
should  be  fattened  and  killed.  Some  months  after  the  examination,  it  was  in  the 
same  condition.  The  accident  was  attributed  at  first  to  pregnancy,  then  to  the  ex- 
ertion the  Cow  made  in  draught  until  parturition,  and  finally  to  the  act  of  parturition 
itself. 

SECTION    V. RUPTURE    OF    THE    BLADDER. 

Rupture  of  the  bladder  alone,  during  parturition,  would  appear  to  be 
an  unusual  accident,  from  the  almost  total  absence  of  mention  of  its 
occurrence.  That  it  may  happen,  however,  is  beyond  dispute,  and  the 
cause  of  it  is  obvious.  In  the  Mare  the  act  of  parturition  is  hurried  and 
energetic,  and  if  it  occurs  while  the  bladder  is  distended  with  urine,  the 
pressure  of  the  foetus  during  expulsion  may  rupture  this  viscus,  and  par- 
ticularly if  the  rectum  above  is  also  full  of  faeces,  the  fcetus  large,  and 
perhaps  in  a  wrong  position. 

The  extravasated  urine  gives  rise  to  peritonitis,  and  the  animal  will 
present  the  symptoms  of  that  most  painful  inflammation.  Death  is 
inevitable. 

I.  Furnivall  ( F^/^r/war/Vj-;?,  vol.  x.xxiii.,  p.  377)  was  hurriedly  called  to  attend  a  six- 
year-old  cart  Mare,  which  had  brought  forth  in  previous  years'  two  foals,  and  had  then 
foaled  fourteen  days  before  its  anticipated  time.  Early  in  the  morning  the  wagoner 
entered  the  stable  where  the  Mare  stood  along  with  five  other  horses,  and  found  the 
animal  with  a  foal  hanging  from  it,  the  hips  being  fast  in  the  vagina.  He  removed  the 
Mare  at  once  to  an  empty  stable,  and  went  to  inform  the  owner.  During  his  absence, 
according  to  the  statement  of  a  boy  who  remained,  it  heaved  violently  and  ejected  the 
foal,  which  alighted  on  its  head,  dislocated  the  second  and  third  cervical  vertebrae,  and 
did  not  move  afterwards.  The  Mare  then  commenced  throwing  itself  about  and  breath- 
ing quickly,  striking  at  the  abdomen  with  the  hind-limbs,  and,  whqp  up,  reeling  like  an 
intoxicated  animal.  It  appeared  to  be  in  the  most  terrible  agony,  and  in  a  short  time 
fell  down  as  if  shot,  and  died.  This  occurred  before  the  arrival  of  Furnivall,  who  made 
an  examination  of  the  body.  Every  organ  was  found  to  be  perfectly  healthy  both  in  the 
thorax  and  abdomen,  with  the  exception  of  the  bladder,  which  was  ruptured  to  the  ex- 
tent of  three  inches,  and  the  urine  it  contained  had  necessarily  escaped  into  the  perito- 
neal sac. 


638  ACCIDENTS  INCIDENTAL  TO  PARTURITION. 

1.  Overed  [Ibid.,  vol.  xxxvii.,  p.  505)  communicates  a  case  of  peculiar  interest,  ni 
which  a  Mare,  twelve  years  old,  had  given  birth  to  a  living  foal  about  four  weeks  pre- 
vious to  his  advice  being  sought.  Assistance  had  been  rendered  by  some  farm-laborers, 
after  which  the  Mare  was  observed  to  micturate  more  frequently  and  in  smaller  quan- 
tities, the  effort  being  accompanied  with  pain.  Put  to  the  stallion  nine  days  after  par- 
turition, the  symptoms  became  more  aggravated,  the  desire  to  micturate  being  almost 
continuous  ;  but  nothing  in  the  way  of  advice  was  sought  for  until  a  later  period,  when 
being  put  into  a  pasture,  the  animal  suddenly  ceased  feeding,  trembled  violently,  lay 
down,  rolled  several  times,  got  up,  and  after  much  straining  voided  only  a  few  drops  of 
urine,  great  pain  being  evinced,  and  the  body  was  covered  with  perspiration.  Faeces 
were  freely  passed.  Great  prostration  was  manifested  next  day  ;  there  was  straining  at 
intervals,  the  anus  and  vulva  were  intensely  swollen,  the  latter  being  much  inflamed. 
The  bladder  was  discovered  to  be  quite  empty  and  firmly  contracted  within  the  pelvis, 
and  the  finger  passed  into  the  urethra  caused  a  spasmodic  ejection  of  only  a  few  drops 
of.  urine.  The  Mare  died  during  the  evening  of  the  examination.  On  opening  the 
abdomen  a  large  quantity  of  fluid — from  ten  to  twelve  gallons — escaped;  this  proved  to 
be  urine,  with  possibly  a  small  quantity  of  serum,  as  the  peritoneum  exhibited  slight 
traces  of  inflammation.  The  omentum  was  very  dark  in  color,  and  covered  with  a  thin 
sabulous  deposit,  some  of  which  was  also  found  adhering  to  the  caecum,  colon,  and  blad- 
der. The  latter  was  inflamed,  unusually  thin  at  the  fundus,  in  the  centre  of  which  was 
a  rupture  through  which  a  finger  could  be  passed  in  the  contracted  state  of  the  organ — 
the  rent  would  be  much  larger  when  the  viscus  was  distended.  The  injury  was  sup- 
posed to  have  been  inflicted  during  parturition,  when  probably  the  bladder  was  injured 
at  the  fundus,  and  this  led  to  sloughing  at  the  part  where  the  rupture  occurred. 

SECTION    VI. RUPTURE    OF    THE    INTESTINES. 

There  are  some  instances  recorded  in  which  rupture  of  the  intestines 
has  occurred  during  parturition,  Avithout  the  uterus  or  other  organs  being 
involved.  The  accident  may  have  been  due  to  over-repletion  of  the 
stomach  and  intestines  with  ingesta,  and  the  energetic  action  of  the 
abdominal  muscles  during  the  labor  pains  ;  or  from  the  animal  throwing 
itself  down  violently,  under  the  same  circumstances. 

Schaack  mentions  a  case  in  which  rupture  was  due  to  a  loop  of  intes- 
tine being  compressed  between  the  foetus  and  the  brim  of  the  pelvis, 
when  the  former  was  passing  through  the  genital  canal. 

Such  an  accident  is  beyond  remedy. 

SECTION    VII. RUPTURE    OF    THE    DIAPHRAGM. 

Rupture  of  the  diaphragm  is  a  rare  occurrence  during  parturition,  and 
I  can  only  find  three  cases  recorded.  They  were  probably  due  to  the 
same  causes  as  those  which  produce  rupture  of  the  intestines.  Death 
resulted. 

1.  Molin  {Recueil  de' Med.  Veterinaire,  i^yj)  vidiS  consulted  concerning  an  old  Mare 
which  was  in  foal,  but  nothing  was  known  as  to  when  fecundation  had  taken  place. 
The  extraordinary  size  of  the  abdomen  and  the  movements  of  the  foetus,  left  no  doubt 
as  to  pregnancy,  and  as  the  period  for  birth  had  been  exceeded,  there  were  suspicions 
that  it  was  a  case  of  extra-uterine  pregnancy.  However,  a  few  days  subsequently  labor 
pains  set  in,  and  after  the  animal  had  been  very  uneasy  for  some  time  they  ceased.  Two 
days  afterwards,  the  Mare  was  again  uneasy  from  time  to  time,  and  refused  all  food. 
These  attacks  once  more  subsided,  but  in  four  days  a  message  was  sent  that  the  animal 
was  voiding  its  bowels  through  the  vagina.  When  Molin  arrived,  the  Mare  was  dead, 
and  a  great  part  of  its  intestines  were  spread  over  the  litter.  An  examination  was  made 
when  the  uterus  was  found  to  be  of  an  enormous  size,  the  body  and  cornua  forming  one 
vast  sac ;  it  had  entered  the  thorax  through  an  enormous  rupture  in  the  diaphragm. 
"This  probably  had  been  produced  by  the  violent  straining,  and  was  the  immediate 
cause  of  death."  There  was  a  rent  in  the  vagina  near  the  symphysis  pubis.  The 
cervix  uteri  was  extremely  dense,  and  the  walls  of  the  vagina  were  also  rigid.  The  os 
had  not  dilated.     The  foetus  weighed  140  pounds. 

2.  Hayes  ( Veterinarian,  vol.  xiii.,  p.  268)  performed  the  Caesarean  section  on  a  Cow, 


TRAUMATIC  LESIONS  OF  THE  GENITAL  ORGANS,  ETC.  639 

and  for  twelve  days  it  appeared  to  be  going  on  favorably,  when  it  died  in  a,  few  hours. 
A  rupture  of  the  diaphragm  at  its  central  part,  extending  for  three  inches,  and  with 
much  inflammation  around  it,  was  found.  The  wound -in  the  abdomen  and  uterus  was 
healthy,  but  the  vagina  was  very  dark-colored  and  jelly-like.  Death  in  this  instance 
may  have  been  due  to  septikaemia ;  though  Hayes  was  of  opinion  that  it  was  owing  to  the 
rupture  in  the  diaphragm. 

SECTION   VIII. — RUPTURE   OF   THE   ABDOMINAL   MUSCLES. 

We  have,  at  page  280,  when  treating  of  "  Hernia  of  the  Uterus  "  during 
pregnancy,  explained  under  what  conditions,  and  the  manner  in  which, 
rupture  of  the  abdominal  muscles  occurs.  The  accident  can  scarcely  be 
designated  as  one  consecutive  to  parturition  ;  but  its  treatment  may 
nevertheless  engage  the  attention  of  the  veterinary  surgeon,  after  ^  the 
uterus  has  been  emptied  of  its  contents.  In  the  same  section  allusion 
has  been  made  to  the  appropriate  measures. 

SECTION    IX. — RUPTURE   OF   THE   SACRO-SCIATIC   LIGAMENT. 

We  can  only  find  one  case  of  this  accident  on  record ;  so  that  it  must 
be  extremely  rare.  It  is  given  by  Naylor  (  Veterinarian,  vol.  xxxiii.  p., 
321),  and  the  subject  was  a  three-year-old  cart  Mare,  which  had  a  mal- 
presentation.  The  animal  was  down,  and  the  fore-feet  of  the  foetus  pro- 
truded beyond  th^  vulva,  but  the  head  was  not  visible,  it  being  bent  back 
to  the  side  of  the  chest ;  the  young  creature  was  dead.  Embryotomy 
was  resorted  to,  and  one  limb  was  about  to  be  removed,  when  the  uterus 
suddenly  contracted  with  great  violence,  and  half  expelled  the  foal ; 
traction  then  removed  it.  "  All  attempts  to  get  the  filly  up  were  ineffec- 
tual, and  an  examination  showed  that  a  rupture  of  the  sacro-sciatic  liga- 
ment on  the  right  side,  with  other  lesions,  had  taken  place."  Stimulants 
and  laxatives  were  administered,  and  a  mustard  plaster  applied  to  the 
loins.  "In  two  days  she  was  on  her  legs,  and  tottering  about  the  yard. 
Suffice  it  to  say  that  she  ultimately  recovered,  and  though  for  two  years 
the  off-quarter  was  less  in  size  than  the  other,  she  ultimately  got  quite 
well,  and  had  two  or  three  foals." 


640  PATHOLOGY  OF  PARTURITION. 

BOOK  V. 

PATHOLOGY  OF  PARTURITION. 

Under  the  head  of  Pathology  of  Parturition,  we  intend  to  include  those 
diseases  which  accompany  or  follow  this  act,  and  are  more  or  less  related 
to  it.  Some  of  these  maladies  are  of  great  pathological  interest  and 
practical  importance,  and  deserve  the  closest  study.  The  parturient  or, 
if  we  might  use  the  term,  puerperal  period,  is  a  very  remarkable  and 
critical  one  in  the  life  of  the  female  animal,  and  it  becomes  all  the  more 
so  as  the  creature  is  submitted  to  the  influences  of  domestication,  and  is 
rendered  more  and  more  artificial  by  skilful  management  and  breeding. 

During  pregnancy,  a  large  amount  of  nutritive  material  has  been  ab- 
stracted from  the  parent  to  nourish  and  develop  the  foetus;,  and  when 
birth  takes  place  this  is  retained  until  the  lacteal  secretion  has  been  fully 
established.  Consequent  upon  this  reflux,  there  is  established  a  kind  of 
plethora,  which,  together  with  the  nervous  excitement  and  succeeding 
prostration  induced  by  the  straining  and  pain  of  labor,  renders  the 
animal  more  susceptible  to  the  influence  of  morbific  causes  of  various 
kinds.  Hence  we  have  maladies  which  are  peculiar  to  the  parturient 
state,  or  if  common  at  other  times,  are  at  least  much  aggravated  when 
they  appear  at  this  period.  Though  the  parturient  diseases  of  animals 
are  not  so  numerous  as  those  of  the  human  female,  yet  they  are  neither 
unimportant  nor  few  ;  and  it  is  possible  that,  with  the  advance  of  vet- 
erinary science,  their  number  will  be  increased — so  far  as  exact  definition 
and  differentiation  are  concerned. 

In  this  respect,  the  prominent  part  infection  by  septic  material  plays 
in  the  development  of  parturient  diseases  is  to  be  remarked.  It  is  but 
recently  that  this  agency  has  been  recognized  as  one  well  worthy  of 
consideration  in  veterinary  pathology;  and  the  closer  its  effects  are 
studied,  so  the  more  inclined  are  we  to  attribute  diseases — and  particularly 
those  of  the  parturient  state — to  one  common  source,  septic  infection. 

Of  course,  there  are  other  maladies  or  disturbances,  chiefly  of  a  local 
character,  the  etiology  of  which  cannot  at  present  be  traced  to  septosis, 
and  which  merit  notice  in  this  part  of  our  work. 

The  diseases  which  we  have  to  consider  are:  i.  Vaginitis ;  2.  Leucor- 
rhoea ;  3.  Metritis,  Metro-peritonitis^  and  Parturiejit  Fever;  4.  Parturient 
Apoplexy;  5.  Post-partum  Paraplegia;  6.  Parturient  Eclampsia;  7,  Ep- 
ilepsia Uterina  ox  Mania  Puerperalis ;  8.  Parturient  Laminitis ;  9.  Mam- 
mitis ;  10.  Agalactia;  11.  Injuries  to  the  teats. 


CHAPTER  I. 

Vaginitis. 

Inflammation  of  the  vagina  does  not  often  exist  independently,  but  is 
generally  an  accompaniment  of  inflammation  of  the  uterus,  or  "Metritis," 
which,  being  the  more  serious  evil,  masks  this  malady.  Nevertheless, 
vaginitis  may  occur  independently  of  metritis,  and  is  then  generally  due 


VAGINITIS.  641 

to  protracted  and  laborious  delivery,  which  necessitates  manipulatory 
efforts,  the  use  of  instruments,  etc.,  the  passage  of  a  very  voluminous 
foetus,  the  pressure  of  a  pessary,  or  any  other  cause  which  may  lead  to 
irritation,  bruising,  or  wounding  of  the  mucous  membrane.  In  very  ex- 
ceptional instances,  the  inflammation  may  be  indirectly  due  to  the  action 
of  cold  on  the  skin,  or,  as  Saint-Cyr  observes,  the  ingestion  of  very  cold 
water — though  this  is  more  likely  to  induce  metritis  or  metro-vaginitis. 

The  inflammation  may  lead  to,  or  be  complicated  with,  ulceration, 
gangrene,  or  mortification  to  a  greater  or  less  extent. 

The  labia  of  the  vulva  and  the  lining  membrane  are  more  or  less  swollen, 
the  latter  being  of  a  deep  or  bright  red,  brown  or  livid  hue ;  there  may 
be  also  patches  of  congestion  and  ecchymoses,  with  wounds  or  abrasions, 
and  in  rare  cases  we  may»find  phlyctaenae  on  the  surface  of  the  mem- 
brane. The  temperature  of  the  canal  is  also  greatly  increased,  while  its 
walls  are  dry  and  often  adhesive.  Micturition  is  generally  painful  and 
difficult,  constipation  is  often  present,  and  there  is  sometimes  much  itch- 
ing in  the  region  of  the  vulva,  which  is  indicated  by  the  continued  attempts 
the  animal  makes  to  rub  the  part.  If  the  inflammation  is  severe  and 
extensive,  fever  will  be  manifested. 

When  the  inflammation  has  existed  for  one  or  two.  days,  the  mucus 
secreted  by  the  membrane  is  greatly  increased  in  quantity  \  it  is  at  first  a 
serous  limpid  fluid,  sometimes  streaked  with  blood  ;  then  it  gradually 
becomes  thicker  and  sero  or  muco-purulent,  soiling  the  tail  and  the 
thighs  and  hocks,  and  sometimes  becoming  so  acrid  as  to  cause  removal 
of  the  hair  and  excoriation  of  the  skin. 

Simple  vaginitis,  of  itself,  is  not  a  serious  affection,  and  the  inflam- 
mation often  subsides  spontaneously  in  the  course  of  a  few  days,  or 
rapidly  yields  to  treatment.  In  some  instances,  however,  it  assumes  a 
troublesome,  if  not  a  grave  character.  When  gangrene  ensues  we  may 
have  infective  inflammation  in  the  surrounding  parts,  and  large  portions 
of  the  membrane,  or  even  the  skin  of  the  labia,  may  slough,  while  the 
discharge  is  sanious  and  foetid.  Baumeister  describes  a  diphtheritic 
form  of  vaginitis  which  he  observed  in  a  Cow  that  had  calved  a  few  days 
before,  and  which  died  on  the  third  day.  At  the  autopsy,  the  vagina,  as 
well  as  the  uterus,  was  found  full  of  pseudo-membranous  productions. 
Another  Cow  which  stood  beside  this  one,  and  which  had  calved  four 
weeks  earlier,  contracted  the  disease  a  few  days  after  the  Cow  that  died, 
and  also  perished — leading  to  the  supposition  that  this  form  of  vaginitis 
is  contagious. 

The  treatment  of  simple  vaginitis  does  not  merit  much  consideration. 
Cleanliness,  attention  to  diet,  and  injections  of  cold  or  tepid  water,  or 
mild  astringents,  into  the  vagina,  generally  succeed  in  subduing  the  in- 
flammation. When,  however,  there  is  any  tendency  to  acute  inflammation 
and  gangrene,  or  there  exists  ulceration,  sloughing,  or  even  abrasions, 
disinfecting  treatment  is  advisable — a  solution  of  carbolic  acid  (2  to  10 
per  cent.),  permanganate  of  potass,  or  chlorinated  or  tar  water,  being 
perhaps  the  best  local  applications.  General  constitutional  treatment 
may  also  be  necessary,  and  especially  if  the  fever  runs  high,  and  there 
are  indications  of  septic  infection. 

41 
\ 


642  PA  THOLOG Y  OF  PARTURITION. 

CHAPTER  II. 

Leucorrhcea. 

vVhen  inflammation  of  the  vagina,  and  perhaps  also  of  the  Hning  mem- 
brane of  the  uterus,  becomes  chronic,  the  more  acute  symptoms  disappear  ; 
but  the  vaginal  discharge  continues,  and  may  even  increase  in  quantity. 
Usually  the  fluid  is  of  a  white,  glutinous,  and  odorless  character  ;  or  it 
may  be  purulent,  muco-purulent,  or  even  chocolate-colored  and  sour- 
smelling,  or  sanious  at  times.  The  secretion  is  mainly  composed  of 
mucus.  Histologically,  we  find  mucus  corpuscles,  an  abundance  of 
epithelial  cells,  probably  some  pus  corpuscles,  and  at  times  micrococci, 
and»infusoria,  particularly  the  Trichomonas  vaginalis,  which  is  also  found 
in  healthy  mucus  from  the  vagina.  Sometimes  the  secretion  is  only 
manifest  in  an  intermittent  manner — as  when  the  animal  is  lying  down 
or  in  movement,  or  during  micturition.  It  is  more  frequently  observed 
in  the  Cow — particularly  if  lymphatic — than  the  Mare,  and  especially 
if  there  is  bad  hygiene  ;  it  is  somewhat  rare  in  the  smaller  animals. 
The  appetite  is  in  many  cases  unimpaired,  and  the  creature  does  not  ap- 
pear to  be  inconvenienced  in  any  way  ;  in  other  instances,  with  the  in- 
crease in  the  discharge  and  the  duration  of  the  disease,  there  is  loss  of 
condition  and  appetite,  the  yield  of  milk  is  less,  and  it  may  be  viscid  ; 
signs  of  oestrum  are  more  frequently  present,  but  fecundation  does  not 
take  place  so  readily  as  in  health,  if  the  os  and  uterus  are  affected  ;  if 
it  does  occur,  the  chances  are  that  the  full  period  of  pregnancy  will  not 
be  reached. 

When  the  discharge  comes  chiefly  from  the  cervix  uteri,  it  is  more 
transparent  and  watery-looking  than  when  derived  from  the  vagina  or  in- 
terior of  the  uterus,  and  the  os  is  usually  more  or  less  dilated  when  these 
parts  are  involved,  while  the  uterus  itself  is  not  so  firmly  contracted  as 
when  in  a  sound  condition. 

The  mucous  membrane  of  the  genital  canal  is  pale,  relaxed  and  insen- 
sible ;  in  other  cases  it  may  be  roughened  by  granulations  ;  and  some- 
times it  is  tumefied  and  red.  Vaginal  catarrh  in  the  Bitch  is  often  as- 
sociated with,  or  dependent  on,  the  presence  of  papillomata  or  epithelo- 
mata. 

In  rare  instances  the  tissues  lining  the  canal  become  indurated  and 
lardaceous,  and  its  calibre  diminished.  Lafosse  has  even  observed  ad- 
hesions between  the  sides  of  the  vagina  in  an  old  Mare. 

With  regard  to  treatment^  if  the  disease  is  not  of  very  long  duration,  it 
may  yield  to  cleanliness  and  astringent  injections — such  as  solutions  of 
sulphate  of  zinc,  alum,  permanganate  of  potass,  tannic  acid,  etc.  When 
it  has  been  in  existence  for  a  long  time,  however  (it  may  continue  for 
months  and  even  years),  it  is  generally  very  obstinate,  chiefly  from  the 
relaxed  condition  of  the  membrane.  The  uterus  or  vagina,  or  both  if 
affected,  should  be  thoroughly  washed  out  twice  or  thrice  daily  with 
warm  water,  which  should  be  injected  until  it  flows  out  quite  clear.  A 
solution  of  carbolic  acid  in  warm  water  should  then  be  injected.  A  so- 
lution of  the  sulphate  of  iron  has  likewise  been  successfully  employed. 
Nitrate  of  silver  has  also  been  efficaciously  employed  in  solution  (i  to 
10) ;  as  has  tannic  acid  (i  to  70). 

Tonics  should  also  be  freely  administered. 

If  the  discharge  continues  after  two  or  three  weeks'  treatment,  it  may 
be  found  useful  to  apply  a  blister  to  the  loins,  croup,  or  thighs. 


METRITIS,  METRO-PERITONITIS,  ETC.  643 

CHAPTER  III. 

Metritis,  Metro-Peritonitis,  and  Parturient  Fever. 

Inflammation  of  the  uterus  {Metritis)  may  be  limited  to  one  or  more 
of  the  internal  layers  of  the  organ  {Endo-metritis),  or  it  may  extend  to 
its  outer  covering — the  peritoneum  {Metro-peritonitis),  and  produce  cer- 
tain symptoms  ;  while  the  introduction  of  septic  matters  into  the  blood, 
which  is  very  often  a  result  of  this  inflammation,  will  give  rise  to  symp- 
toms of  septikagmia.  The  latter  cqjnplication,  from  the  febrile  indica- 
tions which  accompany  it,  is  appropriately  distinguished  by  the  name  of 
"  Parturient  Fever  " — a  designation  applied  wrongly  to  another  and  very 
different  malady  of  the  parturient  period — Parturient  apoplexy  or  Eclamp- 
sia— and  which  we  will  study  hereafter. 

It  is  true  that  we  may  have  metritis  and  metro-peritonitis  without  sep- 
tikaemia — at  least  to  any  very  marked  degree  ;  but  the  symptoms  of  fever 
which  accompany  the  former  are  generally  more  or  less  apparent,  and  it 
is  often  difficult  to  discover  when  septic  infection  has  taken  place — the 
high  temperature  and  greatly  accelerated  circulation  being  the  first  no- 
table symptoms  observed,  and  these  often  appear  at  an  early  stage  of 
metritis.  And  we  may  have  septic  infection  without  metritis,  when  putrid 
matter  obtains  admission  to  the  circulating  fluids  through  a  lesion  in  the 
uterus  or  vagina. 

Inflammation  of  the  uterus  and  Septikczinia  puerperalis  occur  in  all  the 
domesticated  animals.  The  latter  would  appear  to  be  very  frequent  in  the 
Bitch ;  but  the  Mare,  Cow,  Sheep,  Goat,  and  Sow  are  liable  to  septic  in- 
fection, either  as  a  result  of  metritis,  or  the  introduction  of  putrefying 
matter  into  the  blood  through  an  abrasion  or  wound. 

The  inflammation,  as  well  as  the  infection,  varies  in  intensity  from 
acute,  sub-acute,  to  chronic. 

Symptoms. 

Inflammation  of  the  uterus  and  parturient  septikaemia  may  ensue  very 
soon  after  birth — rarely  before  the  second  day  with  the  Cow,  and  sel- 
dom beyond  the  eighth  day.  With  the  Mare  and  Bitch,  according  to 
Franck,  the  development  of  these  conditions  may  be  more  retarded.  Im- 
mediately after  parturition  the  animal  may  appear  to  have  quite  recov- 
ered from  the  effects  of  that  act,  yields  milk,  takes  care  of  its  progeny, 
and  there  is  nothing  to  indicate  the  existence  of  disturbance.  The  tem- 
perature in  the  rectum  is  normal,  except  in  those  cases — far  from  rare 
— in  which  birth  has  been  difficult  and  the  genital  canal  has  been 
roughly  treated  and  injured ;  then  the  rectal  temperature  may  be 
higher.  The  increase  of  temperature  is  the  first  indication  of  disease, 
and  within  twenty-four  hours  the  rise  may  be  as  much  as  two  de- 
grees. At  the  commencement  of  this  rise,  there  are  well-marked  rig- 
ors j  the  animal  becomes  dull  and  loses  its  appetite  ;  if  a  Cow,  rumina- 
tion ceases  ;  there  is  horripilation,  and  the  pulse,  small  and  hard,  may 
increase  in  the  Mare  and  Cow  to  100  per  minute  ;  the  secretion  of  milk 
gradually  decreases,  and  soon  ceases  altogether,  while  the  udder  dimin- 
ishes in  size  and  is  flaccid  ;  the  respiration  is  hurried  and  shallow  ;  the 
mouth  hot  and  pasty,  and  the  visible  mucous  membranes  injected ;  while 
the  horns  and  ears  are  very  warm. 

The  animal  grinds  its  teeth,  and  betrays  the  existence  of  colicky  pains 


644  •  ^^  THOL OG  Y  OF  PAR TURITION. 

by  lying  down  and  getting  up,  stamping,  striking  at  the  belly,  and  turning 
the  head  towards  the  flanks,  whisking  the  tail,  and  making  more  or  less 
energetic  expulsive  efforts.  Signs  of  pain  or  lameness  in  the  hind-limbs 
become  apparent.  When  the  uterus  is  more  inflamed,  the  animal  does 
not  lie  down,  because  of  the  increase  of  pain  produced  by  pressure  on 
the  abdomen.  The  smaller  animals,  however,  maintain  the  recumbent 
position. 

A  very  marked  symptom  is  the  tumefaction  of  the  vulva — the  labia 
of  which  are  separated — and  the  discharge  therefrom  of  a  fluid,  at  first 
serous,  and  either  transparent  or  ha*^ing  a  yellow,  chocolate,  or  reddish 
tinge  ;  then  it  becomes  gradually  thicker  and  more  abundant,  and  be- 
comes modified  according  to  the  termination  of  the  disease.  Manual  ex- 
ploration of  the  vagina  discovers  it  to  be  very  hot  and  sensitive,  particu- 
larly towards  the  cervix  uteri  ;  and  when  its  lining  membrane  is  exposed, 
it  is  observed  to  be  swollen  and  reddened,  and  sometimes  there  are  found 
diphtheritic  ulcers  and  croupous  deposits  on  the  inflamed  surface.  In 
some  cases,  when  the  uterus  is  very  much  swollen,  and  particularly  in 
lean,  flat-sided  animals,  the  inflamed  organ  can  be  felt  on  the  right  side, 
and  pressure  on  the  abdomen  often,  but  not  invariably,  causes  pain. 
Rectal  exploration  generally  discovers  the  uterus  larger  than  natural,  and 
more  or  less  distended  by  gas. 

Defecation  is  painful,  and  the  faeces  are  hard. 

The  Mare  attacked  by  metritis  or  metro-peritonitis,  generally  maintains 
the  standing  posture,  with  the  back  arched  and  rigid,  and  marked  indis- 
position to  move :  only  lying  down  on  the  approach  of  death,  or  towards 
convalescence  ;  whereas  flie  Cow  persists  in  lying,  and  this  has  been 
supposed  to  be  due  to  paralysis  of  the  hind-quarters,  but  it  is  more  prob- 
ably owing  to  debility  or  prostration  induced  by  the  pain. 

In  ruminants  there  is  generally  distention  of  the  rumen  with  gas  ;  there 
are  also  acid  eructations,  and  even  regurgitations.  When  the  temperature 
rises  very  high — and  it  may  reach  \2°  Cent. — death  is  certain. 

When  metro-peritonitis  is  present,  there  always  occurs — and  sometimes 
very  rapidly — an  effusion  of  serum  into  the  abdominal  cavity.  When  this 
is  in  large  quantity,  the  abdomen  becomes  enlarged  and  rounded,  as  if  the 
animal  had  been  feeding  freely.  There  is  then  dulness  on  percussion  in 
the  lower  region  of  the  abdomen,  contrasting  markedly  with  the  tympan- 
itic resonance  of  the  upper  regions  ;  while  sudden  pressure  by  means  of 
the  open  hand  on  one  part  while  the  other  hand  is  placed  at  another 
point,  will  cause  a  perceptible  movement  of  the  fluid. 

Terminations. 

•  The  course  of  metritis,  metro-peritonitis,  and  parturient  septikaemia,  is 
generally  very  rapid,  and  may  not  occupy  more  than  a  few  days — usually 
three  or  four,  rarely  five  or  six  days.  In  some  cases  a  chronic  form  may 
be  met  with — and  particularly  in  simple  metritis,  due  to  retention  of  the 
fcetal  membranes,  and  sometimes  to  abortion.  But  these  exceptions  are 
few,  and  the  disease  or  diseases  just  named  may  be  designated  as  serious, 
when  we  learn  that  death  carries  off  more  than  one-half  of  the  number  of 
animals  attacked. 

Though  so  serious,  however,  in  those  animals  which  are  about  to  re- 
cover convalescence  ensues  very  rapidly,  especially  with  the  Cow.  As 
Saint-Cyr  observes,  a  few  hours  often  suffice  to  bring  about  such  a  change 


METRITIS,  METRO-PERITONITIS,  ETC.  645 

for  the  better,  that  one  could  scarcely  believe  it  unless  they  saw  it,  and  it 
might  excite  a  doubt  whether  metritis  had  really  been  present.  In  the 
evening  the  animal  is  left  in  an  almost  hopeless  condition,  and  next  morn- 
ing one  is  astonished  to  find  it  up,  the  eye  limpid,  the  physiognomy  bright 
and  cheerful,  and  caresses  bestowed  on  the  offspring  which,  previously, 
was  unheeded  or  repelled.  The  animal  is  certainly  not  cured,  but  it  is 
out  of  danger,  and  with  a  few  days'  care  it  may  be  on  the  way  to  conva- 
lescence.    The  decrease  in  rectal  temperature  is  always  a  favorable  sign. 

But,  as  has  been  said,  death  is  the  most  frequent  termination  ;  and  this 
may  occur  in  two,  four,  or  six  days  from  the  commencement  of  the 
malady — rarely  a  little  later.  Then  all  the  symptoms  become  aggravated. 
The  tumefaction  of  the  genital  organs  increases,  and  extends  to  the 
mammae  and  hind-limbs  ;  the  vulva  is  covered  with  ecchymosed  patches 
and  becomes  cold;  the  vaginal  discharge  is  ichorous  and  brown  in  color, 
and  emits  a  most  fetid  odor  ;  the  temperature  suddenly  falls  \  the  surface 
of  the  body  is  covered  by  a  cold  glutinous  perspiration — especially  in  the 
Mare — and  the  animal  expires  either  in  a  state  of  profound  coma,  or  in 
convulsions. 

In  such  cases  death  may  be  due  to  the  violence  of  the  inflammation 
and  its  extension  to  the  peritoneum,  gangrene  of  the  uterus,  or  to  septic 
infection  by  absorption  of  the  putrid  matters  in  the  uterus,  and  general 
poisoning  therefrom. 

Franck  mentions  that  in  three  instances  the  disease  manifested  itself  on  the  day  after 
easy  parturition,  and  it  had  become  so  severe  that,  on  the  second  day,  it  was  necessary 
to  slaughter  the  animals.  On  the  inner  surface  of  the  vulvar  labia — which  was  of  a  dark- 
red  hue — were  one  to  three  parturient  ulcers,  and  in  a  few  hours  there  had  occurred  an 
enormous  tumefaction  of  the  labia,  which  extended  to  the  pelvic  connective  tissue  and 
as  low  as  the  hocks,  while  the  dependent  parts  of  the  body  were  also  involved.  Deep 
scarifications— which  caused  no  pain — were  useless,  and  were  not  followed  by  bleeding. 
On  examination  of  the  bodies  after  death,  thrombi  were  discovered  in  the  uterine  and 
ovarian  veins.  In  these  cases  the  infection  seemed  to  have  been  derived  from  an  ad- 
joining Cow,  which  retained  the  placenta. 

Meyer  refers  to  a  case  of  this  kind,  in  which  death  ensued  during  the  evening  of  the 
day  on  which  the  disease  manifested  itself.  He  found  a, large  blood-clot  in  the  uterus, 
and  ecchymoses  on  the  intestines. 

More  frequently  than  rapid  recovery,  the  malady  passes  into  a  chronic 
state.  Then  the  more  acute  symptoms  gradually  diminish,  the  appetite 
returns,  and  the  animal  does  not  exhibit  much  suffering.  But  convales- 
cence is  not  established — the  mammae  remain  flaccid,  and  the  secretion 
of  milk  is  either  very  scanty  or  altogether  suppressed  ;  the  swelling  dis- 
appears from  the  vulva,  but  the  discharge  therefrom  persists  or  is  in- 
creased in  quantity.  This  discharge  is  either  of  a  white  glairy  character 
— leucorrhoea  ;  greyish  and  grumous,  resembling  clotted  milk  \  or  red, 
brown,  or  sanguinolent.  It  is  always  more  or  less  odorous,  and  some- 
times extremely  fetid  ;  more  particularly  is  this  the  case  when,  as  often 
happens  with  the  Cow,  the  discharge  is  mixed  with  or  derived  from  the 
retention  in  the  uterus  of  the  foetal  envelopes,  or  even  the  foetus  itself. 
In  some  instances,  the  croupous  exudates  which  have  been  formed  on  the 
mucous  membrane  become  broken  up,  and  are  cast  ofif  with  the  discharges. 
Franck  states  that,  in  one  case,  a  large  croupous  or  false  membrane, 
which  had  covered  the  greater  part  of  the  interior  of  the  uterus,  was  shed 
in  this  way. 

In  other  instances  the  cervix  uteri  contracts,  though  the  mucous  mem- 
brane is  still  inflamed  ;  consequently,  the  muco-purulent  secretions  are 


646  PATHOLOGY  OF  PARTURITION. 

retained  for  some  time,  and  the  discharge  from  the  vulva  ceases.  But 
when  the  organ  becomes  distended,  it  contracts,  or  it  is  pressed  upon 
when  the  animal  lies  down,  or  during  micturition  or  defecation  ;  then  the 
OS  is  forced  partially  open,  and  the  accumulated  fluid  escapes  in  great 
abundance.  Saint-Cyr  mentions  that  Gohier,  Chouard,  and  other  veter- 
inary writers,  give  instances  of  this  singular  form  of  chronic  metritis  ;  they 
have  seen  Mares  which  every  forty  days,  every  month,  or  at  shorter  inter- 
vals, expelled  fourteen,  sixteen,  and  even  as  much  as  twenty  pints  of  pus, 
after  exhibiting  symptoms  of  colic,  followed  by  more  or  less  marked  ex- 
pulsive efforts. 

In  the  chronic  form  of  metritis,  the  animal  does  not  appear  to  suffer  at 
the  commencement,  but  it  soon  loses  condition ;  the  appetite  is  irregular, 
and  the  skin  unhealthy-looking  and  clings  to  the  bones ;  the  secretion  of 
milk  decreases,  and  finally  disappears  ;  and  though  debility  is  present, 
oestrum  may  occur  far  more  frequently  than  in  health,  yet  fecundation  is 
not  possible.  Marasmus  sets  in,  with  febrile  attacks  at  intervals — pyaemic 
fever  ;  and  though  recovery  is  still  probable,  by  skilful  treatment  and  long- 
continued  nursing,  yet  death  is  only  too  often  the  sequel. 

Even  when  recovery  appears  to  be  progressing  favorably,  relapses  may 
occur,  sometimes  through  the  breaking  up  and  diffusion  of  venous  thrombi, 
which  give  rise  to  a  pyaemic  process,  as  in  the  case  recorded  by  Con- 
tamine.  On  the  morning  after  an  easy  parturition,  the  after-birth  having 
also  been  expelled,  the  Cow  began -to  tremble  very  much  ;  the  udder  was 
small  and  flaccid,  the  back  arched,  the  appetite  was  lost ;  there  was 
anxiety,  with  colicky  pains,  constipation,  and  pressure  in  the  right  flank 
caused  pain  ;  the  labia  of  the  vulva  were  apart,  swollen,  and  of  a  dark-red 
color.  In  three  days  the  animal  was  much  better  ;  but  after  three  weeks 
there  was  a  relapse.  Petechiae  formed  on  the  conjunctivae,  the  hind- 
limbs  became  swollen,  and  bleeding  ensued  from  the  skin  and  nostrils, 
and  there  was  cough.     The  Cow  finally  recovered. 

Occasionally  during  the  sub-acute  or  chronic  stages  of  metritis,  metas- 
tatic formations  occur  in  the  lungs,  liver,  joints,  and  other  parts  ;  not  un- 
frequently  there  are  caseous  or  pseudo-tuberculous  deposits  in  the  uterus, 
which  may  attain  such  a  thickness  in  its  walls  as  to  simulate  pregnancy. 

Pathological  Anatomy. 

In  those  cases  in  which  death  has  taken  place  and  an  examination  of 
the  body  been  made,  the  local  and  essential  lesions  are  found  in  the  gen- 
ital organs  and  peritoneum,  and  when  puerperal  septikaemia  has  been 
present,  there  are  observed  indications  of  general  infection  of  the  body. 
Decomposition  sets  in  early,  the  tissues  are  dark-green*  and  foetid,  and 
meteorism  is  largely  developed. 

In  simple  endo-metritis  we  will  not,  of  course,  find  such  marked  and 
general  lesions,  nor  will  the  peritoneum  be  involved.  In  the  more  acute 
cases,  and  particularly  those  in  which  there  has  been  septic  infection, 
puerperal  ulcers  of  a  dirty  greenish  hue  are  generally  met  with  in  the 
vagina,  often  in  the  vicinity  of  the  meatus  urinarius  and  about  the  labia 
of  the  vulva.  The  mucous  membrane  is  of  a  dull  dark-red  hue,  and 
swollen  in  patches  by  diphtheritic  infiltration,  or  covered  in  parts  by  crou- 
pous exudates.  The  bladder  may  also  be  implicated,  though  not  to 
such  a  serious  extent,  and  especially  if  the  catheter  has  been  employed. 
In  the   cavity  of  the  uterus  is  constantly  found  a  quantity  of  chocolate- 


METRITIS,  METRO-PERITONITIS,  ETC.  647 

colored  or  greyish  fluid,  composed  of  effused  blood,  remains  of  foetal 
envelopes,  the  secretions  of  the  mucous  membranes — all  in  a  more  or  less 
advanced  state  of  decomposition,  and  emitting  the  most  repulsive  odor. 
This  fluid  contains  quantities  of  epithelial  and  round  cells,  fat  globules, 
and  decomposition  bacteria.  The  quantity  of  fluid  varies  considerably, 
according  to  circumstances — amounting  sometimes  to  many  gallons. 

The  uterus  itself  is  never  contracted  as  in  the  normal  condition,  and  it 
is  often  two  or  three  times  larger  than  it  ought  to  be. 

The  walls  of  the  organ  are  thickened,  friable,  softened,  intensely  red, 
and  infiltrated  with  sanguinolent  serosity,  inflammatory  products,  and  pus 
globules.  The  mucous  membrane  is  thickened,  of  a  dirty-brown  or  dark- 
green  tint,  livid,  softened,  ecchymosed  in  places,  and  covered  here  and 
there  with  diphtheritic  or  fibrinous  exudates  and  blood-clots,  the  latter 
being  chiefly  found — in  the  Cow — at  the  base  of  the  cotyledons,  which 
are,  with  the  exudates  and  clots,  in  process  of  putrefaction,  and  are  grey, 
pulpy,  and  almost  detached.  Sometimes  portions  of  decomposed  foetal 
membranes  yet  remain  attached  to  the  cotyledons  ;  and  there  are  here 
and  there  gangrenous  eschars,  in  the  form  of  green  or  greyish  spongy 
masses  of  a  diphtheritic  nature,  and  which  are  in  process  of  softening 
and  dissolution.  In  all  these  alterations — which  are  usually  very  notable 
in  the  cornu  that  contained  the  foetus — we  have  the  characteristic  fea- 
tures of  Endometritis  scptica. 

It  is  seldom,  indeed,  that  the  puerperal  or  septic  inflammation  is  limited 
to  the  mucous  membrane.  Nearly  always  it  extends  to  the  submucous 
connective  tissue  {Metritis  phleg77ionosd)  which  is  infiltrated  with  an  oede- 
matous  transudation ;  or  it  becomes  the  seat  of  acute  inflammatory 
oedema,  in  which  the  tissue  swells,  becomes  tumid,  and  its  interstices 
filled  with  fluid,  small  cells,  and  a  gelatinous,  semi-solid  material.  The 
muscular  tissue  is  swollen  and  softened,  and  a  dark  fluid  flows  from  it. 

The  sub-peritoneal  connective  tissue  of  the  uterus  may  suffer  in  a  like 
manner,  and  undergo  necrotic  softening  and  putrefaction  j  while  the 
serous  membrane  itself  becomes  inflamed  {Metro-perito?iitis) . 

When  this  takes  place,  the  abdominal  cavity  contains  a  quantity  of 
reddish,  turbid,  sanious  serosity,  in  which  are  flakes  of  lymph.  The 
lining  membrane  of  this  cavity,  and  especially  that  covering  the  uterus, 
is  highly  inflamed,  and  its  surface  is  covered  with  pseudo-membranous 
layers  of  fibrin  ;  while  adhesion  may  have  taken  place  between  the  dif- 
ferent organs  it  covers.  In  some  cases  the  inflammation  of  the  peri- 
toneum is  not  so  diffuse,  and  is  more  or  less  limited  to  the  uterus  and 
organs  immediately  adjacent. 

In  other  cases,  again,  the  phlegmonous  inflammation  extends  to  the 
pelvic  connective  tissue  {Parametritis),  and  we  have  diffuse  acute  oedema, 
infiltration  with  pus,  or  even  abscesses. 

Indeed,  in  the  uterine  connective  tissue  we  may  have,  in  different 
parts,  active  cell-proliferation  and  abscesses,  and  if  the  animal  chances 
to  live  beyond  a  certain  period,  these  terminate  in  caseous  inspissation, 
or  even  perforation  into  the  abdominal  cavity. 

A  very  important  pathological  lesion,  and  one  which  is  not  unfre- 
quently  noted  in  parametritis,  is  thrombosis  of  the  veins  and  lymphatics. 
Thrombosis  of  the  uterine  veins  has  been  observed  in  animals  :  solid, 
white  or  yellowish  thrombi  adhering  to  the  internal  surface  of  the  vessels, 
and  extending  towards  the  larger  venous  trunks — even  as  far  as  the  pos- 
terior vena  cava.     Sometimes  the  breaking-up  of  these  thrombi  causes 


648  PA  THOL OG Y  OF  PAR TURITION. 

relapse,  and  embolic  pyaemia  of  the  lungs  or  neighboring  organs.  When 
septic  infection  does  not  occur,  bruising  of  the  soft  parts  during  difficult 
parturition  may  give  rise  to  thrombosis  of  the  veins,  with  secondary 
pysemia.  This  may  explain  the  occurrence  of  abscesses  appearing  at 
the  joints,  and  inflammation  of  the  feet  supervening  on  parturition. 
Thrombosis  of  the  lymphatics  has  rarely  been  observed  in  animals  ;  it  is 
noticed  within  the  inflamed  spot.  "The  coagulated  lymph  either  uni- 
formly fills  the  vessel,  or  gives  the  appearance  of  a  string  of  beads. 
Sometimes,  also,  single  larger  dilatations  of  lymphatic  vessels  are  seen. 
The  thrombosis  may  be  due  to  the  direct  influence  of  the  infecting  mat- 
ter, but  more  frequently  it  is  caused  by  the  inflammation  of  the  connec- 
tive tissue  around  the  vessel.  The  products  also  of  the  inflammation  of 
this  tissue  have  a  tendency  to  coagulate,  and  the  contents  of  the  vessels 
participate  in  the  process."  Sometimes  the  lymphatics  are  filled  with 
pus  (Purulent  lympka?igitis),  and  the  neighboring  glands  are  swollen  and 
softened.  This  thrombosis  of  the  lymphatics  has  been  considered  a 
favorable  circumstance,  since  the  occluded  vessels  are  prevented  from 
conveying  the  infecting  materials  :  the  inflammatory  process  being  at 
least  delayed  at  the  nearest  group  of  lymphatic  glands.  The  lymphan- 
gitis is  therefore  considered  an  accidental  change,  which  usually  remains 
limited  to  the  diseased  part,  and  may  disappear ;  and  it  has  been  re- 
marked that  it  rarely  extends  further  towards  the  thoracic  .duct,  unless 
there  are  other  very  considerable  changes. 

Sometimes  the  thrombi  in  the  vessels  in  the  uterus  soften  ;  so  that,  in 
cutting  into  the  walls  of  the  organ,  these  appear  like  small  abscesses, 
varying  in  size  from  a  pea  to  that  of  a  nut.  They  can  only  be  distin- 
guished from  abscesses  by  their  smooth  walls,  since  the  aff'erent  and 
efferent  vessels  cannot  always  be  found. 

In  intense  parametritis,  with  extensive  infiltration  of  the  subserous 
connective  tissue,  we  may  have  other  organs  involved,  and  especially 
those  which  are  directly  connected  by  means  of  this  tissue — such  as  the 
ovaries.  The  peritonitis  may  extend  through  the  diaphragm  to  the  pleurae, 
or  the  inflammation  in  both  membranes  may  be  due  to  ichorrhaemia. 

In  those  cases  in  which  thrombi  in  the  blood-vessels  have  become  de- 
tached and  broken-up,  the  masses  may  be  carried  in  the  circulation,  and 
then  give  rise  to  embolism  and  haemorrhagic  infarcts,  or  to  metastatic 
abscesses,  in  such  parenchymatous  organs  as  the  lungs,  liver,  spleen,  kid- 
neys, etc. 

In  the  most  rapidly  fatal  cases,  in  which  death  is  due  to  septic  para- 
metritis, there  is  no  time  for  fibrinous  exudation,  and  we  have  appear- 
ances not  unlike  those  observed  in  splenic  fever.  The  blood  is  dark- 
colored  and  non-coagulable,  ecchymoses  are  found  in  various  organs  and 
tissues,  and  there  is  a  marked  tendency  to  rapid  putrefaction.  The  ele- 
mentary structures  of  organs  show  the  commencement  of  an  acute  inflam- 
matory process — the  fine  granular  infiltration  or  "  cloudy  swelling,"  fatty 
degeneration,  or  even  disintegration  of  cells. 

We  have  already  stated  that  there  is  nothing  specific  in  parturient 
fever,  and  so  far  as  its  pathological  anatomy  is  concerned,  the  same  al- 
terations are  observed  in  non-parturient  subjects.  Parturition  only 
predisposes  the  animal  to  its  occurrence,  from  the  fact  that  there  are 
wounds  and  bruises  inflicted  on  the  soft  tissues  of  the  genital  canal  ;  that 
there  is  present  a  quantity  of  matters — fluid  and  solid — either  decomposed 
or  decomposing ;  and  that  the  blood-vessels  and  lymphatics  of  the  uterus 


METRITIS,  METRO-PERITONITIS,  ETC.  649 

at  this  time  are  in  a  favorable  condition  for  the  reception  and  action  of 
this  septic  material.  In  animals  which  have  succumbed  after  the  opera- 
tion of  ovariotomy,  similar  pathological  alterations  are  found. 

With  regard  to  chronic  metritis,  various  changes  have  been  observed. 
In  some  cases  the  uterus  has  contained  a  considerable  quantity  of  fetid 
pus,  or  muco-purulent  matter  of  a  white  or  grey  hue  ;  while  the  mucous 
membrane  has  been  grey  or  dark-colored,  thickened,  and  softened,  and 
the  cotyledons  infiltrated,  softened,  or  even  indurated  ;  the  vaginal  mu- 
cous membrane  is  also  infiltrated  and  indurated  in  some  cases. 

I.  Robinson  (Saint-Cyr,  (?/.  «V.,  p.  686)  reports  the  case  of  a  Cow  which  brought 
forth  a  calf,  naturally  and  without  assistance,  three  weeks  after  purchase,  and  the  fcetal 
envelopes  were  expelled  in  the  ordinary  way  at  the  usual  time.  The  calf  was  strong  and 
lively,  but  the  Cow  did  not  completely  recover  from  the  effects  of  parturition,  but 
remained  unwell,  lost  its  appetite  and  condition,  and  soon  discharged  from  the  vulva — 
which  remained  swollen — a  white  fluid  that,  at  a  later  period,  v.as  streaked  with  blood. 
When  Robinson  saw  it,  the  animal  was  in  the  last  stage  of  emaciation  ;  the  pulse  was 
small  and  72  beats  per  minute,  the  surface  of  the  body  was  colder  than  in  health,  and 
there  was  little  appetite,  though  thirst  was  insatiable.  By  the  vulva  a  purulo-sanguino- 
lent  fluid  escaped,  and  though  the  urine  was  ordinarily  transparent,  yet  sometimes  its 
mingling  with  this  discharge  rendered  it  turbid.  Chronic  metritis  was  diagnosed,  and, 
in  consequence  of  the  condition  of  the  animal,  slaughter  was  recommended.  This 
advice  was  not  adopted,  however,  and  the  Cow  died  in  a  week  afterwards. 

At  the  autopsy  the  whole  mucous  surface  of  the  uterus  was  found  ulcerated,  and  the 
walls  of  the  organ  considerably  thickened,  as  were  also  those  of  the  bladder  and 
ureters — the  latter  particularly.  The  kidneys  were  enormous  in  size — nearly  four  times 
larger  than  in  health ;  in  them  were  several  abscesses,  containing  thick  yellow  pus 
mixed  with  a  little  blood. 

It  is  possible  that,  as  Saint-Cyr  thinks,  there  had  been  uterine  phlebitis,  and  some 
fragments  of  the  thrombus  becoming  detached  from  the  inflamed  veins  and  carried  by 
the  blood,  had,  by  a  reflux  movement,  reached  the  divisions  of  the  renal  veins.  There 
they  would  give  rise  to  capillary  obstructions,  infarct,  inflammation,  and  all  those  acci- 
dents which  accompany  embolism.  In  this  way  the  inflammation  and  abscesses  in  the 
kidney  would  be  produced. 

2.  Gray  {Veterinary  yournal,  ]\\\\e,  1877)  describes  the  case  of  Cow  two  years  old, 
which,  some  time  after  being  put  to  the  bull,  strained  at  times  and  ejected  small  quanti- 
ties of  blood.  In  two  months  the  animal  was  observed  to  be  in  oestrum,  and  was  again 
sent  to  the  bull.  The  symptoms  became  greatly  aggravated ;  there  was  a  continuous 
discharge  from  the  vulva  of  a  chocolate-colored  fluid,  which  had  somewhat  the  consist- 
ency of  cream,  and  the  animal  strained  frequently.  Loss  of  condition  ensued.  On  ex- 
amination the  pulse  was  found  to  be  more  than  80  beats  per  minute,  external  tempera- 
ture normal,  conjunctivae  pale,  and  general  expression  excited  and  anxious.  The  blood- 
discharges  increased  in  quantity  and  frequency,  and  in  another  month  the  anaemia  and 
debility  were  so  great  that  the  Cow  could  not  stand  ;  death  took  place  soon  after,  v  All 
the  organs,  with  the  exception  of  the  uterus,  were  found  healthy.  This  contained 
about  two  quarts  of  a  sero-sanguineous  fluid,  and  externally  the  organ  presented  the 
appearance  and  volume  natural  to  the  third  month  of  gestation,  and  as  if  the  fostus  had 
been  in  the  left  cornu.  The  os  uteri  was  dilated,  and  protruding  from  it  was  an  elon- 
gated piece  of  blood-clot  about  an  inch  in  diameter ;  this  was  merely  a  portion  of  a  very 
large  clot,  weighing  more  than  twelve  pounds,  and  lying  in  the  cavity  of  the  organ.  This 
mass  of  clot  was  in  many  places  firmly  adherent  to  the  mucous  membrane  ;  at  other 
points  it  was  breaking  up.  It  was  surmised  that  abortion  had  occurred,  and  that  this 
led  to  ulcerative  endometritis  and  haemorrhage. 

Causes. 

The  predisposing  cause  of  metritis,  metro-peritonitis,  and  purturient 
fever,  is  the  parturient  or  puerperal  state.  It  is  true  that  septic  infection, 
with  its  train  of  symptoms,  may  occur  at  other  periods  and  from  various 
causes  ;  but  metritis  and  its  complications  are,  as  a  rule,  it  may  be  said, 
observed  only  after  abortion  or  parturition. 

The  occasional  causes  of  metritis,  and  therefore  of  metro-peritonitis  and 


650  PA  THOL OG  Y  OF  PA R  TURITION. 

fever,  are  injuries  to  the  genital  canal  or  interior  of  the  uterus,  during  or 
after  birth.  The  manipulations  necessary  for  the  artificial  removal  of 
the  foetus  or  its  envelopes,  and  by  which  the  mucous  membrane  is  abrad- 
ed or  wounded,  are  a  frequent  cause  ;  inversion  of  the  organ,  and  es- 
pecially when  it  has  been  exposed  for  some  time  to  the  air  and  the  action 
of  irritating  substances,  or  bruised  or  lacerated  in  returning  it,  is  another 
cause.  Retention  of  the  foetus  or  fcetal  envelopes  has  also  been  given 
as  a  cause  of  metritis. 

But  other  cases  have  been  noted  in  which  birth  was  easy  and  natural, 
and  at  the  usual  time  ;  and  yet  towards  the  second,  fourth,  or  sixth  day 
after  parturition,  the  animal  began  to  lose  its  appetite,  the  vulva  became 
swollen,  fever  set  in,  and  all  the  symptoms  of  metro-peritonitis  became 
rapidly  developed.  In  these  cases,  the  occurrence  of  disease  has  been 
attributed  to  some  imprudence  in  management,  which  brings  about  de- 
rangement in  the  functions  of  the  skin  or  digestive  organs — as  exposing 
the  animal  to  wet  and  cold  out  of  doors,  or  draughts  of  cold  air  in  stables, 
or  giving  it  cold  water  to  drink,  or  unsuitable  food. 

Sometimes  the  disease  occurs  among  such  a  large  number  of  animals 
almost  simultaneously,  that  it  has  been  looked  upon  as  epizootic,  and 
due  to  a  miasma.  More  particularly  has  this  been  the  case  with  par- 
turient fever,  but  which  must  now  be  considered  as  due  solely  to'  the 
absorption  of  septic  matter,  i.e.,  decomposing  organic  material. 

The  production  of  parturient  fever  in  animals,  as  in  the  human  female, 
requires  two  conditions  :  i,  a  fresh  wound  by  which  the  septic  poison  can 
enter.  The  wound  need  not  be  large,  but  it  appears  to  be  almost  essen- 
tial that  it  is  recent ;  for  suppurating  or  granulating  sores  do  not  absorb, 
so  long  as  the  infecting  agent  does  not  destroy  the  suppurating  or  gran- 
ulating surface.  If  the  mucous  membrane  is  intact  and  protected  by  its 
epithelium,  absorption  is  also  prevented  ;  2,  an  active  septic  substance, 
either  produced  in  the  animal  which  is  to  be  the  subject  of  parturient 
fever — auto-infection,  or  introduced  from  without — external  infection. 

Birth  rarely  takes  place  in  animals  without  more  or  less  laceration  or 
abrasion  of  the  cervix  uteri,  vagina,  or  labia  of  the  vulva  ;  and  those  in- 
juries which  are  on  the  floor  of  the  genital  canal  are  more  likely  to 
be  followed  by  septic  fever  than  those  which  are  on  the  sides  or  roof, 
simply  because  they  are  brought  more  directly  in  contact  with  the  decom- 
posing material.  Infection  less  frequently  takes  place  from  the  interior 
of  the  uterus  under  normal  conditions,  as  injury  is  much  less  likely  to 
occur  there  from  the  passage  of  the  foetus.  Exceptionally,  it  may  take 
place 'in  the  uterus  through  the  cotyledons,  when  some  of  these  are  torn 
during  the  separation  of  the  foetal  membranes. 

As  has  been  already  mentioned,  the  parturient  period  is  eminently 
favorable  for  the  absorption  of  septic  matters  ;  as  the  mucous  membrane 
of  the  genital  canal  is  exceptionally  vascular,  and  the  blood-vessels  and 
lymphatics  are  greatly  developed. 

Auto-infection  occurs  generally  when  there  is  a  fresh  wound,  and  when 
the  foetus  is  dead,  and,  still  retained  in  the  uterus,  has  become  decom- 
posed through  the  access  of  air  ;  or  from  retention  and  putrefaction  of 
the  envelopes.  The  ichorous  putrefaction  of  wounds,  or  new  growths  in 
the  uterus  or  vagina,  may  also  lead  to  septic  infection. 

PYanck  gives  the  following  illustrations  which  could  be  easily  and  largely  supple- 
mented. 


METRITIS,  METRO-PERITONITIS,  ETC,  651 

1.  The  foetus  of  a  heifer  was  dead  in  the  uterus,  and  much  distended  with  gas.  Em- 
bryotomy had  to  be  resorted  to,  in  order  to  extract  it ;  and  this  was  accompUshed,  ap- 
parently, without  causing  any  noticeable  injury  to  the  vagina.  On  the  third  day  septikae- 
mia  became  manifest,  and  the  animal  had  to  be  killed. 

2.  A  Cow  gave  birth  to  a  calf  in  a  normal  manner  ;  but  the  hoof  of  the  young  creature, 
on  its  passage  through  the  vagina,  made  a  small  wound.  Twenty-four  hours  afterwards 
a  second  calf,  in  a  state  of  putrefaction,  was  removed  by  manual  force,  but  without  in- 
juring the  Cow.  In  two  days  the  latter  was  attacked' with  puerperal  fever,  and  was 
killed. 

3.  Mombrini  removed  a  dead  calf  from  the  uterus  by  embryotomy.  Septic  inflamma- 
tion of  the  uterus  and  peritoneum  set  in,  and  the  Cow  died  on  the  seventh  day. 

4.  It  is  well  known  that  Bitches  which  retain  the  foetus  in  the  genital  canal  for  any 
length  of  time  (eighteen  hours  or  thereabouts),  frequently  perish  from  Septikcetnia  i)uer- 
peralis.  This  appears  to  be  due  to  the  fact  that  the  puppy  so  retained  quickly  dies  ; 
owing  to  the  shortness  of  the  umbilical  cord,  the  early  separation  of  the  placenta,  and 
birth  taking  place  in  the  amnion.  The  young  creature  also  speedily  putrefies,  and  the 
large  raw  surface  formed  by  the  -maternal  placenta  Is  a  ready  inlet  for  the  direct  intro- 
duction of  the  septic  material  into  the  blood.  Speedy  death  of  the  Bitch  is  the  conse- 
quence. 

Embryotomy,  when  the  foetus  is  decomposing,  is  a  dangerous  operation, 
if  a  wound  chances  to  be  inflicted  during  its  performance.  It  is  the  same 
with  the  removal  of  the  foetal  envelopes. 

A*  Cow  retained  the  foetal  envelopes  for  five  days  after  parturition,  when  they  were 
removed.  The  operator  had  evidently  wounded  a  cotyledon  or  the  uterine  mucous 
membrane  in  doing  so,  as  his  hand  was  stained  with  blood.  In  three  days  the  animal 
was  affected  with  parturient  fever  and  died.  No  injury  to  the  uterus  could  be  detected 
on  post-mortem  examination. 

With  the  Mare,  removal  of  the  foetal  membranes  does  not  appear  to  be 
dangerous.  Retention  of  these  is  not  usually  followed  by  infection  ;  for 
it  is  not  until  the  second  or  third  day  after  parturition  that  their  decom- 
position usually  commences  ;  so  that  if  small  injuries  have  been  pro- 
duced during  birth,  it  is  most  likely  that  they  will  be  suppurating  or 
granulating  by  that  time,  and  thus  be  proof  against  the  passage  of  putrid 
matter.  If,  however,  a  fresh  w^ound  is  made,  or  the  granulations  are  in- 
jured by  mechanical  means,  then  removal  of  the  putrid  envelopes  is  full 
of  risk.  F»elen  mentions  that  a  Cow  had  a  wound  on  the  vulva,  and 
this  was  infected  by  putrid  membranes  ;  on  the  fourth  day  after,  the  an- 
imal died  with  all  the  symptoms  of  parturient  septikiemia. 

External  infection  does  not  appear  to  be  so  frequent  as  auto-infection 
among  animals.  It  takes  place  when  septic  materials  are  brought  to  the 
recent  wounds  or  lacerations  of  the  genital  organs  by  any  means — as  di- 
rectly by  the  hand,  instruments,  sponges,  straw,  etc,  or  indirectly  by 
means  of  the  atmosphere,  when  the  septic  materials  are  suspended  there- 
in— the  so-called  miasmatic  infection.  There  is  a  dose  relationship  be- 
tween abortion  and  parturient  fever — a  Cow  suffering  from  the  latter 
being  undoubtedly  dangerous  in  a  stable  or  pasture  -where  there  are  a 
number  of  pregnant  cattle  ;  while  a  case  of  abortion  or  placental  reten- 
tion occurring  in  a  stable,  might  be  considered  nearly  as  serious  among 
parturient  Cows. 

A  retained  and  decomposed  placenta  is  undoubtedly  a  fertile  source  of 
parturient  fever.  Franck  refers  to  three  instances,  in  which  the  Cows 
calved  in  a  normal  manner  and  the  foetal  membranes  came  away  in  four 
hours  after  ;  but  a  trifling  wound  existed  in  the  mucous  membrane  of  the 
labia,  at  the  commencement  of  the  vagina.  In  two  or  three  days  after- 
wards these   animals  showed  very  acute  symptoms  of  parturient  fever. 


6^i  PA  THOLOG Y  OF  PARTURITION. 

They  stood  near  another  Cow  whose  uterus  contained  a  decomposing 
placenta.  The  emanations  from  the  vulva  or  discharges  of  this  animal 
had,  there  can  scarcely  be  a  doubt,  infected  the  three  ;  or  the  soiled 
straw  may  have  been  the  means  of  conveying  the  septic  matter  to  the 
vulvar  wounds  ;  the  tail  of  the  Cow  may  even  have  been  an  active  agent 
in  throwing  the  vaginal  discharges  about,  as  it  is  generally  much  soiled 
by  them. 

External  infection  may  also  be  conveyed  by  means  of  cords,  crotchets, 
and  other  obstetrical  appliances,  if  they  are  soiled  with  septic  matters  : 
which  they  may  be  if  previously  used  in  the  removal  of  a  decomposing 
foetus ;  and  the  operator  himself  may  be  the  means  of  infecting.  An  in- 
stance of  this  kind  is  related  where,  in  Switzerland,  during  1861-63,  in  a 
large  cowshed  containing  about  200  head  of  cattle,  suddenly  a  number 
died  of  parturient  fever,  though  they  had  no  difficulty  in  calving.  For  a 
long  time  afterwards  no  other  births  took  place,  so  no  more  accidents  of 
this  kind  were  observed  ;  but  it  was  strongly  suspected  that  the  herds- 
man who  attended  the  first  sick  animal,  cleaned  it,  etc.,  in  helping  the 
others  during  parturition,  had  conveyed  the  infection  to  them.  And  it 
is  quite  possible  that  many  serious  and  wide-spread  outbreaks  of  partu- 
rient fever  in  cattle  are  due  to  an  obstetrist  who  has  been  engaged  in 
removing  a  dead  foetus  or  a  retained  placenta.  The  same  cause  may^be 
in  operation  among  Ewes  during  the  lambing  season,  when,  as  is  well 
known,  parturition  occurs  in  the  flocks  within  a  limited  period,  and  un- 
der circumstances  favorable  to  the  spread  of  infection  •  and  not  unfre- 
quently  large  numbers  of  Ewes  perish  from  parturient  septikaemia 
(*'  heaving  pains  "). 

We  have  mentioned  that  exposure  to  cold  is  supposed  to  be  one  of  the 
causes  of  parturient  fever.  Franck,  however,  is  of  opinion  that  real  par- 
turient fever  cannot  be  so  produced. 

With  regard  to  the  nature  of  the  infective  material,  there  is  yet  much 
to  be  learned.  The  active  agent  has  been  surmised  to  be  the  Microsporon 
septicum,  which  has  some  analogy  to  the  Leptoihrix  buccalis.  In  the  putrid 
matters  and  fluids  from  the  uterus,  bacteria,  are  always  found.  But 
whether  these  organisms  are  really  concerned  in  the  genesis  of  septi- 
kaemia is  still  doubtful.  Some  authorities  are  inclined  to  believe  that 
there  is  a  chemical  body — septin  or  sepsin — in  such  infective  fluids,  which 
possesses  great  putrefactiv'^e  powers  ;  so  that  a  very  small  quantity  intro- 
duced into  the  blood  may  produce  the  most  serious  results.  In  favor  of 
the  latter  view,  it  is  to  be  noted  that  very  often  after  rapid  death  from 
parturient  fever,  no  bacteria  or  other  similar  bodies  can  be  found  in  the 
blood. 

Another  hypothesis  is  that  these  organisms  are  only  the  originators  or 
bearers  of  the  infective  material. 

In  the  puerperal  fever  of  woman,  it  is  recognized  that  the  infecting  mat- 
ter may  be  derived  from  a  great  variety  of  sources.  It  is  formed  wherever 
organic  compounds  decompose;  therefore  it  is  derived  from  dead  bodies, 
from  suppurating  wounds,  disintegrating  neoplasms,  and  especially  from 
the  secretions  of  diseased — and  sometimes  also  of  healthy — women.  So 
it  is  that  puerperal  fever  is  looked  upon  as  nothing  more  than  poisoning 
with  septic  matter  from  the  genital  organs. 

The  experiments  of  Weber,  Billroth,  and  others,  have  demonstrated 
that  septic  matter  has  pyrogenetic  and  phlogogeneous  properties,  being 
capable  of  producing  fever  and  local  inflammation. 


METRITIS,  METRO-PERITONITIS,  ETC.  653 

The  theory  therefore  is,  that  in  cases  of  acute  septikaemia  such  a  quan- 
tity of  septic  matter  has  been  absorbed,  that  the  blood  has  received 
phlogogeneous  properties,  and  that  it  is  able  to  produce  inflammatory 
changes  wherever  it  goes.  Such  a  general  inflammation  of  the  whole  or- 
ganism, and  especially  of  those  organs  whose  undisturbed  function  is  ne- 
cessary for  the  maintenance  of  existence,  must  be  capable  of  destroying 
life  before  marked  pathological  alterations  have  been  developed  in  indi- 
vidual organs.  Accordingly,  in  such  cases  functional  disturbance  of  the 
drgans  are  alone  observed  during  life,  and  after  death  only  the  com- 
mencement of  parenchymatous  inflanmntion  of  those  organs — the  "  cloudy 
swelling  "  of  the  cell. 

In  other  cases  the  infection  of  the  blood  is  not  so  intense ;  fever  is  the 
only  symptom  of  general  disturbance  ;  the  functions  of  the  organs  im- 
portant to  the  maintenance  of  life  are  not  so  disturbed  that  death  must 
inevitably  follow.  If  infective  matter  has  only  once  been  absorbed 
into  the  blood,  the  disturbances  caused  by  it  soon  pass  off,  as  shown  in 
numerous  experiments  on  animals  ;  the  poison  is  rendered  innocuous 
within  the  organism,  or  eliminated  from  it.  Such  is  the  case  when  putrid 
matter  has  been  once  injected  into  the  blood. 

By  infection  from  a  wound,  the  absorbed  matter  has  still  another 
effe'ct.  Locally,  it  sets  up  around  the  wound  an  inflammation  progres- 
sive in  character — the  acute  inflammatory  oedema — with  a  tendency  to 
extend  along  the  connective  tissue.  In  this  inflamed  spot,  again,  materials 
are  produced  by  the  disintegration  of  tissues,  equally  possessed  of  pyroge- 
netic  and  phlogogeneous  properties.  Continually  small  quantities  of  these 
materials  are  absorbed  into  the  blood,  and  thus  the  fever  is  sustained. 
At  the  same  time  the  blood,  now  possessed  of  phlogogeneous  properties 
— though  in  a  slight  degree — may  also  cause  inflammation  in  other 
organs  predisposed  thereto,  either  from  their  anatomical  condition,  or 
from  the  idiosyncrasy  of  the  patient.  Such  organs  are  chiefly  the  large 
abdominal  glands  and  the  serous  membranes,  also  the  striped  muscles 
and  the. connective  tissue.  Whilst  the  process  described  as  consisting  of 
a  uniformly  acute  degeneration  of  all  the  organs  has  been  called  "  septi- 
kaemia," that  just  mentioned,  where  the  process  is  more  chronic  and 
limited  to  individual  organs,  has  been  designated  "ichorrhaemia."  A 
specific  difference  between  the  two  does  not  exist — it  is  only  one  of 
degree  ;  for  where  septikaemia  has  not  quite  an  acute  course  it  ceases  to 
be  a  pure  intoxication  with  the  original  infecting  agent ;  but  the  infection 
of  the  blood  is  now  aided  by  the'  absorption  of  the  products  of  the  local 
inflammation — which  products,  however,  are  not  specifically  different 
from  the  original  agent. 

On  the  whole,  septikaemia  may  be  considered  the  acute,  icorrhaemia  the 
chronic,  or  rather  sub-acute,  septic  infection.  The  whole  organism  may 
also  be  effected  from  the  local  disease  by  the  occurrence  of  thrombus  in 
a  vein ;  but  this,  properly  speaking,  is  not  peculiar  to  septic  infection 
(Schroeder). 

General  infection,  then,  in  the  majority  of  cases,  is  due  to  the  presence 
of  parturient  sores  or  ulcers  m  the  vulva,  vagina,  or  uterus,  and  this  in- 
fection is  manifested  externally  by  the  high  temperature  and  other  serious 
symptoms.  In  other  cases,  when  only  a  small  quantity  of  septic  matter 
has  been  absorbed,  the  symptoms  have  more  of  a  local  character  ;  they 
are  less  severe,  and  though  the  fever  may  be  of  a  continuous  character, 
yet  it  is  not  so  acute,  and  indications  of  peritonitis  are  generally  absent. 


654  P^  THOL  OG  Y  OF  PA R  TURITION. 

Indeed,  we  may  have  si.nple  metritis   without  much  constitutional  dis- 
turbance. 

Prognosis. 

The  prognosis  of  parturient  fever  must  be,  in  the  majority  of  cases,  un- 
favorable, as  the  veterinary  surgeon  is  only  too  frequently  not  called  in 
until  too  late.  When  infection  is  but  slight,  or  when  the  local  inflamma- 
tion is  not  very  severe,  then  careful  treatment  may  restore  the  patient  to 
health.  It  must  not  be  forgoten,  however,  that  what  appears  at  first,  a 
a  mild  form  of  metritis,  may  become  a  very  grave  attack  of  ichorraemia, 
or  even  septikaemia. 

Prophylaxis. 

From  what  we  have  said  with  regard  to  the  causes  ot  parturient  fever 
and  metro-peritonitis,  it  will  seen  that  in  obsterical  operations  great  care 
should  be  exercised,  so  as  to  avoid  wounding  the  genital  canal,  and 
especially  the  interior  of  the  uterus,  the  vagina,  or  the  vulva.  Should 
injury  be  unfortunately  inflicted,  cleanliness,  and  careful  dressing  with 
some  such  disinfectant  as  carbolic  acid,  should  be  enforced.  This  is 
especially  necessary  when  extraction  of  a  dead  foetus  or  retained  placenta 
takes  place. 

No  person  who  has  been  handling  a  creature  suffering  from  parturient 
fever  or  any  decomposing  animal  matters,  should  be  allowed  to  assist 
animals  in  parturition  \  and  the  same  rule  should  be  observed  with  regard 
to  instruments  and  other  obstetrical  means,  unless  these  have  been 
thoroughly  cleansed  and  disinfected. 

If  a  case  of  parturient  fever  should  occur  where  there  are  other  pregnant 
animals,  or  animals  which  have  quite  recently  brought  forth,  these  should 
be  immediately  removed.  An  animal  which  retains  a  decomposing  foetus 
or  foetal  membranes,  is  also  dangerous  among  these.  The  same  remark 
applies  to  animals — such  as  Ewes  and  Cows — at  pasture.  The  soiled 
ground  should  be  most  carefully  disinfected  with  lime,  and  pregnant  or 
parturient  animals  should  be  kept  away  from  it. 

Treatment, 

Metritis,  metro-peritonitis,  and  parturient  fever  being  grave  disorders, 
and  rapid  in  their  progress,  demand  prompt,  rational,  and  energetic  treat- 
ment. The  first  thing  to  be  attended  to  is  the  condition  of  the  uterus, 
and  the  removal  of  any  infective  matters  it  or  the  vagina  may  contain  ; 
as  well  as  the  disinfection  of  any  wounds  or  abrasions  in  these  parts. 

The  genital  canal  should  be  thoroughly  cleansed  by  injections  of  warm 
water,  and  the  wounds  dressed  with  carbolic  acid  and  olive  oil  (i  to  lo), 
applied  by  means  of  a  brush  or  feather  ;  or  salicylic  acid,  i  part;  spirits  of 
wine,  20  parts ;  warm  water,  24  parts. 

After  the  interior  of  the  uterus  has  been  cleansed  by  injections  of  warm 
water,  an  injection  of  carbolic  acid  solution  (i  to  20-50)  should  be  made 
every  day,  and  the  wounds,  if  accessible,  must  be  dressed  at  the  same 
time. 

Permanganate  of  potash  (i  to  50  of  water)  may  be  employed  to  inject 
into  the  genital  canal,  when  the  disease  is  less  acute. 

With  regard  to  constitutional  treatment,  this  must  be  directed  towards 
neutralizing  the  effects  of  the  septic  matter  by  the  exhibition  of  antiseptic 
remedies,  and  reducing  the  high  temperature  ;  as  a  long  continuation  of 


METRITIS,  METRO-PERITONITIS,  ETC.  655 

this  leads  to  rapid  consumption  of  the  tissues,  and  is  fraught  with  danger 
to  the  system. 

There  is  no  specific  remedy  with  which  to  neutralize  the  action  of  the 
septic  matters  in  the  blood  and  tissues.  The  sulphites  of  soda  and  potash 
have  been  recommended,  as  well  as  sulphurous  acid.  These  appear  to  have 
acted  favorably  in  some  cases.  Carbonate  of  soda  and  permanganate  of 
potash  have  also  been  well  spoken  of,  as  well  as  large  doses  of  quinine. 
Carbolic  and  salicylic  acids  are  now  most  in  repute,  and  are  given  in 
small  but  frequent  doses. 

If  there  is  a  tendency  to  constipation,  a  purgative  may  be  administered  ; 
indeed,  unless  special  circumstances  forbid  it,  a  purgative  may  prove 
most  serviceable  in  assisting  in  the  removal  of  the  septic  matter  through 
the  intestinal  canal.  Dogs  which  have  been  poisoned  by  this  matter, 
often  recover  after  profuse  and  foetid  diarrhoea  ;  and  a  purgative  generally 
reduces  the  temperature. 

In  acute  cases,  in  order  to  obtain  the  more  prompt  action  of  antiseptics, 
it  has  been  proposed  to  introduce  them  directly  into  the  circulation  by 
intravenous  injection.  Solutions  of  carbolic  acid  and  iodine  have  been 
employed  successfully ;  and  in  woman  a  desperate  case  has  recovered 
after  the  intravenous  injection  of  liquor  ammoniae  (i  to  3). 

As  a  last  resource,  and  to  substitute  healthy  for  poisoned  blood,  trans- 
fusion has  been  also  practised  in  woman,  and  with  good  results.  The 
experiment  is  worth  trying  in  the  parturient  fever  of  animals. 

With  regard  to  the  diminution  of  temperature,  quinine  has  been  highly 
lauded.  Bleeding  is  certainly  not  to  be  recommended.  If  the  tempera- 
ture continuously  remains  very  high,  then  the  application  of  cold  water  to 
the  surface  of  the  body  is  indicated.  The  cold  water  may  be  applied  to  the 
larger  animals  by  means  of  cold  wet  sheets  wrapped  round  the  body,  and 
kept  cold  for  an  hour  or  two  at  a  time  by  pouring  on  water,  at  intervals, 
by  means  of  a  small  vessel.  Smaller  animals  may  be  put  in  a  gradually- 
cooled  bath. 

The  skin  must  be  well  dried  after  the  application  of  the  cold  water,  and 
with  the  larger  animals  a  dry  blanket  should  be  thrown  over  the  body. 
The  stable  must  be  kept  scrupulously  clean  and  well  ventilated. 

Tonics  and  good  food  must  be  allowed  when  recovery  is  taking  place, 
and  the  sequelce  of  the  disease  treated  according  to  their  indications. 

Peritonitis  may  be  combated  by  the  exhibition  of  large  and  frequent 
doses  of  calomel.  Van  den  Eide  and  Clement  were  successful  in  treating 
serious  cases  of  metro-peritonitis,  by  administering  calomel,  and  applying 
mercurial  ointment  to  the  abdomen. 

When  the  pain  is  very  severe,  mustard  may  be  applied  to  the  surface 
of  the  abdomen,  and,  in  the  case  of  small  animals,  linseed-meal  poul- 
tices on  which  laudanum  has  been  sprinkled  ;  while  subcutaneous  injec- 
tions of  morphia  may  be  freely  resorted  to.  When  great  exhaustion  or 
collapse  is  present,  large  and  frequent  draughts,  containing  diffusible 
stimulants,  must  be  administered,  with  nutritious  gruel.  To  the  smaller 
animals  milk  or  beef-tea  may  be  given. 

In  the  chronic  form  of  metritis,  the  same  treatm.ent  may  be  adopted,  so 
far  as  the  genital  canal  is  concerned  ;  and  if  there  is  vaginal  discharge, 
the  treatment  recommended  for  leucorrhoea  will  be  suitable.  If  the  uterus 
is  not  contracted,  this  may  be  promoted  by  the  exhibition  of  prepara- 
tions of  ergot  of  rye. 

In  handling  animals  suffering  from  parturient  fever,  or  in  examining 


656  PATHOLOGY  OF  PARTURITION. 

the  carcases  of  those  which  have  died,  the  veterinary  surgeon  should  be 
on  his  guard  against  inoculation.  More  particularly  is  this  necessary 
when  exploring  the  genital  canal  of  the  living  animal,  or  removing  a 
putrescent  foetus  or  foetal  envelopes.  The  arm  and  hand  should  then  be 
well  smeared  with  oil  or  lard,  and  thoroughly  cleaned  with  carbolic  acid 
soap  when  the  operation  is  completed. 


CHAPTER  IV. 

Parturient  Apoplexy. — Parturient  Collapse. 

Few  diseases  affecting  animals  have  received  a  greater  amount  of  atten- 
tion, or  given  rise  to  more  widely  divergent  opinions  as  to  their  nature, 
than  the  malady  to  which,  chiefly  for  convenience,  we  have  given  the 
designation  of  parturient  apoplexy  or  parturient  collapse.  Veterinary 
literature,  since  the  commencement  of  the  century,  teems  with  descrip- 
tions and  discussions  relative  to  the  disease,  and  the  most  eminent  veteri- 
nary pathologists  still  appear  to  be  far  from  unanimous  as  to  its  nature. 
The  great  number  of  names  given  to  it — some  of  which  either  indicate  the 
opinions  prevalent  with  regard  to  its  pathology  or  causes,  or  point  to 
prominent  symptoms — are  evidence  of  the  uncertainty  which  has  pre- 
vailed, and  now  prevails,  with  regard  to  it.  For  instance,  it  has  been  ^&^- 
\gr\2i\.td  puerperal  fever,  fiervous  or  paralytic  form  of  puerperal  fever,  77iilk- 
fever^  puerperal  apoplexy,  paraplegia,  puerperal  collapse,  vitulary  fever,  vitu- 
lary  apoplexy,  vitulary  paralysis,  processus  puerperal,  puerperal  typhus,  calf 
fever,  dropping  after  calving,  eclampsia  puerperalis.,  etc. 

The  ordinary  French  name  is  "  Vitulary  Fever  "  (that  given  to  it  by 
Saint-Cyrand  other  veterinary  authorities  in  France),  while  in  Germany 
it  is  commonly  known  as  "Calving  Fever"  (Franck  and  others).  In 
England  it  is  usually  designated  V  Parturient  Apoplexy,"  "Puerperal 
Fever,"  "  Milk  Fever,"  etc. 

The  malady  appears  to  have  been  known  from  an  early  period,  but  the 
first  exact  description  of  the  symptoms  we  can  find  is  that  given  by  Skel- 
let  (^Practical  Treatise  on  the  Parturitioii  of  the  Cow,  London,  1807),  who 
names  it  "  Milk  Fever,  or  Dropping  after  Calving  ;  "  in  the  following 
year  it  is  alluded  to  by  Jorg  {Anleitung  zu  eifier  rationellefi  Geburtshulfe, 
e\.c.,fUr  Thierdrzie),  who  evidently  knew  Skellet's  work,  as  the  latter's 
plates  are  copied.  Some  years  after  this  period  the  disease  began  to 
attract  much  attention,  as  with  the  improvement  in  the  breeding  of  Cat- 
tle, it  gradually  became  more  prevalent ;  until  now,  the  literature  of  the 
subject  is  very  extensive. 

Without  entering  at  this  moment  into  a  discussion  as  to  the  nature  of 
the  disease,  it  may  be  sufficient  to  say  that  it  is  a  very  serious  and  acute 
affection,  peculiar  to  Cows  in  the  parturient  state — and  especially  to  those 
of  the  improved  Milch  breeds,  in  which  it  is  frequent ;  that  its  invasion  is 
sudden  and  its  course  rapid ;  and  that  it  is  characterized  by  loss  of  con- 
sciousness and  paralysis,  seldom  by  convulsions.  It  is  extremely  fatal, 
death  ensuing  in  a  very  short  time ;  or  if  recovery  takes  place,  this  is 
sometimes  nearly  as  rapid  as  the  attack  was  sudden.  It  has  been  con- 
founded with  parturient  fever,  or  considered  to  be  only  a  nervous  or 
paralytic   form   of   that  malady  ;    while  Franck,   who  appears  to  have 


PARTURIENT  APOPLEXY.— PARTURIENT  COLLAPSE.     657 

studied  it  very  carefully,  is  of  opinion  that  it  is  identical  with  the  eclampsia 
of  the  human  female,  and  considers  that  "  parturient  eclampsia  "  {^Ek- 
lampsie  in  Folge  der  Geburt)  is  the  best  designation  for  it.  He  asserts 
that  to  look  upon  it  as  a  "fever"  is  a  mistake,  as  a  high  temperature — 
the  sure  sign  of  such  a  condition — is  not  present ;  while  to  name  it  "  calv- 
ing-fever  "  is  not  quite  exact,  as  it  has  been  known  to  affect  oxen  and 
other  domesticated  animals — though  seldom. 

We  shall,  however,  revert  to  this  question  presently 

Symptoms, 

The  disease  sets  in  suddenly  after  calving,  and  without  any  premonitory 
symptoms.  It  may  attack  the  Cow  so  early  as  twelve  or  twenty  hours 
after  parturition,  but  it  is  most  frequent  on  the  second  or  third  day,  and 
generally  follows  a  rapid  and  an  easy  birth.  It  has,  though  very  rarely, 
manifested  itself  before  parturition,  and  also  during  that  act.  It  is  seldom 
that  it  appears  after  the  third  day  ;  though  Harms  says  it  may  occur  so 
late  as  the  tenth  day ;  Hess  records  an  instance  on  the  fourteenth  day, 
and  a  case  has  been  witnessed  in  the  fourth  week  ;  while  Gierer  states 
that  he  saw  a  Cow  which  offered  all  the  symptoms  of  the  disease  seven 
weeks  after  calving. 

In  some  instances,  before  the  symptoms  commence,  the  lacteal  secre- 
tion is  either  diminished  or  suspended.  Generally,  however,  the  first 
indications  are  the  Cow  hanging  back  in  the  stall,  or  the  head  drooping ; 
there  is  uneasiness,  whisking  of  the  tail,  striking  at  the  belly  with  the 
hind  feet ;  the  appetite  is  suddenly  lost  and  rumination  ceases  ;  the  faeces 
are  hurriedly  expelledj  and  the  animal  becomes  indifferent  to  its  calf. 
There  is  often  a  shivering  fit,  but  this  is  not  followed  by  an  increase  of 
temperature.  In  a  few  cases,  congestion  of  the  brain  appears  to  be  pres- 
ent at  the  commencement  ;  as  the  Cow  presses  its  head  to  "the  wall  or 
leans  against  the  stall-post,  it  bellows,  looks  stupid,  its  mouth  is  hot,  the 
eyes  are  reddened,  and  the  eyelids  wink,  and  it  half  unconsciously  treads 
with  the  hind  feet.  The  respiration  becomes  hurried  and  plaintive, 
though  the  pulse  may  be  normal  \  and  if  the  animal  is  conscious,  its 
physiognomy  expresses  anxiety  and  suffering.  Unsteadiness  and  stagger- 
ing are  manifested  ;  the  animal  can  no  longer  stand,  and  it  either  lays 
itself  down,  or  falls  on  the  floor  9f  the  stall.  Then  it  may  remain  tran- 
quil, merely  moaning  or  bellowing,  or  striking  with  its  feet  at  the  belly  as 
if  affected  with  colic,  and  making  convulsive  movements.  Congestion  of 
the  brain  may  be  more  or  less  marked  ;  the  ears  and  horns  may  be  warm- 
er than  natural,  and  in  addition  to  the  redness  of  the  eyes,  tears  may  flow 
down  the  cheeks. 

All  these  changes  may  become  developed  in  a  very  few  hours;  so  that 
an  animal  which  was  left  in  apparent  good  health  only  a  short  time  be- 
fore, is  found  lying,  cannot  get  up,  and  is  in  a  soporific  condition.  This 
is  the  stage  of  the  malady  at  which  the  veterinary  surgeon  is  usually  sent 
for. 

Then  he  finds  it  lying  tranquilly  on  its  side,  fully  extended  ;  or,  which 
is  far  more  frequent,  resting  on  the  sternum,  and  the  head  turned  round 
towards  the  shoulder  or  flank  (fig.  206).  This  position  of  the  head  is 
supposed  to  be  due  to  contraction  or  tonic  spasm  of  the  cervical  muscles 
of  one  side  of  the  neck.  It  is  sometimes  observed  at  the  commencement 
of  the  attack,  even  while  the  animal  is  standing.     The  neck  is  so  rigidly 

42 


658  PA THOL OGY  OF  PAR TURITION. 

bent  that  force  cannot  extend  it,  and  the  temperature  is  distinctly  in- 
creased on  the  concave  side — that  on  which  the  muscles  are  contracted. 

From  time  to  time  it  may  attempt  to  rise,  but  it  cannot,  as  a  rule,  do 
so  ;  the  knees  may  be  flexed,  but  the  hind  parts  of  the  body  seem  to  be 
nailed  to  the  ground.  If  assistance  is  afforded,  it  cannot  avail  itself  of  it ; 
or  if  it  chances  to  be  raised,  it  falls  again  as  soon  as  let  alone.  It  appears 
to  be  insensible  to  blows  or  pain  of  any  kind,  and  if  the  head  is  lifted 
and  let  go,  it  drops  an  inert  mass,  or  is  again  pressed  round  against  the 
shoulder.  The  teeth  are  ground  at  intervals,  and  the  stupor  or  coma 
becomes  more  marked.  The  animal  pays  no  heed  to  surrounding  objects  ; 
the  eyes  are  half-closed,  and  they  either  move  convulsively  in  their  orbits, 
or  are  dull  and  lustreless ;  the  hair  is  erect  and  dry,  and  flies  settle  on 
the  surface  of  the  body. 

The  pulse  does  not  vary  much  in  the  earlier  stage  ;  it  may  number 
fifty,  sixty,  or  seventy  beats  per  minute,  or  it  may  be  fewer  than  in  health, 
but  it  is  very  full  and  soft.  When  coma  is  well  advanced,  however,  and 
paralysis  appears  to  be  complete,  it  becomes  small  and  quick. 


•««§& 


Fig.  206. 
Puerperal  Apoplexy :    Cow. 

The  respirations  may  be  increased  to  eighty  or  ninety  per  minute,  and 
this  occurs  more  particularly  when  there  is  pneumonia,  due  to  the  passage 
of  foreign  matter  into  the  bronchia — an  accident  which  is  frequently  noted 
in  this  disease.  When  the  coma  and  paralysis  are  very  marked,  the  re- 
spirations are  often  slow  and  deep,  sighing  or  stertorous,  at  other  times 
calm  and  regular.  We  may  have  all  these  variations  in  the  same  animal 
— the  hurried,  stertorous  breathing  succeeding  the  quiet  and  deep  respi- 
rations in  a  very  abrupt  manner.  As  the  pulse  increases  in  frequency  the 
breathing  sometimes  becomes  slower. 

The  temperature  of  the  body  is  not  increased,  as  a  rule  ;  on  the  con- 
trary, it  is  very  often  below  the  normal  standard — Harms  and  Adams 
have  found  it  as  low  as  35°  Cent.  (95°  Fahr.).  The  extremities  are  gen- 
erally icy  cold,  and  the  surface  heat  of  the  trunk  is  irregularly  distributed. 
Sometimes,  during  the  first  stage,  the  temperature  is  for  a  very  brief  period 
slightly  elevated. 

The  mucous  membrane  of  the  mouth  is  pale,  and  saliva  accumulates 
about  or  flows  continually  from  it  (hence  the  disease  is  sometimes  des- 


PARTURIENT  APOPLEXY.— PARTURIENT  COLLAPSE.     659 

ignated  Abtropfeln  aus  dent  Maide  by  the  Germans).  Food  and  water 
are  refused,  and  indeed  at  an  early  period  there  appears  to  be  paralysis 
of  the  deglutition  organs,  and  if  care  is  not  taken  the  solids  or  fluids  at- 
tempted to  be  administered  may  find  their  way  into  the  air-passages,  and 
if  they  do  not  quickly  produce  asphyxia,  they  will  probably  give  rise  to 
pneumonia.  The  functions  of  the  rumen  and  digestive  system  are  more 
or  less  suspended,  and  the  peristaltic  movement  of  the  intestines  de- 
creased. Hence  we  have  tympany,  eructations,  and  constipation.  The 
eructations  may  carry  fluid  and  food  from  the  rumen  into  the  pharynxj 
and  even  into  the  nostrils,  and  these  may  pass  from  thence  into  the  trachea. 
So  that  we  may  have  pneumonia  from  this  cause  alone,  and  without  at- 
tempts having  been  made  to  administer  food  or  medicine.  Constipation 
is  also  a  marked  feature  of  this  paralyzed  condition. 

Micturition  is  also,  as  a  rule,  suspended  from  the  commencement. 
Consequently,  urine  accumulates  in  the  bladder  and  faeces  in  the  rectum. 

The  secretion  of  milk  may  be  diminished  or  suspended,  and  sometimes 
very  suddenly,  even  before  the  voluntary  muscles  are  paralyzed;  in  other 
instances  it  may  be  uninterrupted. 

When  the  animal  is  about  to  recover,  these  symptoms  may  persist  for 
some  hours,  or  even  for  two,  three,  or  four  days.  Then  it  appears  to 
rouse  up  suddenly  from  the  stupor  into  which  it  was  plunged  ;  the  tongue 
is  moved  about  ;  the  head  is  raised  ;  attempts  are  made  to  get  up  ;  it  ele- 
vates the  fore-part  of  the  body,  and  after  some  struggles  finally  gets  on 
its  hind-legs  and  stands.  The  first  favorable  indications  are  elevation  of 
the  temperature,  and  resumption  of  the  intestinal  peristalsis.  The  latter 
is  assured  when  the  rectum  is  found  to  be  filled  with  faeces,  after  it  has 
been  emptied. 

The  animal's  physiognomy  changes,  and  becomes  natural — though  it 
may  still  look  half-stupefied  \  it  drinks  and  seeks  food,  and  is  not  long  in 
commencing  to  ruminate  ;  its  calf  is  caressed  ;  urine  and  faeces  are  passed  ; 
and  recovery  sets  in  so  promptly,  and  goes  on  so  quickly,  that  in  many 
cases  it  is  scarcely  possible  to  believe  that  the  animal  which,  twenty-four 
hours  previously  appeared  to  be  dying,  is  now  not  only  recovering,  but 
completely  recovered. 

When  death  is  about  to  take  place,  the  more  serious  symptoms  are  bet- 
ter marked.  The  coUapsus — the  coma — becomes  more  and  more  complete. 
The  nose  rests  on  the  ground  as  if  the  animal  could  no  longer  support 
the  head,  and  at  times  sways  from  side  to  side.  The  decubitus,  instead 
of  being  sternal,  becomes  lateral,  and  the  body  is  stretched  out  at  full 
length  on  its  side.  The  eye  is  glassy,  and  there  is  no  movement  of  the 
eyelids  when  the  cornea  is  touched  ;  the  body  and  mouth  are  colder;  the 
tympanitis  increases  ;  the  pulse  becomes  small,  irregular,  and  intermit- 
tent, and  very  quick,  until  at  last  it  is  imperceptible  ;  the  breathing  is 
pufiing,  slower,  and  more  stertorous,  and  the  animal  dies  without  a  strug- 
gle, or  in  the  midst  of  slight  convulsions. 

In  some  cases  there  are  epileptiform  convulsions,  or  there  may  be  symp- 
toms of  delirium  :  the  animal  throws  its  head  about  violently  from  side 
to  side,  or  bends  it  rigidly  backwards,  struggles,  bellows,  groans,  extends 
the  limbs  convulsively  as  if  undergoing  an  electric  shock,  and  appears  to 
be  unconscious  ;  the  breathing  is  deep  and  spasmodic,  and  apoplexy — 
parturient  apoplexy — seems  to  be  the  cause  of  death. 


66o  PA  THOLOG Y  OF  PARTURITION. 

Duration,  Terminatmis,  and  Complications. 

The  duration  of  the  disease  is  very  brief.  There  are  instances  on 
record  in  which  it  has  been  less  than  twenty-four  hours  ;  but  two  or  three 
days  is  the  ordinary  term  ;  it  has  rarely  extended  to  five  or  six  days. 

If  there  are  no  complications,  the  terminations  are  death  or  recovery. 
The  chief  complications  are  broncho-pneumonia,  milk-metastasis,  amau- 
rosis, and  temporary  or  permanent  paralysis. 

Pneumonia  is  due  to  the  passage  of  foreign  matters — either  food  or 
medicine — into  the  air-passages  during  the  period  when  the  animal  can- 
not swallow,  or  when  it  is  comatose,  and  meteorismus,  with  eructations, 
are  present.  This  is  often  a  cause  of  death  when  the  Cow  has  recovered 
from  the  parturient  malady.  Indeed,  the  animal  may  perish  from  suifo- 
cation  alone  when  the  quantity  of  matter  that  passes  through  the  larynx 
is  considerable.  And  not  unfrequendy,  when  the  creature  has  lingered 
for  a  few  days,  and  is  then  killed,  the  existence  of  pneumonia  from  this 
cause  will  be  discovered  on  making  an  examination^  of  the  body.  Adam 
{Wochenschrift  fur  Thier/ieilkunde,  1870-71)  believes  that  ten  per  cent,  of 
the  Cows  which  recover  from  parturient  collapse  eventually  die  of  pneu- 
monia, due  to  extraneous  matters  introduced  during  the  paralyzed  condi- 
tion of  the  pharynx. 

Sometimes  the  animal  appears  to  be  almost  recovered  from  the  attack 
of  parturient  apoplexy,  when  symptoms  of  lung  congestion  or  inflamma- 
tion are  suddenly  developed,  and  death  soon  occurs. 

Another  complication  of  parturient  apoplexy,  is  the  so-called  milk-me- 
tastasis, which  does  not  appear  to  have  been  noted  in  England,  but 
which  is  alluded  to  by  Bentele,  Born,  and  Franck  in  Germany,  and  Alle- 
mani  in  Italy.  Occasionally  there  is  observed,  after  an  attack  of  the  dis- 
ease, a  white,  milky-looking  emulsion,  similar  to  chyle,  expelled  as  urine, 
or  as  a  discharge  from  the  nostrils  ;  and  at  one  time  it  was  imagined  that 
this  was  the  milk  which,  instead  of  being  got  rid  of  by  the  mammae,  was 
absorbed  or  retained  in  the  blood,  acted  upon  the  nervous  centres,  and 
was  then  expelled  in  this  vicarious  manner. 

Though  no  analyses  appear  to  have  been  made  of  this  fluid,  Franck  is 
of  opinion  that  the  fluid  is  only  the  normal  secretions  mixed  with  lymph. 
The  milk-metastasis  theory  is  untenable,  as  it  is  quite  opposed  to  what 
we  know  of  the  lacteal  secretion,  especially  during  this  disease. 

1.  Bentele  {Wochenschrift  fiir  Thierheilktmde,  1857,  p.  145)  states  that  a  Cow  attacked 
by  calving-fever  lay  for  sixty  hours  in  a  state  of  lethargy.  The  urine,  which  was  passed 
six  hours  afterwards,  was  milk  (?)  with  clots — as  if  boiled — in  it.  The  animal  recovered 
from  the  attack,  but  some  weeks  later  had  to  be  killed  in  consequence  of  diseased  lungs 
— probably  pneumonia  from  foreign  matters. 

2.  Born  (Anacker's  Thierarzt,  1871.  p.  279)  relates  a  case,  in  which  milk  flowed  from 
the  nostrils  of  a  Cow  that  was  affected  with  calving-fever. 

3.  Allemani  (//  Medico  Veterinaria,  1870,  p.  289)  tells  us  of  a  Cow  proprietor,  who  be- 
lieved one  of  his  Cows  passed  milk  instead  of  mine.  The  supposed  milk — which  was  of 
a  yellowish-white  color — contained  epithelium  from  the  bladder,  a  large  quantity  of 
epithelium  from  the  kidney,  lymph-corpuscles,  and  albumen.  After  some  days  this 
condition  disappeared.     The  fluid  did  not  coagulate  spontaneously. 

With  regard  to  paralysis,  this  is  not  evident  until  the  animal  recovers 
consciousness,  and  begins  to  look  bright  and  anxious  for  food,  when  it  is 
found  that  it  cannot  be  made  to  rise.  The  paralysis  may  be  limited  to 
one  limb,  to  the  two  hind-limbs  (paraplegia),  or  to  one  side  of  the  body 


PARTURIENT  APOPLEXY.— PARTURIENT  COLLAPSE.    66i 

{hemiplegia).  Saake  says  he  has  sometimes  seen  instances  in  which  the 
fore-limbs  were  paralyzed,  while  the  posterior  ones  could  be  moved 
freely. 

Afuanrosis  is  readily  discovered,  from  the  animal  being  blind.  It  is 
generally  persistent.  Breulet,  Gabler,  Dommelen  and  Festal  have  re- 
corded instances. 

Prognosis. 

The  prognosis  of  parturient  apoplexy  is  generally  difficult,  if  not 
unfavorable;  as  a  fatal  termination  occurs  in  a  large  proportion  of  cases. 
Of  721  cases  treated  by  various  methods,  Franck  states  that  294  either 
died  or  were  slaughtered — 40  8  per  cent.  Of  course,  no  definite  conclu- 
sion can  be  drawn  from  these  figures  ;  as  it  is  possible  that  some,  if  not 
many,  of  the  cases  may  have  been  parturient  fever,  while  of  those  killed 
probably  a  few  recoveries  might  have  been  noted.  Saint-Cyr,  in  466 
cases,  gives  45  per  cent,  deaths  ;  while  Stockfieth  gives  50  per  cent. 

Often  cases  which  appear  very  trifling  at  first,  have  a  rapidly  fatal 
termination ;  while  others  which  commenced  with  alarming  symptoms, 
quickly  recover.  Therefore  it  is,  that  perhaps  in  no  disease  with  which 
we  are  acquainted  is  a  reliable  prognosis  more  difficult  to  be  arrived  at, 
not  only  in  the  earlier  stages,  but  during  the  whole  of  its  course.  "  There 
is  no  absolute  fr/Z^r/w;;/,"  says  Lanzillotti,- "by  which  we  can  positively 
say  whether  we  can  cure  the  case,  or  whether  death  will  ^nsue ;  and  it 
often  happens  that  the  result  contradicts  the  prognosis."  And  Allemani 
slates  that  he  has  seen  cases  which  looked  so  favorable,  as  to  lead  him 
to  believe  they  would  recover,  suddenly  become  aggravated  without  any 
apparent  cause,  and  succumb  ;  while  others  which  exhibited  the  gravest 
symptoms  in  all  their  intensity,  and  gave  no  hope  of  recovery,  have  been 
restored  to  health. 

This  is  probably  the  experience  of  every  one  who  has  had  to  contend 
with  the  disease ;  it  is  in  consequence  of  this  uncertainty,  and  the  fatality 
attending  the  malady,  that  the  butcher  is  so  frequently  called  in,  and  the 
animal  is  killed  and  its  flesh  sold  as  food.  As  to  the  propriety  of  util- 
izing the  flesh  in  this  manner,  there  have  been  different  opinions;  but 
provided  the  animal  has  not  been  drugged  to  any  considerable  extent 
before  death,  and  it  is  killed  early,  we  cannot  see  any  objection  to  its 
flesh  being  consumed.  We  have  no  evidence  whatever  that  there  is  any 
deleterious  agent  developed  during  the  malady.  With  regard  to  using 
the  flesh  of  animals  which  have  been  2&Q.QXQA'^'Vi\i parturietit fever — a 
disease  with  which  parturient  apoplexy  is  so  often,  and  has  been  for  so 
long,  confounded — that  is  quite  another  matter,  as  in  this  we  have  a 
blood  poison, — sepsin. 

Though  the  prognosis  is  generally  so  uncertain,  yet  there  are  certain 
manifestations  which  may  assist  us,  at  any  rate  to  some  extent,  in  form- 
ing an  opinion  as  to  the  probability  of  recovery  or  death.  Thus,  the 
earlier  the  attack  occurs  after  parturition,  the  more  serious  the  case  may 
be  considered  ;  while  the  longer  its  invasion  takes  place  after  that  act,  so 
is  it  less  likely  to  be  fatal.  When  it  appears  within  twenty-four  hours 
after  calving,  then  it  nearly  always  terminates  in  death.  It  is  the  same 
when  the  attack  is  very  sudden  and  powerful ;  when  there  is  marked 
coma,  rapid  and  general  loss  of  h^at,  great  distension  of  the  rumen 
(which  may  speedily  cause  asphyxia),  violent  convulsions,  deep  mucous 
rales  in  the  trachea  and  bronchi,  lustreless  eyes,  insensible  to  light  or 


662  PA  THOL  OG  Y  OF  PA  R  TURITION. 

touch;  paralysis  of  the  digestive  organs — indicated  by  meteorismus,  tor- 
pidity of  the  bowels,  so  that  the  rectum  remains  empty  when  it  has  been 
evacuated  ;  as  well  as  paralysis  of  the  pharynx  and  oesophagus — shown 
by  inability  to  swallow  ;  suspended  lacteal  secretion,  relaxed  sphincters, 
puffing  breathing  by  the  mouth  and  pendulous  lower  jaw,  and  total 
suppression  of  milk. 

The  favorable  indications  are  a  maintenance  of  the  normal  tempera- 
ture in  body  and  limbs,  or  the  slightest  elevation  when  this  is  low  ; 
natural  tint  of  the  mucous  membranes,  expulsion  of  the  urine  either 
spontaneously  or  when  the  finger  is  introduced  into  the  urethra  ;  and, 
according  to  Schaack,  "a  mode  of  respiration  in  which  the  animal  retains 
its  breath  for  an  instant,  then  allows  the  air  to  escape  by  a  long  and 
slightly  plaintive  expiration." 

It  is  likewise  a  very  favorable  sign  when  the  faeces  are  passed.  A 
return  to  consciousness  is  also,  of  course,  a  happy  omen,  and  particularly 
if  the  animal  attempts  to  rise,  desires  food  or  drink,  and  the  lacteal 
secretion  begins  to  re-appear. 

In  some  cases,  however,  there  appears  to  be  slight  recovery,  and  fatal 
relapse  takes  place.  The  pulse  will  also  aid  in  forming  an  opinion  as  to 
the  probable  termination  of  the  malady. 

The  longer  the  disease  continues,  so  the  more  hope  there  is  of  recov- 
ery ;  though  there  is  all  the  more  danger  of  pneumonia  from  extraneous 
matters  in  the  bronchia,  if  the  coma  or  paralysis  of  the  muscles  of  de- 
glutition lasts  for  some  days.  Weigand  says  that  when  an  animal  con- 
tinues lying  for  six  to  eight  days,  unless  it  can  eat  and  drink,  it  should 
be  killed. 

Causes. 

The  unanimous  opinion  with  regard  to  this  disease  is  that  it  is  peculiar 
to  the  parturient  condition,  and  that  it  has  a  close  relation  to  the  state  of 
the  Cow  previous  to  parturition — to  a  more  or  less  marked  race  or  zW/- 
7V^z/^/ predisposition.  So  far  as  breed  is  concerned,  it  is  a  fact  that  the 
Cows  most  liable  to  be  attacked  are  those  in  which  the  secretion  of  milk 
is  abundant — "  deep  milkers  " — and  which  are  in  a  more  or  less  plethoric 
condition.  With  the  perfecting  of  Cows  for  the  production  of  milk,  this 
disease  has  become  vastly  more  prevalent.  Numerous  observers  testify 
to  this  fact.  "  Since  in  Algau,"  writes  Bentele,  "  the  Cow  has  been  so 
largely  utilized  for  the  production  of  cheese — converted  into  a  milk  ma- 
chine, in  fact — the  previously  unknown  calving-fever  has  appeared." 

So  it  is,  that  in  countries  or  districts  where  bovines  are  reared  more 
for  their  flesh  than  their  milk,  parturient  apoplexy  is  not  a  very  common 
malady,  and  the  losses  from  it  are  comparatively  small.  It  is,  therefore, 
a  disease  almost  peculiar  to  the  best  breeds  of  milch.  Cows. 

With  regard  to  individual  predisposition,  there  can  be  no  doubt  that 
even  in  these  breeds  there  are  animals  which  suffer  from  parturient  apo- 
plexy more  than  others ;  and  instances  are  reported  of  Cows  being 
attacked  after  several  consecutive  births. 

Plethora^  there  can  be  no  doubt,  exercises  a  great  influence  in  the  produc- 
tion of  the  disease.  Thus  it  is  chiefly  among  the  well-fed  Cows,  particu- 
larly those  kept  for  milk,  in  the  vicinity  of  large  towns,  and  which  seldom 
or  ever  leave  their  stable,  and  are  abundantly  nourished  immediately 
before  calving,  that  parturient  apopfexy  prevails  most  seriously  and  exten- 
sively.    It  is  true  that  it  may  attack  Milch  Cows  in  moderate,  or  even  in 


PA  R  TURIENT  A  POPLEXY.—PA  R  TURIENT  COLL  A  PSE.    663 

comparatively  poor  condition  ;  but  then  it  will  be  found  that  their  hygienic 
management  is  at  fault.  For  instance,  as  Saint-Cyr  observes,  they  are 
Cows  which,  having  been  scantily  fed  during  a  long  winter,  are  abundantly 
supplied  with  food  in  the  spring  ;  or  they  are  Cows  which,  purchased  in 
low  condition,  receive  a  large  supply  of  food  from  their  new  owner. 
Kohne  (Gurlt  and  Hertwig's  Magazin,  1855)  states  that  he  had  occasion 
10  observe  eighty  cases  of  this  disease  at  Kemper  (Rhenish  Prussia),  and 
that  the  majority  were  Cows  which,  bought  lean  in  Holland  some  time 
before  parturition,  had  passed  without  any  gradual  transition  from  the 
Dutch  pastures  to  the  stables  of  the  Rhenish  feeders,  where  they  received 
a  large  amount  of  food.  Kniebusch  {Ibid.)  and  others  have  made  similar 
observations.  It  has  also  been  remarked  that  a  uniform,  and  ev^en  abun- 
dant diet,  is  less  dangerous  than  an  abrupt  change  from  scarcity  to 
generous  allowance. 

Permanent  confinement  to  the  stable  also  acts  in  a  similar  manner  to 
abundant  and  stimulating  food,  by  inducing  plethora  and  laxity  of  fibre. 
Thus  it  is,  that  while  the  disease  is  prevalent  in  the  cowsheds  of  towns, 
or  in  those  from  which  the  cattle  are  seldom  driven  out  to  graze  or  for 
exercise,  it  is  almost,  if  not  quite,  unknown  in  hilly  pastures. 

Age,  or  rather  the  development  of  lactation,  has  also  a  powerful  influence. 
When  the  secretory  power  has  reached  a  certain  point,  the  Cow  appears 
to  become  much  more  predisposed  to  an. attack.  Thus  it  is  asserted  that 
parturient  apoplexy  has  never  been  observed  in  a  primipara,  and  very 
rarely  indeed  before  the  third  calf,  when  the  lactiferous  system  has  almost 
attained  its  maximum  development  in  the  more  precocious  breeds.  In 
twenty-nine  cases  reported  by  Haycock  {Veterinarian,  185 1),  3  occurred 
after  the  third  calf,  5  after  the  fourth,  16  after  the  fifth,  2  after  the  sixth, 
3  after  the  eighth.  After  the  third  calf,  or  even  previous  to  its  birth, 
dairy-keepers  are  averse  to  purchasing  the  better-bred  Milch  Cows. 

Temperature  is  supposed  to  influence  the  production  of  the  disease,  and 
especially  exposure  to  cold.  The  suppression  of  the  cutaneous  functions, 
and  the  determination  of  the  blood  from  the  surface  of  the  body  to  the 
internal  organs,  must  favor  congestion  of  these  organs.  Therefore  it  is 
that  currents  of  cold  air,  lying  on  cold  ground,  and  cold  fluids  ingested 
immediately  after  parturition,  have  been  looked  upon  as  powerful  occa- 
sional causes.  Sanson  thinks  that  the  sudden  expulsion  of  the  blood  so 
abundantly  contained  in  the  uterine  mucous  membrane  and  cotyledons 
— and  which  should  be  only  slowly  diffused — forces  that  fluid  into  the 
neighboring  vessels,  and  surcharges  them  beyond  measure;  while  Ayr- 
ault  is  of  opinion  that  the  cold  air,  entering  the  uterine  cavity  by  its 
partially  dilated  os,  drives  the  blood  from  the  mucous  membrane  into  the 
other  viscera,  suddenly  checks  the  lochial  secretion,  and  thus  gives  rise 
to  the  disease.  This  lochial  secretion  plays  an  important  part  in  the 
genesis  of  the  malady,  according  to  several  authorities. 

Other  writers  suppose  that  the  disease  is  more  common  during  warm 
than  cold  seasons.  In  fact,  it  prevails  in  the  most  diverse  temperatures, 
and  it  is  as  serious  in  cold  as  in  warm  weather.  Sometimes  the  number 
of  cases  is  very  great,  without  any  reference  to  heat  or  cold  ;  then  almost 
suddenly  they  subside,  and  no  more  outbreaks  occur  for  some  time.  This 
has  led  to  the  supposition,  again,  that  it  depends  for  its  development  on 
a  peculiar  condition  or  epizootic  constitution  of  the  atmosphere,  but  in 
what  this  consists  no  one  has  attenfipted  to  explain.  Kohne  says:  "  It  is 
certain  that  when  one  of  these  periods  of  vitulary  fever  prevails,  a  change 


664  PA  THOLOG Y  OF  PARTURITION. 

of  atmosphere  has  occurred  or  is  about  to  take  place,  though  the  con- 
verse is  not  true — for  when  an  atmospheric  change  takes  place  we  cannot 
predict  an  invasion  of  this  fever.  But  if  it  happens  that  several  cases  of 
the  malady  follow  each  other  immediately  during  a  certain  atmospheric 
constitution,  we  may  assuredly  predict  a  change  in  the  weather.  This 
change  most  frequently  consists  in  a  transition  from  settled  to  rainy 
weather,  bringing  about  a  duninution  in  the  barometric  pressure." 

Some  veterinarians  have  ascribed  the  disease  mainly  to  infection — 
assimilating  the  puerperal  fever  of  woman  to  the  ^^TiXixxn^Vii processus  in 
the  Cow,  but  of  this  there  is  little  evidence  indeed ;  while  others,  as 
already  mentioned,  imagine  that  it  is  merely  a  nervous  form  of  parturient 
fever,  and  due  to  blood-poisoning. 

Gtinther,  very  many  years  ago,  and  a  few  others  more  recently,  fancied 
it  was  produced  by  a  moral  influence,  and  that  this  was  the  removal  of  the 
Calf  soon  after  birth,  which  distressed  the  Cow.  But  it  was  forgotten 
that  the  malady  sometimes  occurs  when  the  Calf  is  with  the  Cow,  and 
sucking  ;  and  that  other  creatures  in  which  the  moral  faculties  are  more 
highly  developed,  and  which  exhibit  great  anxiety  and  distress  on  being 
deprived  of  their  progeny,  yet  do  not  suffer  from  parturient  apoplexy. 
Besides,  the  latter  is  no  more  prevalent  in  those  countries  or  districts 
where  the  calves  are  taken  away  from  the  Cows  at  an  early  period,  than 
where  they  are  allowed  to  remain  with  them. 

Others  also  have  attributed  the  occurrence  of  the  disorder  to  mental 
excitement  during  the  act  of  parturition  ;  but  surely  this  excitement  must 
be  greater  with  the  first  calf  or  with  the  second — when  the  disease  seldom 
or  never  appears — than  with  the  third,  fourth,  or  fifth  calf,  when  it  is  so 
frequent.  Not  only  this,  but  it  is  a  notorious  fact  that  parturient  apoplexy, 
in  almost  every  case,  follows  an  easy  and  rapid  expulsion  of  the  foetus 
without  assistance,  and  ejection  of  the  foetal  membranes  at  the  ordinary 
time.  Indeed,  parturition  is  generally  wonderfully  easy  and  the  opposite 
of  abnormal.  So  much  is  this  the  case,  that  Kohne  boldly  asserts  that  a 
difficult  or  protracted  delivery  is  never  followed  by  this  disease  ;  and 
another  authority  (Banderschieren)  is  no  less  positive  in  declaring  that 
if  a  Caw  has  a  difficult  calving,  or  if  the  placenta  is  retained,  there  is 
little  reason  to  apprehend  an  attack  of  the  disease. 

The  more  rapidly  the  uterus  contracts  and  resumes  its  normal  size,  so 
the  more  danger  there  is  of  parturient  apoplexy  ;  while  the  longer  it 
remains  relaxed  or  the  memoranes  are  retained  in  it,  so  the  chances  are 
diminished.  In  the  examination  of  the  bodies  of  Cows  which  have  per- 
ished, the  uterus  is  generally  found  very  firmly  contracted.  Before  the 
expulsion  of  the  foetal  membranes,  the  disease  is  exceptionally  rare.  In 
a  very  few  cases,  the  attack  has  commenced  during  parturition,  and  in  still 
fewer  before  birth,  and  then  when  the  lacteal  secretion  has  not  appeared. 

Constipation  and  gastric  repletion  have  been  held  by  one  or  two  writers 
to  be  causes,  and  others  attribute  it  to  over-feeding  immediately  before 
parturition. 

These  are  the  chief  causes  which  have  been  given  as  operating  in  the 
production  of  this  grave  affection  ;  and  it  will  be  seen  that  they  are  suffi- 
ciently numerous  and  diversified  to  prove  that  the  nature  of  the  disease 
is  obscure — so  far  at  least  as  its  etiology  is  concerned.  We  shall  only, 
therefore^  recapitulate  what  we  have  said  with  regard  to  the  salient  points 
of  this  question,  by  stating  that  parturient  apoplexy,  as  a  rule,  attacks 
Cows  within  one  to  five  days  after  parturition,  and  especially  when  that 


PARTURIENT  APOPLEXY.— PARTURIENT  COLLAPSE.     665 

act  has  been  easy,  prompt,  and  natural  ;  and  that  the  animals  which  are 
affected  are  those  of  the  higher  breeds,  good  milkers,  in  a  state  of  ple- 
thora, and  pluriparas.  This  brings  us  to  a  consideration  of  the  patho- 
logical anatomy  and  nature  of  the  malady. 

Pathological  Anatomy. 

Notwithstanding  the  numerous,  characteristic,  and  striking  symptoms 
;which  mark  this  disease,  \\\q  post-mortem  appearances,  no  matter  whether 
the  animal  has  been  killed  or  allowed  to  die,  are  for  the  most  part  of  a 
negative  character.  In  the  majority  of  the  descriptions  there  is  much 
confusion,  the  lesions  of  parturient  fever  being  mistaken  for  those  of 
parturient  apoplexy,  and  vice  versd,  just  as  the  two  diseases  are  con- 
founded with  each  other.  In  this  malady  the  generative  organs  are  usu- 
ally little  changed  ;  the  uterus  may  be  congested — which  it  always  is 
immediately  after  parturition,  or  it  may  even  be  paler  than  usual ;  it  is 
generally  firmly  contracted. 

The  digestive  organs  are  also  usually  normal,  or  their  blood-vessels  are 
much  distended — perhaps  due  to  paralysis  of  the  vaso-motor  system  of 
nerves.  The  rumen  is  distended  with  gas  in  many  cases,  and  the  third 
compartment  of  the  stomach  often  filled  with  hard  dry  food  between  its 
leaves,  while  the  intestines  contain  somewhat  hardened  faeces.  The  gall- 
bladder is  sometimes  much  distended.  The  lungs  are  normal,  perhaps 
slightly  emphysematous  ;  at  other  times  congested,  or  in  different  stages 
of  pneumonia  if  foreign  matters  have  obtained  access  to  the  air-passages. 
The  examination  of  the  brain  has  not  yielded  very  satisfactory  or  con- 
stant results.  Some  authorities  have  not  discovered  any  pathological 
lesions  worthy  of  note,  either  in  the  brain,  spinal  cord,  or  their  envelopes  ; 
while  others  have  found  well-marked  and  important  lesions.  These  va- 
ried from  venous  congestion  to  oedema,  anaemia,  and  exudation.  Bragard, 
cited  by  Rainard  and  Saint-Cyr,  constantly  found  injection  of  the  brain 
and  its  meninges.  Saake  and  Festal  have  also  witnessed  congestion  of 
the  vessels  of  the  encephalon,  sub-arachnoideal  effusion,  extravasation, 
and  blood-clots  on  the  surface  of  the  cerebrum  and  cerebellum.  Lecou- 
turier  has  seen  serous  effusion  in  the  lateral  ventricles — traces  of  spinal 
meningitis  ;  while  Binz  has  observed  a  sanguineous  extravasation  and 
gelatinous  matter  at  the  origin  of  the  sympathetic  nerve,  and  Fabry 
blood-clots  at  the  base  of  the  brain,  with  ser.iim  in  the  cavity  of  the  arach- 
noid. 

In  one  instance  Schaack  irlet  with  a  clot,  three-fourths  of  a  line  in 
thickness,  covering  the  left  side  of  the  medulla  oblongata,  and  serous 
effusion  into  the  lateral  ventricles  ;  and  in  anotiier  instance  an  inflam- 
matory exudate  on  the  right  side  of  the  cerebellum.  Harms  has  found,  in 
many  cases,  air  in  the  cerebral  blood-vessels  ;  and  Noquet  and  others 
have  reported  alterations  in  the  spinal  cord,  with  was  reddened,  con- 
gested, more  rarely  covered  with  exudate — chiefly  in  its  lumbar  portion, 
and  sometimes  the  sciatic  plexus  of  nerves  has  been  affected. 

Abadie  {Recueil  de  Med.  Vt'terinaire,  1873,  P-  953)  made  a  careful  examination  of  a 
Cow  which  was  attacked  twenty-four  hours  after  an  easy  delivery,  and  died  in  eighteen  • 
hours.  The  rumen  was  filled  with  dry  food  ;  the  second  compartment  of  the  stomach 
was  normal,  but  the  third  was  distended  with  hard  cakes ;  the  fourth  was  normal.  The 
mucous  membrane  was  leaden-colored,  and  in  the  pylorus  and  caecum  he  found  a  large 
patch  of  ecchymosis.  In  the  uterus  the  cotyledons  were  shrivelled,  whitish,  and  the 
lining  membrane  pale.     The  organ  itself  was  well  contracted,  and  there  was  no  trace  of 


666  PATHOLOGY  OF  PARTURITION. 

after-biith  or  lochia  :  it  was  more  dry  than  moist,  and  the  cervix  was  covered  by  a  small 
quantity  of  mucus.  The  color  of  the  uterus  contrasted  strongly  with  that  of  the  vagina, 
the  posterior  part  of  which  was  congested,  and  towards  the  vulva  was  a  wide  patch  of 
ecchymosis.  The  upper  surface  of  the  lining  membrane  was  dry.  In  the  udder  was 
plenty  of  milk  of  good  quality.  The  kidneys  and  bladder  were  normal ;  the  latter  was 
filled  with  reddish  urine.  The  blood  in  the  vessels  was  dark-colored  and  inclined  to 
coagulate.  There  were  a  few  ecchymosed  spots  on  the  surface  of  the  heart,  which  was 
otherwise  healthy.  The  lungs  were  normal,  though  full  of  dark  blood,  and  emphyse- 
matous at  the  left  anterior  border ;  the  bronchial  mucous  membrane  was  of  a  livid-red 
hue,  and  without  mucus  ;  out  of  the  trachea,  as  well  as  from  the  nostrils,  flowed  a  quan- 
tity of  fluid  mixed  with  food.  When  the  head  was  cut  off  no  fluid  escaped.  The  dura 
mater  of  the  brain  was  normal ;  no  fluid  in  the  sub-arac^noideal  space,  but  the  arachnoi- 
deal  membrane  and  pia  mater  appeared  somewhat  infiltrated  and  opaque.  The  brain- 
substance  had  a  natural  hue  without  blood-points  {punda  vasculosa)  on  section.  There 
was  no  trace  of  fluid  in  the  ventricles.     The  other  organs  were  healthy. 

Nature. 

With  regard  to  the  nature  or  efficient  cause  of  the  disease,  there  has 
been,  and  is  even  now,  much  divergence  of  opinion,  as  already  stated. 
With  some  authorities  it  is  a  fever — a  nervous  or  paralytic  form  of  par- 
turient fever,  closely  allied  to  the  puerperal  fever  of  woman,  and  due  to 
a  blood-poisoning :  the  two  forms  only  differing  in  degree.  But  we  have 
shown  that  there  is  no  fever  ;  that  the  temperature  is  rarely  above,  but 
is  generally  below,  the  normal  standard  ;  and  that  sometimes  the  animal 
recovers — all  the  symptoms  disappear  in  a  remarkably  brief  space  of 
time,  and  leave  not  the  slightest  trace  of  either  fever  or  inflammation.^ 
This  theory  is  opposed  to  the  most  careful  and  exact  observations,  and 
is  evidently  based  upon  erroneous  notions,  or  through  mistaking  metritis 
or  metro-peritonitis,  with  its  septic  fever,  for  this  disease. 

With  other  writers  the  disease  is  considered  to  be  a  grave  form  of 
gastric  fever — this  opinion  being  based  on  the  circumstance  that  there  is 
constipation,  and  impaction  of  the  digestive  organs  with  hard  dry  food. 
But  impaction  does  not  produce  the  symptoms  of  parturient  apoplexy, 
neither  does  it  cause  death  in  such  a  brief  period.  Again,  it  is  supposed 
that  mephitic  gases,  generated  in  the  digestive  apparatus,  enter  the  blood, 
alter  it,  and  so  produce  disturbance  and  stupefaction  in  all  the  organs. 
But  no  proof  of  the  existence  of  such  a  gas  i^  given  us. 

The  increase  in  the  proportion  of  white  corpuscles  in  the  blood  to- 
wards the  end  of  pregnancy  and  after  parturition,  has  led  some  writers 
to  imagine  that  the  disease  might  be  a  kind  of  leucocythaemia.  But  it  is 
evident  that  this  cannot  be  so. 

Again,  the  disease  has  been  considered  as  in  its  essence  a  cerebral  or 
spinal  congestion,  encephalitis,  myelitis,  a  meningo-cephalitis,  or  a  cere- 
bral or  medullary  apoplexy,  according  to  the  nature  or  the  scr.t  of  the 
lesions  found  after  death.  But  some  of  these  opinions  are  opposed  by 
the  fact,  that  many  of  the  lesions  on  which  they  are  based  are  not  found 
in  all  cases  of  death,  and  that  recovery  is  often  quite  rapid.  With  re- 
gard to  cerebral  congestion  and  apoplexy  we  shall  have  to  refer  hereafter. 

Many  high  authorities — such  as  Kohne,  Carsten-Harms,  Wannovius, 
Fusch,  Roll,  Baumeister-Rueff,  Barlow,  and  others — have  maintained  that 
the  disease  is  primarily  a  derangement  or  paralysis  of  the  ganglionic 
nervous  system,  which  affects,  or  is  extended  to,  the  spinal  cord  and 
brain  during  the  course  of  the  disease.  The  following  explanation  is 
offered  in  support  of  this  opinion.  A  too  easy  birth  throws  out  of  play 
a  certain  amount  of  the  nervous  force  destined  to  the  accomplishment  of 
this  act.    Hence,  there  is  a  disproportion  between  the  polar  tension  of  the 


PARTURIENT  APOPLEXY.— PARTURIENT  COLLAPSE.    667 

force  conveyed  by  these  nerves  and  the  muscular  irritability,  and  conse- 
quently an  obstacle  to  the  conductibility  of  the  nerves  charged  with  the 
distribution  of  this  superfluous  portion  of  the  nerve  force.  Barlow  thought 
that  this  disturbance  in  the  function  of  the  sympathetic  nerves  produces 
arrest  of  secretion  and  general  congestion,  especially  of  the  brain  and 
spinal  cord.  Contamine  is  more  or  less  a  partisan  of  this  theory,  as  he 
explains  the  origin  of  the  disease  by  stating  that  a  reserve  of  nervous 
influence  which  is  not  expended  in  the  animals  that  calve  easily,  by  a 
reflex  movement  acts  at  first  upon  the  spinal  cord,  and  afterwards  on  the 
brain. 

Another  theory — that  of  Lafosse — is  that  the  malady  is  due  to  the  cir- 
cumstance that  the  milky  fluid  secreted  by  the  cotyledons,  and  absorbed 
by  the  chorial  villi  for  the  nutrition  of  the  foetus,  being  no  longer  sepa- 
rated from  the  blood  after  parturition,  remains  in  the  circulation  and 
accumulates  there  until  the  mammary  glands  eliminate  it.  When  these 
glands  act  promptly,  the  febrile  movement  is  imperceptible  or  almost 
nil ;  but  if  they  are  slow  in  secreting,  the  arises  a  more  or  less  intense 
morbid  disturbance,  due  more  especially  to  then  presence  in  the  blood  of 
a  product  foreign  to  its  normal  composition.  Without  commenting  at 
any  length  on  this  theory,  it  may  be  sufficient  to  mention  that  in  some 
cases  of  parturient  apoplexy,  the  function  of  the  mammary  glands  is  not 
suspended. 

Others — among  them  Deneubourg — trace  the  commencement  of  the 
disease  to  milk  fever,  the  intensity  of  which,  originated  by  a  rapid  and 
easy  delivery,  is  in  proportion  to  the  development  and  secretory  power  of 
the  mammae.  The  resulting  disturbance  is  spread  over  the  entire  economy, 
and  favored  by  the  repletion  of  the  stomach  and  the  pre-existing  plethora 
— suddenly  increased  by  the  mass  of  blood  which  goes  to  the  uterus  dur- 
ing pregnancy — as  well  as  by  the  state  of  the  nervous  system  in  general 
which  the  pains  of  labor  have  induced,  excites  grave  disturbance  in  the 
important  functions  of  digestion,  circulation  and  innervation.  Hence 
arise  disorders,  as  much  more  sudden  and  serious  as  the  repletion  of  the 
stomach  and  the  plethora  are  great,  the  blood  is  rich  and  plastic,  and  the 
irritability  of  the  nervous  system — especially  the  ganglionic — is  excited. 
Consequently,  we  have  a  general  functional  disturbance  resulting  from 
the  "  congesting  "  action  of  all  the  cerebro-spinal  and  trisphlanchnic  or 
ganglionic  nervous  systems. 

For  Sanson,  the  collapsus  of  parturition  is  the  consequence  of  a  sudden, 
disturbance  in  the  physiological  condition  of  the  uterus  after  parturition, 
consisting  in  the  sudden  removal  of  blood  which  congested  the  organ  at 
that  time. ;  as  during  gestation  a  large  portion  of  the  bl4)od  is  diverted 
towards  the  pelvic  region,  where  the  uterus  is  lodged.  After  parturition 
the  mucous  membrane  and  cotyledons  of  the  organ  have  lost  their  func- 
tion, and  the  enormous  quantity  of  blood  they  contained  is  suddenly 
thrown  into  the  circulation,  surcharges  the  neighboring  vessels  beyond 
measure,  and  produces  collapse.  In  proof  of  this,  at  the  autopsies  he 
made,  Sanson  affirms  that  the  mucous  membrane  and  cotyledons  were 
always  found  bloodless,  and  of  a  pale-yellow  color. 

Wermer  is  of  opinion  that  the  vascular  system  is  involved, — as  mani- 
fested by  the  diminution  in  temperature  and  the  lacteal  secretion — as 
well  as  the  ner\^ous  system — shown  by  the  general  depression  and  loss  of 
sensibility,  inactivity  of  the  spinal  cord  in  the  dorsal  region,  difficulty  in 
digestion,  quickened  heart's  action,  and  slowing  of  the  respiration  ;  and 


668  PATHOLOGY  OF  PARTURITION. 

the  causes  he  believes  to  be  a  bad  regime,  and  pressure  of  the  foetus  on 
the  stomach  and  intestines,  diaphragm,  vena  cava,  and  posterior  aorta. 
A  too  rapid  evacuation  of  the  contents  of  the  uterus  brings  about  a  fall 
of  the  abdominal  viscera,  dilatation  of  the  posterior  aorta,  and  slacken- 
ing of  the  circulation. 

This  theory  of  Wermer's  is  somewhat  analogous  to  that  of  Franck, 
who  compares  the  disease  to  the  parturient  eclampsia  of  woman,  and 
has  done  more  to  elucidate  its  pathology  by  calling  to  his  aid  modern 
physiological  teaching,  than  any  previous  investigator. 

The  great  importance  of  the  subject  from  a  pathological  and  therapeu- 
tical, no  less  than  from  an  ecomical,  point  of  view,  induces  us  to  notice 
his  statements  at  greater  length  than  we  have  done  those  of  other  veteri- 
nary writers,  as  we  think  they  go  far  to  furnish  an  explanation  of  the 
phenomena  of  this  disease. 

Franck  {Woc/imschrift /iir  Thierheilkimde,  1876,  Nos.  21,  22)  says  that 
nearly  all  the  theories  set  up  have  this  in  common,  that  their  correctness 
or  incorrectness  has  never  been  supported  by  experiments.  If  we  con- 
sider the  conditions  which  are  present  at  parturition,  as  well  as  the  symp- 
toms of  the  disease,  we  are  led  to  attribute  the  origin  of  the  latter  to  an 
acute  ancemia  ("  Blutarmuth  " — poverty  of  blood),  and  consequent  sudden 
loss  of  brain  power.  With  respect  to  this  the  following  questions  have 
to  be  answered  : 

1.  Do  the  same  symptoms  appear  in  sudden  brain  anaemia  as  occur 
in  calf-fever  ("  Kalbefiebers,"  the  popular  name  for  the  malady  in  Ger- 
many) ? 

2.  Has  brain  anaemia  any  relation  to  calf-fever? 

3.  If  so,  what  occasions  this  brain  anaemia  ? 

Now  as  regards  the  first  question,  it  is  an  indisputable  fact  that  the 
functions  of  the  brain  are  in  a  great  measure  dependent  on  the  state  of 
the  circulation.  A  large  array  of  physiological  facts  tend  to  show  that 
reduoed  flow  of  blood  in  this  organ,  and  consequent  diminished  oxidation' 
of  the  brain  ganglia,  lead  to  lethargy,  lessened  reflex  action,  loss  of 
volition,  and  complete  unconsciousness.  Snakes,  which  seldom  feed,  but 
which  on  these  occasions  consume  an  enormous  quantity  of  food,  are 
known  to  be  in  this  comatose  state  after  one  of  their  heavy  meals  ;  they 
either  move  about  sluggishly  or  not  at  all,  are  quite  stupid,  make  no 
attempt  to  flee  from  danger,  and  can  be  then  easily  destroyed.  This  is 
due  to  a  peculiar  distribution  of  the  blood.  A  large  proportion  of  this 
fluid  must  necessarily  be  diverted  to  the  stomach,  in  order  to  convert  the 
enormous  quantity  of  food  into  chyle  ;  consequently,  the  stomach  has 
much  more  blo^d  during  the  process  of  digestion  than  when  this  is  not 
going  on.  The  stomach  having  absorbed  the  blood,  it  follows  that  the 
brain  and  muscular  system  must  suffer  from  a  deprivation  of  it.  Now 
there  is  a  general  physiological  law  to  the  effect,  that  organs  cannot  per- 
form their  functions  without  a  sufficient  supply  of  the  vital  fluid  ;  and  as 
the  cerebrum  is  the  seat  of  volition  and  of  consciousness,  these  two  func- 
tions are  diminished  in  activity  by  sudden  loss  of  blood,  and  if  the  depri- 
vation is  very  considerable,  the  brain  entirely  ceases  to  act. 

Remove  the  cerebrum  from  an  animal  (such  as  a  pigeon),  and  the  same 
symptoms  appear;  the  animal  is  no  longer  conscious  of  what  is  going  on  ; 
it  can  no  longer  assert  its  will  or  control  its  movements  ;  it  lies  as  if  in 
a  dream,  but  otherwise  its  health  is  unimpaired.  It  is  different,  however, 
if  the  whole  of  the  brain  loses  much  blood  j  then  certain  functional  dis- 


I 


PARTURIENT  APOPLEXY.— PARTURIEXT  COLLAPSE.     669 

turbances  of  the  organ  are  manifest,  which  often  terminate  in  total  un- 
consciousness. In  narcosis  the  brain  is  poor  in  blood  and  pale  ;  the 
action  of  cold  on  it  produces  contraction  of  the  blood-vessels  and  anaemia, 
resulting  in  lethargy  and,  finally,  unconsciousness. 

Even  during  sleep  there  is  less  blood  in  the  brain  than  when  awake. 
The  fontanella  of  children  collapse  somewhat  during  sleep,  and  the  upper 
surface  of  the  brain  itself  becomes  pale,  as  has  been  shown  to  be  the 
case  in  animals  by  Durham,  Strike  a  dog  a  severe  blow  on  the  muzzle, 
and  it  will  at  once  become  insensible,  and  perhaps  quickly  die.  This  is 
owing  to  the  blow  having  affected  the  inhibitory  filaments  (in  the  track 
of  the  fifth  cerebral  nerve  are  a  number  of  these  filaments,  which  excite 
the  contraction  of  the  vessels),  and  caused  them  to  bring  about  complete 
contraction  of  the  small  cerebral  arteries,  so  that  the  brain  becomes 
suddenly  deprived  of  arterial  blood  ;  hence  unconsciousness  and  death. 
There  is  also  the  instructive  experiment  of  Goltz,  by  which,  when  the 
heart's  movements  are  made  to  stop  at  the  diastole,  the  blood-vessels 
dilate,  especially  those  of  the  portal  system,  and  there  is  brain  anoemia. 

All  this  tends  to  show  that  the  same  symptoms  are  common  to  anaemia 
of  the  brain  and  calf-fever.  No  doubt  coma  can  result  from  deficient  oxida- 
tion of  the  ganglion-cells  of  the  cerebrum,  from  exclusion  of  air  ;  or  blend- 
ing of  matter  or  carbonic  acid  therein,  which  prevent  the  blood  from  pass- 
ing into  the  tissues,  will  readily  induce  coma.  Another  symptom  must  be 
referred  to — paralysis.  I'his  symptom  manifests  itself  in  two  ways — in 
single  muscles  or  in  groups  of  muscles.  In  the  first,  the  nerve  connected 
with  the  muscles,  or  its  centrum  in  the  brain  or  spinal  cord,  ceases  to 
act.  This  is  the  commonest  form  of  paralysis,  and  may  be  due  to  apo- 
plexy. In  the  second  case,  the  paralysis  may  arise  from  functional  inac- 
tivity of  the  volitional  centre,  located  in  the  cerebrum.  The  animal,  as 
a  rule,  makes  no  attempt  to  move,  or  cannot  take  the  initiative  in  move- 
.ment ;  and  we  might  be  inclined  to  designate  it  as  a  "paralysis  of  the 
will."  Some  of  the  symptoms  of  paralysis  which  appear  at  the  com- 
mencement of  calf-fever  may  certainly  be  traced  to  the  latter  form. 
Saake  seems  to  be  quite  convinced  of  this,  for  he  says  that  the  paralysis 
is  owing  to  a  disinclination  to  move  the  hinder  parts. 

In  the  second  place,  it  is  particularly  interesting  to  note  the  frequent 
occurrence  of  epileptic  attacks  and  spasms.  The  latter  can  be  produced 
by  sudden  anaemia  of  the  brain.  The  various  centres  in  the  medulla  ob- 
longata can,  according  to  Landois,  be  irritated  by  anaemia ;  and  sudden 
and  acute  anaemia  of  the  medulla  oblongata  is  most  likely  to  occur  in  the 
fourth  ventricle,  above  and  behind  the  pons  where  the  "  spasm-centre  " 
{^Kra77ipfezefitrmn)  is  situated.  From  this  may  arise  convulsions  which 
are  very  similar  to,  if  not  identical  with,  epilepsy.  Epilepsy  can,  how- 
ever, in  many  instances  be  traced  to  anaemia  of  the  brain  and  medulla 
oblongata,  induced  by  reflex  action  of  the  vaso-motor  centres,  or  direct 
influence  of  the  inhibitory  nerves.  We  may  easily  be  convinced  of  this 
by  watching  an  animal  which  is  being  bled  to  death  after  being  stunned. 
When  nearly  all  the  blood  has  escaped,  and  reflex  action  through  the 
cornea  can  no  longer  take  place,  insensibility  and  acute  convulsions 
(Opisthotonos)  then  set  in — the  latter  bearing  the  closest  resemblance  to 
those  of  epilepsy  and  calf-fever,  and  are  assignable  to  the  same  cause. 

The  comatose  symptoms  occur  chiefly  in  distinct  ansemia  of  the  brain 
surface  and  cerebral  ganglia,  and  when  the  medulla  oblongata  is  involved 
convulsions  prevail.     It  does  not  seem  out  of  place  to  direct  attention  to 


670  PA THOLOG Y  OF  PARTURITION. 

the  Rosenberg-Traube  theory  as  to  the  eclampsia  of  woman,  which  ap- 
plies equally  to  that  of  Cows.  This  theory  can  be  summed  up  in  the 
following  sentences  :  i.  The  origin  of  the  symptoms  of  eclampsia  lies  in 
the  altered  conditions  of  the  brain  circulation,  and  not  in  a  uraemic 
blood-poisoning,  as  Frerichs,  Listzmann,  Braun,  and  others  have  main- 
tained ;  2.  This  altered  circulation  in  the  brain  is  brought  about  by  in- 
creased aortic  pressure,  and  perhaps  also  by  direct  reflex  brain-stimulus. 
Owing  to  the  sudden  and  violent  contractions  of  the  uterus,  blood  must 
be  poured  into  the  aorta,  and  the  consequence  will  be  hyperaemia,  and 
afterwards  oedema  and  anaemia,  of  the  brain  ;  3.  The  brain  oedema  and 
the  anaemia  resulting  therefrom,  are  materially  afifected  by  the  aqueous- 
ness  of  the  blood  after  parturition.  This  hydrsemia  is  undoubtedly  in- 
creased during  the  last  period  of  pregnancy,  by  the  appearance  of  albu- 
men in  the  urine. 

This  theory  is  all  the  more  valuable,  as  its  correctness  has  been  ex- 
perimentally demonstrated  on  living  animals.  Bidder  and  Munk  have 
made  experiments  with  regard  to  eclampsia  in  animals.  They  first  in- 
jected tepid  water  into  the  carotids;  and  as  soon  as  the  pressure  of  the 
water  reached  seven  times  that  of  the  blood,  coma  and  convulsions  im- 
mediately set  in.  The  dilution  of  the  blood  does  not  altogether  account 
for  the  convulsions.  Strong  and  momentary  pressure  had  no  effect ;  but 
when  the  pressure  was  applied  continuously,  coma,  spasms,  or  at  least  un- 
consciousness, resulted.  Bidder  came  to  the  conclusion  that  increased 
blood-pressure  alone  would  not  produce  eclampsia  ;  and  that  this  fluid 
must  be  much  more  impoverished,  and  the  pressure  more  durable,  to  in- 
duce this  condition.  Although  it  cannot  be  denied  that  the  injection  of 
warm  water  causes  certain  changes  in  the  blood  and  unknown  disturb- 
ances in  the  brain,  and  although  we  can  arrive  at  no  definite  conclusion 
as  to  the  extent  of  blood-pressure  in  the  vessels  of  the  brain,  these  ex- 
periments are  of  the  utmost  importance. 

The  question  now  is  whether,  in  calf-fever,  changes  in  the  brain  occur,' 
such  as  are  portrayed  in  the  Rosenberg-Traube  theory  t  This  question 
must  be  answered  in  the  affirmative.  Nearly  all  those  who  have  had  op- 
portunities of  dissecting  Cows  which  died  of  calf-fever,  mention  that,  ac- 
cording to  the  stage  in  which  death  occurred,  hyperaemia  of  the  brain, 
brain  oedema,  and  exudation  in  the  cranial  cavity.  As  soon,  however,  as 
it  reaches  the  degree  of  brain  oedema,  anaemia  sets  in.  It  may  as  well 
be  casually  remarked,  that  animals  may  suffer  from  arterial  anaemia — 
and  this  is  most  likely  to  induce  eclampsia — simultaneously  with  venous 
hyperaemia  of  the  brain. 

The  question  may  be  asked.  How  is  it  that  such  a  brain  anaemia  en- 
sues after  calving,  and  what  makes  it  so  prevalent  among  cattle  ?  As  a 
matter  of  fact,  there  are  a  host  of  conditions  during,  and  particularly  after, 
calving  which  are  most  favorable  to  an  attack  of  eclampsia,  from  the 
Traube-Rosenberg  point  of  view.  It  is  also  a  fact  that  calf-fever  sets  in 
almost  without  any  exception,  during,  or  after,  parturition,  and  simul- 
taneously with  the  involution  period  of  the  uterus.  In  many  cases,  the 
commencement  of  the  malady  corresponds  with  the  "after-pains."  Fur- 
thermore, the  malady  in  question  principally  attacks  Cows  which  are  in 
good  milk,  and,  as  a  rule,  those  which  are  best  fed  ;  and  these  attacks 
generally  follow  easy  parturitions.  Consequent  on  the  uterus  contrac- 
tion and  diminution,  a  great  portion  of  the  circulation  is  diverted  from 
it.     The  blood  is  poured  into  the  larger  trunks  and  into  the  aorta.     The 


PA R  TURIENT  A POPLEXY.—PA R TURIENT  COLLAPSE.     6 7 1 

quicker  and  more  continuous  the  uterus  contractions,  the  more  consider- 
able is  this  flow  of  blood.  Attention  may  casually  be  directed, to  the  fact, 
that  the  after-pains  are  much  more  severe  and  continuous  after  a  speedy 
parturition,  than  after  a  tardy  one.  The  blood  forced  back  generally 
finds  its  normal  outlet  by  the  udder  and  skin  ;  and  by  watching  every  nor- 
mal parturition  one  can  observe  the  acute  swelling  of  the  udder,  which  swel- 
ling varies  in  proportion  to  the  number  and  violence  of  the  pains.  By  this 
outflow  into  the  udder  and  skin,  and  by  which  a  collateral  fluxion  is  es- 
tablished, the  accumulation  of  blood  already  alluded  to,  which  would  be 
followed  by  aortic  pressure,*  is  got  rid  of  without  detriment  to  the  ani- 
mal. In  cases,  however,  where  this  stoppage  is  sudden  and  violent — as 
happens  after  a  chill  to  the  surface  of  the  body — the  aortic  pressure 
must  undoubtedly  be  considerably  increased. 

One  consequence  of  the  increased  pressure — always  easily  observable 
after  a  little  time,  as  will  be  shown  presently — must,  among  others,  be 
congestion  of  the  brain.  But  the  soft  brain-tissue  can  only  offer  a  slight 
opposition  to  the  distention  of  the  vessels ;  consequentl}^,  sudden  effu- 
sion and,  as  a  result,  brain  oedema,  ensues.  This  brain  oedema,  on  its 
part,  causes  contraction  of  the  vessels  and,  in  this  way,  arterial  anaemia. 
Tlie  whole  process,  which  can  be  followed  step  by  step,  is  greatly  aided 
by  {a)  the  heart's  hyperplasia,  {h)  the  increased  flow  of  blood,  and  (<r) 
the  hydraemia  which  exists  in  pregnant  animals.  After  parturition,  the 
heart  does  not  at  once  resume  its  normal  size  ;  it  remains  for  some  time 
in  a  hypertrophied  state.  In  fact,  it  seems  as  if  the  heart,  in  good  milk- 
ing Cows,  follows  the  same  law  as  increased  circulation  in  the  swollen 
udder,  and  is  much  more  enlarged  than  is  the  case  with  inferior  milking 
animals.  The  result  of  increased  power  of  the  heart  is  increased  action. 
The  blood,  which  has  been  largely  increased  in  a  pregnant  animal,  does 
not  at  once  return  to  its  normal  quantity  after  parturition,  but  materially 
aids  in  producing  congestion, 

■  The  remarkable  fact  always,  however,  holds  true,  that  animals  which 
are  in  good  condition  without  being  fattened  up,  and  those  in  which 
the  circulation  is  healthy,  are  particularly  susceptible  to  calf-fever.  An 
animal  which  has  calved,  is  like  one  into  whose  circulation  a  certain 
quantity  of  blood  has  been  transfused.  This  superabundance  of  blood 
does  not  quickly  disappear  from  the  body;  it  takes,  so  to  say,  the  place 
of  a  new  organ.  In  animals  which  have  just  brought  forth,  the  milk 
secretion  expends  this  blood.  Hydraemia  is  common  to  them  all.  Doubt- 
less, the  dilution  of  blood  in  pregnant  animals  is,  as  a  rule,  over-estimated. 
There  are,  however,  many  cases  of  albuminous  urine  among  Cows  for 
some  weeks  before  parturition.  Hydraemia  is  the  natural  result  of  this 
condition  of  the  urine,  if  it  be  of  long  standing.  The  watery  condition  of 
the  blood  tends  materially  to  brain  oedema,  if,  indeed,  this  be  not  really 
the  actual  consequence  of  such  a  condition.  Particular  inquiries  furnish 
statistical  information  as  to  the  number  of  cases  of  calf-fever  accompanied 
or  unaccompanied  by  albuminous  urine. 

It  is  necessary,  however,  to  append  a  consideration  of  a  teleological 
character.  The  act  of  parturition  is  naturally  accompanied  by  great  irri- 
tability of  the  sensory  nerves,  and  with  much  pain;  whilst  all  other  ope- 
rations in  animals,  which  have  as  their  object  the  preservation  of  the 
creature  or  species — such  as  appeasing  hunger,  slaking  thirst,  etc. — are 

*  It  must  be  remembered  that  blood  stasis  and  undue  distention  of  vessels,  is  not  always  due  to  blood- 
pressure.    Altered  innervation  of  the  walls  of  the  vessels  themselves  can  bring  this  about. 


672  PATHOLOGY  OF  PARTURITION.    ' 

unaccompanied  by  pain.  There  must  be  some  particular  reason  for  this. 
We  know  that  the  vaso-motor  centre,  and  more  especially  the  vaso-motor 
nerves,  together  with  the  distention  of  the  vessels,  are  greatly  influenced 
by  the  sensory  nerves,  because  of  a  reflex  mechanism  which  exists  be- 
tween them  \  as  we  know  to  be  the  case,  on  a  larger  scale,  between  the 
sensory  and  motor  nerves.  As  a  rule,  irritation  of  the  sensory  nerves  is 
followed,  first  by  contraction,  then  by  great  dilatation  of  the  vessels, 
which  may  even  lead  to  extravasation  in  some  cases.  The  tendency  to  in- 
flammation and  its  results  must  also  not  be  lost  sight  of.  It  might  be 
imagined  that  the  pains  at  birth  would  have  the  effect  of  expanding  the 
vessels,  to  admit  of  the  flow  of  blood  driven  out  of  the  gravid  uterus. 

It  has  been  remarked  by  nearly  every  authority,  that  calf-fever  ensues 
after  quick  and  easy  parturition,  when  but  little  assistance  has  been  re- 
quired. In  such  cases  there  can  be  but  little  pain,  and  therefore  one 
would  expect  little,  if  any,  distention  of  the  vessels.  But  it  is  just  in 
these  cases  of  easy  parturition  that  a  particularly  severe  aortic  distention 
arises  ;  as  at  times  the  uterus  contracting  too  quickly,  causes  a  mass  of 
blood  to  be  suddenly  propelled  into  this  vessel.  At  other  times,  the 
whole  vascular  system  is  unprepared  for  the  mass  of  blood  forced  into  it ; 
consequently,  the  aortic  pressure  reaches  its  higl^eslr degree.  The  ques- 
tion now  presents  itself  :  Are  there,  then,  anatomical- indications  to  show 
clearly  why  the  disease  in  question  should  be  so  prevalent  among  cattle, 
whilst  with  the  other  domestic  animals  it  occurs  but  seldom,  or  not  at 
all  ?  Such  indications  exist,  as  a  matter  of  course.  The  process  of  con- 
veying blood  to  the  brain  of  cattle — particularly  to  that  of  ruminants^is 
a  peculiar  one.  The  Cow  has  no  single  large  vessel — no  carotis  i?iterna — 
to  convey  blood  to  the  brain,  as  is  the  case  with  the  Mare,  but  a  number 
of  small  vessels  which  penetrate  to  the  cranial  cavity.  These  vessels, 
however,  do  not  spread  over  the  surface  of  the  brain,  as  in  the  Mare  ; 
they  form  a  sort  of  network — the  rete  mirabile — from  both  sides  of  which 
a  branch  develops  itself,  and  which  forms  the  proper  brain  arteries.  The 
following  seems  to  be  the  result  of  the  peculiar  distribution  of  the  ves- 
sels : 

I.  The  circulation  of  arterial  blood  to  the  "brain  is  very  uniform  ;  2.  Ir- 
regular pressure  in  the  aortic  system  cannot  easily,  and  then  only  slowly, 
be  transmitted  to  the  arteries  of  the  brain.  Now,  however.  Bidder's  ex- 
periments have  shown  that  sudden  increase  of  blood-pressure  does  not 
produce  any  comatose  symptoms,  but  that  these  always  set  in  if  the  in- 
creased pressure  is  of  any  duration.  Under  these  circumstances,  brain 
oedema  is  much  more  likely  to  set  in  than  if  the  blood  pressure  were  to 
disappear  quickly. 

The  anatomical  arrangement  of  the  rete  mirabile  is  such  that  it  chiefly 
supplies  the  cerebrum.  This  should  tend  to  explain  why,  in  eclampsia  of 
the  Cow,  the  comatose  symptoms  are  so  common  that  convulsions  seem 
exceptional.  It  is  an  interesting  fact  that,  in  Swine,  this  fever  is  often 
observable  in. those  in  which  the  rete  mirabile  is  greatly  developed.  Not 
long  ago,  Wall ey  ( /^/m/^«r/a«,  1874)  asserted  that  this  so-called  calf-fever 
was  dependent  on  this  peculiar  distribution  of  the  vessels. 

Practically,  as  yet  no  illness  has  been  observed,  such  as  attacks  the 
Cow  and  Mare,  where  the  flow  of  blood  to  the  brain  is  direct,  and  con- 
veyed through  large  vessels.  As  in  the  latter,  the  flow  of  blood  to  and 
from  the  brain  is  rapid,  a  check  in  the  circulation  sufficient  to  cause 
brain  oedema  and  anaemia  is  with  difficulty  effected.     In  the  Mare,  in- 


PARTURIENT  APOPLEXY.— PARTURIENT  COLLAPSE.     673 

creased  aortic  pressure  can  very  quickly  be  transmitted  to  the  brain,  and 
can  also  readily  lead  to  apoplexy.  It  is  worthy  of  notice  that  the  first 
stage  of  parturient  fever — viz.,  the  stage  marked  by  congestion  of  the 
brain — is  observed  in  the  Mare.  It  soon  terminates  in  death,  as  is  also 
sometimes  the  case  with  the  Cow,  as  a  result  of  apoplexy.  Such  cases, 
though  not  sufficiently  substantiated  by  the  results  of  autopsies,  have  been 
described  by  Gerrard  {Veterinarian^  1874).  The  Mares  in  question  died 
during  parturition,  or  soon  after. 

The  second  stage,  however — which  in  the  Cow  is  marked  by  anaemia 
of  the  brain  and  comatose  symptoms  arising  therefrom,  as  also  by  con- 
vulsions, and  which  has  all  the  characteristic  features  of  parturient  fever 
— has  hitherto  not  been  observed  in  the  Mare.  We  must  now  ask  the 
question  whether  anaemia  of  the  brain  can  arise  in  any  other  manner? 
Must  congestion  and  effusion  always  be  the  forerunners  of  anaemia  "i 
There  is  no  doubt  that  anaemia  of  the  brain  can  occur  in  quite  a  different 
manner  ;  but  the  question  is  whether,  in  the  case  of  calf-fever,  it  shows 
itself  in  any  other  way  than  that  already  described  .''  The  portal  circu- 
latory system,  which  is  governed  by  the  splanchnic  nerve — the  largest 
and  most  important  vaso-motor  nerve  in  the  body — is  a  most  powerful 
one.  Under  certain  conditions,  this  portal  system  can  receive  the  whole 
mass  of  blood  in  the  body ;  the  animal  can,  to  use  the  expression  of  a 
celebrated  physiologist,  "  bleed  to  death  in  its  own  portal  vessels." 

If  the  portal  vein  of  a  dog  is  tied,  all  the  symptoms  of  anaemia  set  in, 
and  result  in  death  ;  as  the  intestines,  and  more  especially  the  spleen, 
are  distended  with  blood.  The  animal  dies  from  want  of  blood,  yet  with- 
out losing  a  single  drop  of  blood  from  its  vessels. 

Similar  symptoms  were  the  result  of  Goltz's  experiments  and  nicotine 
poisoning.  The  latter  poison  has  the  effect  of  paralyzing  the  circulatory 
nervous  centre,  and  this  is  followed  by  a  general  dilatation  of  the  vessels. 
In  many  diseases — among  others,  in  rabies — there  are  somewhat  similar 
symptoms.*  It  is  also  known  that  after  rapid  escape  of  the  stomach  gas 
in  tympanitis,  the  evacuation  of  large  abscesses  in  hydrops,  etc.,  sudden 
collapse  follows  from  brain  anaemia.  In  these  cases  the  blood  flows 
quickly  to  the  stomach  and  its  organs,  and  the  brain  becomes  emptied. 
A  similar  rush  of  blood  into  the  portal  vein  can  also  be  brought  about  in 
a  reflex  manner — viz.,  through  stimulation  of  the  sensory  nerves.  Stop- 
page of  the  heart  by  reflex  vagus  stimulation  or  reflex  splanchnic  pa- 
ralysis (consequent  paralysis  of  the  portal  system),  can  thus  be  brought 
on.  Quite  recently  Fischer  (Volkmann's  Satfinilung  Klinischer  Vortrdge, 
No.  10)  has  attributed  the  occurrence  of  "shock  "  in  man  to  the  reflex 
paralysis  of  the  nerves  of  the  vessels.  The  conditions  and  arguments 
hold  good  for  those  of  calf-fever  in   the  Cow. 

Werner,  in  particular  {Wochenschrift  fiir  Thierheilkunde,  1868,  p.  363, 
etc.),  decidedly  inclines  to  this  idea.  He  draws  attention  to  the  fact, 
that  in  calf-fever  there  is  always  hyperaemia  (?)  of  the  intestines.  This 
primary  hypercemia  directly  causes  brain  anaemia.  Calf-fever  might, 
therefore,  be  looked  upon  as  "  parturient  shock."  We  will  not  attempt 
to  deny  that  such  cases  occur,  but  they  do  not  as  a  rule  ;  added  to  which, 
it  is  probable  that  this  abundance  of  blood  in  the  intestines  in  calf-fever 
is  looked  upon  as  symptomatic  of  paralysis,  which  first  originates  from 
brain   anasmia,    resulting  from    lessened   stimulation  of  the   vaso-motor 

*  In  rabies  in  the  Horse,  this  appearance  is  often  present  in  the  highest  degree.    There  is  extreme 
distension  of  the  portal  system,  with  marked  anasmia  of  the  brain. 

43 


674  P^  THOL OG  Y  OF  PAR TURITION. 

centre.  This  last  theory  does  not  in  any  way  account  for  the  congestion 
of  the  brain.  Besides,  if  one  admits  this  theory,  one  must  expect  to 
see  calf-fever  set  in  as  soon  as  the  act  of  parturition  is  over — i.e.,  as  soon 
as  the  uterus  is  empty,  which  is  very  seldom  the  case.  As  a  rule,  calf- 
fever  sets  in  simultaneously  with  the  after-birth  period  (inclusive  of  the 
period  of  after-pains),  fifteen  hours  after  delivery,  but  generally  within 
the  first  twenty-four  hours. 

Now,  if  it  is  admitted  that  calf-fever  does  not  in  most  cases,  according 
to  this  theory,  account  for  the  direct  brain  anaemia,  it  often  really  occurs 
in  some  diseases  which  are  very  similar  to  this  one.  Thus  Gierer  re- 
niarked,  after  feeding  with  leaves  of  the  red  beet,  plethora  of  the  intes- 
tines and  anaemia  of  the  brain  similar  to  that  in  calf-fever.  Lies  saw 
anaemia  of  the  brain  and  epileptic  fits  in  a  Mare  after  a  dose  of  aloes, 
etc.  Some  of  the  symptoms  of  rabies,  especially  towards  the  end  of 'the 
disease,  are  to  be  traced  to  anaemia  of  the  brain,  and  have  a  great  simi- 
larity to  calf-fever.  Likewise  the  kind  of  aberration  which  is  often  notice- 
able in  cattle;  here  also  there  is  anaemia  of  the  brain. 

Saake  gives  a  good  instance  of  primary  brain  shock,  which  must  come 
under  the  head  of  calf-fever.  A  portion  of  the  lower  jaw  of  a  Cow  was 
broken  off  by  a  blow,  and  the  animal  developed  symptoms  of  illness 
which,  after  Saake's  assurance,  any  one  would  have  taken  for  calf-fever, 
had  he  not  known  the  origin  of  it.  These  symptoms  are  in  this  case 
clearly  attributable  to  anaemia  of  the  brain,  arising  from  powerful  stimu- 
lation of  the  inhibitory  fibres.  The  same  happened  in  the  case  of  a  Dog 
which  received  a  heavy  blow  on  the  nose. 

Anaemia  of  the  brain  can,  therefore,  arise  in  the  following  ways,  ex- 
clusive of  excessive  haemorrhage  : 

I  St.  Through  excessive  stimulation  of  the  inhibitory  fibres,  caused  by 
painful  injuries  to  the  head. 

2d.  By  reflex  paralysis  of  the  vessels. 

3d.  Through  congestion  of  the  brain  in  brain  oedema.  The  latter  is 
clearly  that  in  operation  in  calf-fever. 

Numberless  are  the  hypotheses,  as  we  have  already  said,  as  to  the 
origin  of  calf-fever.  The  most  far-fetched  is  that  which  attributes  it  to 
paralysis  of  the  sympathetic  nervous  system.  None  of  the  symptoms  of 
the  malady  favor  this  belief.  The  nerve  of  the  intestines  is  a  vessel- 
nerve,  and,  indeed,  the  largest  vessel-nerve  in  the  body.  Were  this  to 
be  paralyzed,  the  vessels  of  the  intestines  would  be  paralyzed  also,  which 
would  clearly  appear  on  dissection. 

In  opposition  to  this,  there  is  no  doubt  that  in  the  course  of  the  dis- 
ease there  is  paralysis  of  the  vagus.  The  quickened  pulse,  the  labored 
breathing,  especially  towards  the  end  ;  the  paralysis  of  the  pharynx,  the 
suspended  peristalsis — all  point  to  this  with  certainty. 

Harms,  in  his  earlier  days,  was  of  opinion  that  the  disease  in  question 
arose  from  introduction  of  air  into  the  veins.  This  is,  however,  most 
improbable  ;  as  if  air  be  admitted  into  the  veins,  the  symptoms  are 
quite  different  from  those  of  calf-fever.  Added  to  which,  it  is  incompre- 
hensible how,  in  normal  parturition,  air  can  get  into  the  veins,  as  there  is 
no  wounding  of  the  uterus.  Others  believe  that  the  malady  comes  from 
infection.  Results  of  dissection  disprove  this.  Confounding  calf-fever 
yixXh/ebris puerperalis,  which  designates  quite  a  different  malady  in  man- 
kind, has  misled  many  people.  Calf-fever  in  cattle  is  an  eclampsia  pirn-- 
peralis.     It  has  already  been  noticed  that  the  malady  can  arise  from 


PARTURIENT  APOPLEXY.— PARTURIENT  COLLAPSE.     675 

other  causes  ;  and  really  it  has  been  observed  in  oxen,  non-parturient 
cows,  etc.  Those,  therefore,  who  have  been  accustomed  to  name  the 
disease  "  calf-fever,"  are  compelled  to  speak  of  a  malady  bearing  a  re- 
semblance to  calf-fever.     By  the  \qx\x\  febris  puerperalis  one  designates 

septic  metro-peritonitis  and  its  results. 

Preventive   Treatment. 

When  we  see  the  great  and  speedy  fatality  of  parturient  collapse,  and 
when  we  know  that  the  subjects  of  it  are  hearty-feeding,  high-milking 
Cows  in  a  more  or  less  advanced  state  of  plethora,  we  have  every  reason 
to  lay  great  stress  on  preventive  treatment,  and  to  combat  the  predisposi- 
tion to  the  malady  by  a  strict  attention  to  hygiene,  particularly  during 
the  last  months  of  pregnancy  and  immediately  after  parturition.  The 
diet  should  be  soft  and  easily  digested,  so  as  to  avert  constipation ;  and 
if  the  animal  is  plethoric,  the  allowance  ought  to  be  moderate.  When  it 
is  possible  to  allow  exercise  for  some  time  before  parturition,  this  should 
not  be  withheld.  Nothing  is  so  likely  to  prevent  an  attack  of  the  disease, 
than  keeping  the  Cow  in  as  natural  and  free  a  condition  as  possible. 
Exposure  to  cold  and  currents  of  air,  and  every  thing  likely  to  diminish 
the  functions  of  the  skin,  should  likewise  be  avoided. 

More  special  precautions  have  been  recommended  by  various  author- 
ities, founded  generally  on  the  opinions  they  may  have  entertained  as  to 
the  pathology  of  the  disease  ;  but  the  utility  of  these  prophylactic  meas- 
ures has  been  more  or  less  disputed.  Bleeding  during  the  month  before 
parturition  has  been  highly  lauded,  but  th(3re  is  every  reason  to  believe 
that  it  is  more  injurious  than  useful.  Others  recommend  the  adminis- 
tration of  nux  vomica,  tartar  emetic,  nitrate  of  potass,  sulphate  of  soda 
or  magnesia,  and  laxatives  of  various  kinds — all  of  which  may  prove 
more  or  less  useful  ;  while  others,  again,  speak  favorably  of  milking  the 
Cow  by  hand  a  few  days  |pefore  calving,  and  thrice  instead  of  twice  a 
day  for  a  short  time  after  that  event,  if  the  Calf  is  removed  or  cannot 
abstract  sufficient  milk.  This  they  insist  upon  doing  if  the  udder  is 
largely  developed  or  distended. 

As  there  may  be  danger  if  the  newly-calved  Cow  is  allowed  to  drink 
much  cold  water,  this  should  either  be  very  sparingly  given,  or,  better 
still,  warm  gruel,  in  small  but  frequent  quantities,  may  be  substituted. 

Curative  Treatment. 

The  different  methods  of  treatment  enumerated  for  the  cure  of  this 
disease  are  completely-  bewildering,  and  they  are  so  diametrically  op- 
posed to  each  other — from  the  obscurity  which  prevails  as  to  the  nature 
of  the  malady,  we  suppose — that  we  can  scarcely  be  astonished  to  find 
that  they  are  all  more  or  less  unsuccessful,  and  that  the  majority  of  the 
most  observant  practitioners  are  inclined  to  believe  that  recovery  has 
followed  most  frequently  when,  without  adopting  violent  measures,  the 
attendant  has  waited  for  the  curative  effects  of  nature — usually  decided 
about  the  second  or  third  day :  only  attempting  to  combat  certain  mor- 
bid conditions  which  might  aggravate  the  case. 

Nevertheless,  it  is  evident  that  some  mode  of  treatment  must  be  re- 
sorted to,  and  that  this  should  be  based  on  the  indications  furnished  by 
the  symptoms  during  the  course  of  the  malady,  or  upon  what  we  know  of 
its  pathology.  We  shall  glance  at  some  of  the  means  which  may  be 
employed  in  the  curative  treatment  of  the  disease. 


676  PATHOLOGY  OF  PARTURITION. 

Previous  to  doing  so,  however,  we  must  draw  attention  to  the  position 
of  the  affected  animal,  and  we  cannot  do  this  in  better  terms  than  those 
of  Williams  {Principles  and  Practice  of  Veteri?iary  Aledicine,  p.  418)  :  "  If 
the  Cow  is  already  down  when  first  seen  by  the  practitioner,  his  first  care 
must  be  to  see  that  she  is  made  to  lie  as  near  the  natural  position — on 
the  sternum — as  possible ;  and  this  he  will  do  by  having  her  packed  up 
at  the  side  by  bundles  of  straw,  or,  what  is  better,  sacks  filled  with  straw, 
firmly  wedged  under  the  quarter  and  shoulder,  the  head  at  the  same  time 
being  properly  propped  by  the  same  means,  and  care  being  taken  at  all 
times  that  the  Cow  is  prevented  from  injuring  her  head  by  striking  it 
against  hard  bodies."  We  may  add  that  some  practitioners  are  particu- 
larly careful  to  have  the  head  well  raised  above  the  other  parts  of  the 
body,  especially  when  the  animal  is  comatose  ;  and  this  is  sometimes 
effected  by  means  of  a  halter  on  the  head,  or  a  rope  round  the  base  of 
the  horns,  the  other  end  being  passed  over  a  beam  in  the  stable.  This 
elevation  of  the  head  prevents  increased  congestion  of  the  brain,  and 
facilitates  the  return  of  blood  from  that  organ. 

It  is  often  beneficial  to  alter  the  position  at  intervals — every  two  or 
three  hours  ;  and  Williams  recommends  that  the  mammary  gland  be 
also  "  stripped  and  hand-rubbed." 

The  abstraction  of  blood  has  found  much  favor  with  many  authorities. 
Williams  says  :  "  In  the  earlier  stages,  whether  the  animal  is  standing 
or  lying  prostrate  and  in  a  state  of  coma,  if  the  pulse  be  not  exces- 
sively weak  and  the  heart's  action  almost  fluttering,  recourse  must  be 
had  to  venesection.  Slow  and  deep  breathing,  with  a  tendency  to  ster- 
tor,  add  greatly  to  the  necessity  for  immediate  bleeding.  The  beneficial 
action  of  the  withdrawal  of  blood  is  shown  by  the  pulse  becoming  fuller, 
stronger,  and  better  in  tone.  The  opening  into  the  jugular  is  to  be  a 
large  one,  in  order  that  the  blood  may  flow  freely  to  relieve  the  conges- 
tion— to  check,  if  possible,  a  further  extravasation  of  blood  or  effusion 
of  serum,  and  to  divert  its  active  flow  into  the  head  ;  but  it  must  not  be 
carried  out  so  as  to  debilitate  the  heart's  action.  When  the  pulse  be- 
comes fuller  and  stronger,  the  bleeding  is  to  be  stopped  ;  from  three  to 
five  quarts  will  generally  be  sufficient." 

Theoretically,  venesection  is  to  be  commended.  If  we  accept  Franck's 
opinion  that  the  disease  is  analogous  to  or  identical  with  the  eclampsia  of 
woman,  and  if  the  Traube-Rosenberg  theory  be  correct,  then  a  sudden 
depletion  of  the  vascular  system,  by  which  the  pressure  is  diminished, 
must  stop  the  attack.  It  is  known  from  experience,  says  Schroeder,  that 
after  venesection  the  quantity  of  the  blood  soon  becomes  the  same, 
through  the  serum  taken  from  all  the  tissues,  whilst  the  quality  is  greatly 
deteriorated  by  the  abstraction  of  blood.  A  short  time  after  venesec- 
tion, we  shall  expect  to  find  the  former  blood-pressure  in  the  arterial  sys- 
tem, but  the  blood  far  more  watery  than  previously.  From  this  theoret- 
ical consideration,  it  follows  that  abstraction  of  blood,  if  the  above-men- 
tioned conditions  really  cause  convulsions,  must  be  attended  by  an  im- 
mediate favorable  result,  and  under  certain  circumstances  the  whole  dis- 
ease may  surely  be  cut  short  by  it.  But  if  all  other  conditions  remain 
the  same,  the  blood-pressure  will,  after  some  time,  again  reach  its  pre- 
vious height ;  the  quality  of  the  blood  has,  in  the  mean  time,  been  greatly 
deteriorated,  and  consequently  the  danger  of  the  disease  will  be  in- 
creased. 

Williams  adds  :  "  The  bleeding  is  for  the  purpose  of  removing  pres- 


PARTURIENT  APOPLEXY.— PARTURIENT  COLLAPSE.    677 

sure  from  the  brain,  and  although  the  pulse  may  indicate  stimulants 
rather  than  depletion,  it  will  be  found  that  as  the  blood  flows  the  tone  of 
the  pulse  will  improv^e  ;  for  the  weakness  of  the  pulsation,  the  want  of 
impulse,  and  debility  of  the  heart's  action,  are  results  of  brain-pressure. 
If,  hx)wever,  the  surface  of  the  body  be  cold,  if  the  animal  be  t>'mpanitic, 
the  heart's  action  fluttering,  and  the  pulse  almost  undetectable,  bleeding 
is  calculated  to  do  more  harm  than  good,  as  the  heart's  action  would 
now  be  further  impaired,  and  the  amount  of  arterial  blood  sent  to  the 
brain  diminished.  For  it  must  be  remembered  that  the  cerebral  conges- 
tion is  now  less  due  to  an  over-abundant  supply  of  arterial  blood  than  to 
pressure  upon  it  by  venous  or  capillary  engorgement ;  that,  in  fact,  the 
brain — engorged  as  it  may  app'ear — is  in  an  anaemic  condition  in  regard 
to  its  arterial  supply  ;  and  when  this  is  the  case,  paralysis  of  the  heart  is 
to  be  prevented,  if  possible,  by  the  use  of  stimulants," 

A  principal  indication  in  the  treatment  of  the  disease,  viewing  it  in  the 
light  we  have  done,  is  Xo  favor  the  cutaneous  circulation  and  stimulate  the 
skin  by  every  means  in  our  power,  and  thus  relieve  those  organs  in  which 
the  blood-pressure  is  too  considerable.  With  this  object  in  view,  the 
skin  is  to  be  well  rubbed  with  straw  wisps,  and  then  warmly  clothed.  Or 
the  course  of  the  spine  and  for  some  distance  on  each  side,  may  after- 
wards be  stimulated  with  strong  ammonia  liniment.  Some  authorities 
recommend  the  application  of  a  mixture  of  croton  oil  with  oil  of  turpen- 
tine j  others  employ  a  thick  layer  of  mustard,  after  the  skin  has  been 
well  cleansed  with  warm  water  and  the  hair  removed  ;  others  resort  to 
sacks  steeped  in  boiling  water  apiplied  to  the  spine — sometimes  after 
deep  scarifications  have  been  made. 

In  addition  to  the  applications  of  turpentine  or  mustard  to  the  spine, 
they  are  often  made  to  the  limbs. 

In  some  cases,  a  hot  iron — the  laundress's  flat  iron — has  been  applied 
to  the  back  in  an  "ironing"  fashion,  and  at  a  somewhat  high  tempera- 
ture, a  piece  of  flannel  being  interposed  between  it  and  the  skin.  The 
action  of  the  skin  can  be  greatly  augmented  by  covering  the  body  with  a 
wet  sheet,  and  above  this  a  thick  woollen  one,  surrounding  the  animal 
with  plenty  of  litter. 

Cold  water  or  ic6  may  be  applied  to  the  head  ;  but  this  application  re- 
quires care,  as  the  resulting  coryza  and  other  complications  may  prove 
very  serious,  should  the  animal  recover  from  the  collapse. 

With  regard  to  the  tympanitis  which  is  so  often  present  as  a  conse- 
quence of  the  torpidity  in  the  digestive  organs,  this  should  be  combated 
in  the  ordinary  way,  by  the  administration  of  stimulants.  These  are 
most  effective  and  rapid  in  their  action  when  given  in  the  fluid  form,  if 
the  animal  can  swallow.  If  it  cannot,  then  they  may  be  administered  by 
means  of  the  stomach-pump  or  probang,  or  even  in  bolus.  Williams  rec- 
ommends giving  carbonate  of  ammonia  in  bolus  ;  the  hand  being  well 
oiled,  is  to  be  pushed  as  far  as  possible  into  the  pharynx,  when  the  dose 
"  will  slowly  gravitate  into  the  rumen."  Should  the  medicine  not  act 
promptly,  or  should  the  tympanitis  be  so  great  that  suffocation  is  to  be 
apprehended,  then  the  rumen  ought  to  be  punctured  without  delay.  This 
may  be  effected  by  the  ordinary  trocar  and  cannula,  the  latter  being 
allowed  to  remain  in  the  rumen  for  some  time.  It  may  be  closed  by  a 
cork,  which  is  to  be  withdrawn  when  the  gas  accumulates.  If  care  is 
exercised,  fluid  medicaments. may  be  introduced  into  the  stomach  through 
the  cannula. 


678  PA  THOL OG V  OF  PAR TURITION. 

Even  when  the  tympanitis  is  not  extreme,  but  the  animal  is  comatose 
and  there  is  gastric  regurgitation,  it  will  be  advisable  to  puncture  the 
rumen  ;  as  by  this  means  the  entrance  of  food  into  the  trachea  may  be 
prevented,  by  allowing  the  gases  to  escape  through  the  cannula,  instead 
of  by  the  oesophagus. 

Enetnas  are  as  essential  as  counter-irritation.  The  rectum  should  first 
be  emptied  manually,  and  then  either  enemas  of  warm  water,  or  those  of 
a  stimulant  or  laxative  nature,  administered.  By  the  rectum  enemas  of 
linseed  oil,  common  salt,  sulphate  of  soda  or  magnesia,  aloes,  tobacco, 
oil  of  turpentine,  camphor,  etc.,  have  been  administered.  The  rectum 
forms  a  safe  and  convenient  channel  for  the  introduction  of  medicines, 
and  especially  those  intended  to  act  upon  the  torpid  digestive  organs, 
when  the  animal  can  no  longer  swallow.  Powdered  camphor  in  small 
quantities  has  even  been  introduced  into  the  rectum  to  stimulate  the  in- 
testines, when  drugs  exhibited  by  the  mouth  have  failed  to  effect  this. 

Enemas  may  be  given  as  frequently  as  necessary  without  danger  to  the 
animal,  and  with  ease :  advantages  not  available  with  the  mouth  admin- 
istration. , 

The  urine  should  be  frequently  removed  from  the  bladder,  either  by 
pressure  on  the  viscus  through  the  rectum,  the  introduction  of  the  cathe- 
ter or  no2zle  of  the  ordinary  injection  syringe  into  the  urethra,  or  even 
by  passing  the  finger  into  that  canal. 

The  milk  should  be  often  removed,  and  the  udder  completely  emptied. 
Even  when  there  is  no  milk,  the  teats  should  be  well  and  repeatedly 
stripped.  ^ 

Purgatives  are  in  nearly  every  case  necessary,  and  they  should  be  ac- 
tive, and  given  in  larger  doses,  than  in  ordinary  circumstances,  constipa- 
tion being  a  constant  and  serious  symptom  ;  while  action  of  the  bowels 
■may  be  considered  a  most  favorable  sign.  The  most  common  are  sul- 
phate of  magnesia  or  soda,  aloes,  chloride  of  sodium,  cream  of  tartar, 
linseed  oil,  castor  oil,  tartar  emetic,  ipecacuanha,  croton  oil,  etc. 

In  the  great  majority  of  instances  these  agents  are  not  given  alone,  but 
are  associated  with  other  substances. 

A  very  favorite  compound  in  Germany  is  that  mentioned  by  Kohne, 
the  composition  of  which  is  as  follows  : 

Nux  vomica         -  -  -  -  8>^  drams. 

Tartar  emetic      -  .  -  -  2      ounces. 

Sulphate  of  soda  -  -  -  18  " 

Common  salt       -  -  -  -  4^        " 

These  are  boiled  together  for  about  a  quarter  of  an  hour  in  four  pints  of 
water,  and  one-fourth  given  every  hour  or  every  two  hours. 

Harms  places  great  confidence  in  tartar  emetic.  He  gives  8^  drams 
in  about  two  pints  of  water,  in  four  hours  three  drams  in  a  pint  of  water, 
and  in  five  hours  two  drams.  In  one  serious  case  he  gave  as  much  as 
two  ounces  in  fourteen  hours.  In  thirty-seven  cases  of  the  disease,  only 
two  died. 

When  it  is  desired  to  increase  the  activity  of  any  of  the  ordinary  pur- 
gatives, croton  oil  is  generally  added  in  the  proportion  of  six  to  twelve — 
or  even  forty — drops,  or  oil  of  turpentine  one  or  two  ounces. 

Some  practitioners  extol  nux  vomica  in  tolerably  large  doses,  to  aid  in 
rousing  the  action  of  the  intestines. 

Stimula?its  are  often   administered,  and   in   conjunction  with  bleeding 


POST-PA RTUM  PARALYSIS. 


679 


they  may  prove  of  the  greatest  service  at  the  commencement  01  the  at- 
tack, or  they  may  be  associated  with  the  purgatives.  If  given  alone,  they 
should  be  exhibited  in  small  doses  and  very  often. 

Other  medicaments  have  been  employed — as  aconite,  bryonia,  camphor, 
phosphorus,  datura,  quinine,  gentian,  digitalis,  etc. — with  varying  suc- 
cess. 

When  recovery  commences,  small  doses  of  stimulants  may  be  benefi- 
cial if  there  is  much  debilit}',  and  the  animal  can  swallow  readily.  But  in 
the  administration  of  fluids  when  the  animal  is  comatose,  or  deglutition  is 
impeded,  the  greatest  care  is  necessary  to  prevent  their  entering  the 
trachea — -an  accident  which  might  prove  fatal.  To  test  whether  the 
animal  can  swallow,  a  little  cold  water  may  be  poured  into  the  mouth 
from  a  bottle.  If  swallowing  is  difficult,  then  the  only  safe  mode  of  ad- 
ministration is  by  the  stomach-pump  or  probang,  or  directly  into  the  rumen 
by  the  trocar  and  cannula.  Large  quantities  of  fluids  are  objectionable, 
and  the  amount  in  any  single  dose  should  not  exceed  a  pint. 

It  must  also  be  remembered,  that  if  it  is  probable  that  the  animal  will 
not  recover,  but  will  be  killed  and  its  flesh  consumed  as  food,  drugs  of  a 
poisonous  kind,  or  likely  to  flavor  the  meat,  should  not  be  given.  Many 
cases  are  recorded  in  which  people  have  been  poisoned,  through  eating 
of  the  flesh  of  Cows  which  had  received  large  quantities  of  poisonous 
medicines  before  being  killed  by  the  butcher. 

Electricity  has  been  employed  with  success,  both  in  the  comatose 
stage  and  when  paralysis  has  remained  after  the  attack.  Neumann  and 
Holden  relate  instances  of  recovery.  The  Leyden  jar,  or,  better,  the 
induction  coil,  may  be  employed. 

To  sum  up,  the  treatment  of  parturient  collapse  consists  chiefly  in  re- 
lieving the  congestion  of  the  brain  (at  the  commencement),  restoring 
the  functions  of  and  stimulating  the  skin,  promoting  the  action  of  the 
intestines,  and  jfcmoving  the  milk  or  stimulating  the  function  of  the 
mammary  gland. 

All  violent  arfd  heroic  treatment  should  be  avoided,  as  well  as  large 
doses  of  medicine. 

Consecutive  congestion  or  inflammation  of  the  lungs  must  be  treated 
according  to  circumstances  ;  and  paralysis  will  be  best  combated  by  stim- 
ulation to  the  loins,  and  the  subcutaneous^  injection  of  strychnia,  with 
diuretics  and  purgatives. 

Easily  digested  food  in  small  quantities  should  alone  be  allowed  im- 
mediately after  recovery,  and  the  animal  must  not  be  given  any  indiges- 
tible food,  nor  be  permitted  to  eat  hay  or  litter. 

It  is  judicious  not  to  breed  from  a  Cow  which  has  suffered  from  partu- 
rient collapse,  unless  every  precaution  is  taken  towards  the  next  calving 
period. 


CHAPTER  V. 

Post-Partum  Paralysis. 

In  treating  of  the  diseases  peculiar  to  pregnancy,  we  alluded  to  paraple- 
gia (p.  180)  as  one  of  these.  Paralysis  of  the  hind-quarters  is  more 
frequent  previous  to  birth  than  after  that  event,  and  is  generally  observed 
in  the  Cow.     After  birth,  paralysis  is  comparatively  rare,  and  may  affect 


68o  PA  THOLOG  Y  OF  PARTURITION. 

nearly  the  whole  of  the  body,  or  both  or  only  one  of  the  hind-limbs.  The 
Cow  is  also  the  animal  which  oftenest  exhibits  post-partum  paralysis. 
The  affection  may  be  due  to  parturient  apoplexy  or  collapse — as  already 
noticed  ;  it  may  also  be  a  result  of  metritis  ;  or  it  may  follow  difficult 
parturition,  and  especially  after  the  birth  of  a  large  calf,  or  if  the  latter 
has  been  in  a  wrong  position.  Franckhas  often  witnessed  its  occurrence 
after  delivery,  when  the  uterus  has  been  half-twisted.  Williams  gives  an 
instance  in  which  paralysis  appeared  to  be  due  to  mental  disturbance ! 

Symptoms. 

The  symptoms  are  similar  to  those  of  ante-pa?'tum  paralysis. 

The  animal  continues  to  lie,  and  one  or  both  hind-limbs  may  be  moved 
in  a  convulsive  irregular  manner,  or  they  are  completely  incapable  of 
movement.  In  the  majority  of  cases,  however,  the  animal  is  able  to  turn 
itself  over  at  intervals  from  side  to  side — particularly  during  the  night. 
Sometimes  only  one  leg  is  paralyzed.  Apparent  paralysis  is  at  times 
observed  in  Cows,  which  persist  in  lying  after  parturition,  and  though 
they  can  move  their  limbs  readily,  yet  they  will  not  attempt  to  get  up ; 
their  appetite  is  unimpaired,  they  exhibit  no  symptoms  of  disease,  but 
yield  plenty  of  milk,  and  the  excretions  are  normal.  • 

This  condition  may  continue  for  weeks  or  months,  and  often  animals 
have  to  be  killed  in  consequence  of  it. 

Nature. 

Little  is  known  as  to  the  nature  of  this  affection.  Harms  and  othen 
thought  it  was  due  to  injury  inflicted  on  the  sacral  and  other  nerves  dur 
ing  difficult  parturition.  The  sciatic  nerves  are  particularly  liable  t( 
injury.  Post-mortem  examination,  however,  has  on-ly  furnished  negativ; 
evidence  of  this.  Franck  thinks  that  injury  to  the  cervix  uteri  may  giv 
rise  to  reflex  paralysis  ;  this  has  been  witnessed  in  a  Bitch  ;  and  refie; 
paralysis  of  the  legs  has  been  seen  in  woman,  and  asq^ibed  to  uterine 
injury  or  derangement — when  this  was  repaired  the  paralysis  disappeared. 
It  is  not  at  all  improbable  that  the  same  causes  will  produce  the  same 
effects  in  animals. 

We  can  easily  understand  how  paralysis  is  induced  in  parturient  apoplexy. 
Williams  states  that  it  is  due  to  inflammation  and  red  softening  of  the 
spinal  cord  in  the  lumbar  region. 

Treatment. 

When  paralysis  is  actually  present,  the  animal  must  be  kept  clean  and 
healthy.  Blisters,  or  even  the  actual  cautery,  should  be  applied  to  the 
loins,  and  the  subcutaneous  injection  of  strychnia  resorted  to.  The  con- 
dition of  the  bowels  and  bladder  must  be  attended  to  ;  the  former  being 
regulated  by  feeding,  and  if  necessary  by  laxatives,  the  latter  by  diuretics. 
Electricity  may  be  useful  in  some  cases,  and  particularly  when  only  one 
limb  is  involved. 

In  all  cases,  the  state  of  the  uterus  should  be  ascertained,  and  if  it  is 
unsatisfactory,  then  remedial  measures  should  be  adopted  with  regard 
to  it. 

When  the  animal  cannot  turn  itself,  this  must  be  done  by  its  attend- 
ants ;  and  if  it  is  a  valuable  one,  and  the  paralysis  is  likely  to  continue 
for  some  time,  slinging  for  a  short  period  everyday  may  be  tried.     With 


PARTURIENT  ECLAMPSIA.  68 1 

Cows,  however,  unless  there  are  special  reasons  to  the  contrary,  and  if 
they  are  in  good  condition,  it  is  often  advisable  to  have  them  killed  for 
food. 

1.  Williams  {Op,,  cit.,  p.  414)  mentions  that  a  she-Goat  had  its  kids  taken  away  when 
they  were  four  weeks  old,  and  in  an  hour  afterwards  it  was  completely  paralyzed,  moan- 
ing piteously,  and  evidently  in  great  distress.  It  remained  in  this  condition  for  several 
days — lying  extended  on  its  side  and  quite  conscious,  but  powerless.  It  then  gradually 
sank  and  died. 

2.  "  Veterinarius  "  ( Veterinarian,  vol.  xii.  p.  288)  gives  a  case  of  parturient  paralysis 
in  a  Mare,  succeeding  abortion.  There  were  at  first  evident  symptoms  of  metritis.  It 
ultimately  recovered. 

3.  Toll  {Ibid.,  vol.  xxxvii.  p.  824)  relates  a  case  of  parturient  apoplexy  from  which  the 
Cow  recovered  in  three  days,  but  could  not  reise  until  ten  days  afterwards,  when  it  was 
discovered  that  one  of  the  hind-limbs  was  paralyzed.  The  leg  was  drawn  along,  the 
foot  being  turned  back.  In  a  month  extensive  ulceration  had  occurred  at  the  fetlock 
and  hock,  and  there  was  a  large  abcess  in  the  gluteal  region.  The  Cow  was  eventually 
killed. 

4.  The  same  writer  gives  a  similar  instance,  in  which  paralysis  of  a  hind-limb  followed 
parturient  apoplexy.  It  recovered  sufficiently  well  to  walk  about  at  pasture,  and  yielded 
a  liberal  quantity  of  milk. 


CHAPTER  VI. 

Parturient  Eclampsia. 

We  have  seen  that  Franck  has  compared  the  malady  we  have  designated 
"  parturient  apoplexy  "  or  "  collapse,"  with  the  disease  known  in  woman 
as  "  eclampsia,"  and  has  endeavored  to  establish  their  identity.  To  a 
certain  extent  we  admit  that  he  has  been  successful,  but  we  are  far  from 
convinced  that  the  eclampsia  of  woman  and  the  malady  of  the  Cow  are 
identical  ;  though  we  do  not  dispute  that  the  same  or  similar  causes  may 
be  in  operation  in  the  production  of  both.  In  the  first  place,  the  eclamp- 
sia of  woman  is  essentially  epileptic  or  convulsive,  the  convulsions  being 
of  a  tonic  and  clonic  nature  ;  and  though,  in  the  disease  of  the  Cow, 
convulsions  are  sometimes  present,  yet  they  are  far  from  being  a  constant 
symptom. 

The  symptomatology  of  the  two  diseases,  indeed,  is  widely  different. 
In  the  woman  there  are  premonitory  signs — such  as  uneasiness,  headache, 
nausea,  twitchings,  sudden  vertigo.  Then  the  attack  begins  by  rapid 
contractions  of  the  muscles  of  the  face,  eyelids,  and  eyeballs  :  the  latter 
rolling  about  in  their  orbits.  These  movements  soon  extend  to  the  head, 
neck,  and  other  parts  of  the  body,  and  are  rapidly  replaced  by  tonic  con- 
traction of  all  the  extensor  muscles  either  of  the  trunk  or  limbs.  The 
respiration  is  stertorous  or  suspended  ;  the  pulse — at  first  full  and  strong 
— is  so  weak  that  it  is  scarcely  perceptible  ;  the  tongue  is  protruded  from 
the  mouth,  and  often  bitten ;  foam  appears  between  the  lips  ;  uncon- 
sciousness is  complete.  The  attack  may  last  for  twenty  or  thirty  seconds  ; 
then  the  tonic  convulsions  are  replaced  by  those  of  a  clonic  kind,  pre- 
ceded by  a  general  state  of  rigidity.  The  movements  are  jerking,  and 
so  convulsive  that  they  shake  the  whole  body.  The  respiration  gradu- 
ally returns,  the  pulse  resumes  its  natural  rhythm  ;  the  jerking  of  the 
limbs  and  body  subsides,  perspiration  appears,  and  in  from  one  to  five 
minutes  all  is  tranquil  ;  the  comatose  condition  which  supervenes  varies 
in  duration,  but  the  patient  awakes  greatly  exhausted,  and  complaining 


682  PA  THOL  OG  Y  OF  PA  R  TURITION. 

of  pain  in  the  limbs.  Exceptionally,  there  is  only  one  attack  ;  generally 
there  are  several,  which  may  succeed  each  other  quickly,  when  the  pa- 
tient may  remain  comatose  between  the  pauses,  and  at  the  height  of  an 
attack  death  may  take  place  from  cedema  of  the  lungs  or  apoplexy.  In 
favorable  cases  the  intervals  become  longer,  the  attacks  tliemselves  more 
imperfect  and  shorter,  until  they  finally  cease.  Parturient  collapse  in 
the  Cow  has  not  the  intermittent  character  of  the  eclampsia  of  woman, 
and  there  are  seldom,  if  ever,  real  convulsions  ;  there  is,  on  the  contrary, 
loss  of  the  cerebral  faculties,  and  paralysis  of  the  m.uscles,  particularly 
of  the  hind-limbs  :  indeed,  the  most  marked  features  of  the  disease  are 
progressive  paralysis,  continuous  course,  absence  of  convulsions,  and 
rapid  death  in  fatal  cases. 

But  if  we  cannot  at  present  admit  that  this  bovine  disorder  and  eclamp- 
sia of  woman  are  the  same,  there  is  a  malady  which  attacks  not  only  the 
Cow,  but  also  the  Goat,  Bitch,  and  Sow,  and  which  certainly  closely  re- 
sembles the  human  disease.  It  has  been  studied  chiefly  by  Hertwig, 
Zundel  (who  had  only  observed  it  in  the  Bitch),  Mauri  (who  has  studied 
it  in  the  Cow,  Goat,  and  Bitch),  Harms  (who  describes  it  in  the  Goat), 
and  Ellenberger,  Seller,  and  Wostendorf  (who  have  seen  it  in  the  Sow). 
It  is  possible  that  the  disease  is  rare ;  but  it  is  more  probable  that  it  has 
been  confounded  with  other  maladies.  We  have  only  seen  one  case  of 
it,  the  victim  being  a  Bitch  suckling  too  many  puppies. 

Symptoms. 

With  the  Cow  and  Goat,  the  attack  appears  to  come  on  soon  after  pj-r- 
turition,  but  in  the  Bitch  it  may  occur  in  from  two  to  thirty  days  after 
that  event,  and  always  during  lactation.  In  the  Sow,  it  usually  begins 
between  three  to  five  days  after  parturition.  With  the  Bitch  and  Sow  it 
is  not  so  serious  as  in  the  Cow,  and  with  the  latter  the  disease  is  far  less 
fatal  than  in  woman.  It  would  appear  that  it  is  hereditary.  In  the  Cow 
and  Goat  the  malady  closely  resembles  that  in  woman,  the  attacks  being 
multiple,  and  sometimes  accompanied  by  loss  of  consciousness  ;  though, 
as  with  the  Bitch,  the  two  periods  of  tonic  and  clonic  convulsions  are  not 
well  marked. 

The  eclamptic  attacks  are  not  sudden  in  their  invasion.  They  gen- 
erally begin  with  tremblings,  anxiety,  agitation,  and  very  perceptible 
feebleness  in  movement.  These  symptoms  progressively  increase  in  in- 
tensity, until  the  animal  can  no  longer  stand.  This,  the  first  period,  is 
not  constant  in  its  duration.  When  lying,  the  animal  is  seized  with  gen- 
eral convulsions  of  the  voluntary  muscles  ;  the  limbs  are  extended  and 
agitated  as  if  by  electric  discharges  ;  the  eyes  pirouette  in  their  orbit,  or 
more  or  less  squint ;  the  mouth  is  half  open,  the  tongue  pendent,  and 
spumous  foam  flows  from  the  commissures  of  the  lips.  The  Bitch  ap- 
pears to  retain  its  consciousness,  but  the  Cow  loses  its  senses  more  or 
less  completely.  After  a  variable  period  of  time — from  a  quarter  of  an 
hour  to  several  hours — the  convulsions  cease,  the  patient  rises,  and  after 
standing  for  a  few  seconds  as  if  in  a  state  of  deep  coma,  it  gradually  re- 
gains its  senses  and  ordinary  condition. 

The  attacks  may  be  more  or  less  numerous  and  intense,  and  conse- 
quently constitutes  a  disease  of  which  the  gravity  is  variable,  according 
to  Mauri. 

Hertwig,  who  was  the  first  to  describe  the  disease  in  the  Bitch,  and 
Zundel,  give  a  similar  account  of  the  symptoms   in  that  animal.     The 


PARTURIENT  ECLAMPSIA. 


683 


latter  had  never  witnessed  iDremonitory  signs  of  the  disease,  though  Hert- 
wig  had.  He  says  that  with  Bitches  which  are  suckling,  and  particularly 
those  kept  in  the  house  and  well  fed,  it  is  not  rare  to  observe  a  state  of 
tetanic  rigidity  and  incomplete  paralysis,  with  the  following  symptoms  : 
The  animal  suddenly  commences  to  be  uneasy  and  anxious  ;  the  eyes 
are  haggard,  sometimes  the  nose  is  a  little  hot ;  the  respiration  is  very 
short  and  quick,  though  pressure  on  the  chest  or  abdomen  does  not  cause 
any  pain.  In  a  short  time — about  a  quarter  of  an  hour  after  the  difficulty 
in  respiration  was  observed — the  animal  cannot  stand,  but  falls  on  its 
side,  and  lies  with  the  limbs  extended ;  even  when  raised  it  cannot 
stand.  The  breathing  becomes  still  quicker — from  60  to  100  per  min- 
ute ;  while  the  pulse  is  small,  hard,  and  irregular,  and  beats  100.  Con- 
sciousness appears  to  be  retained,  but  the  animal  refuses  food  and  drink, 
and  the  alvine  and  urinary  excretions  are  suppressed.  The  mammary 
glands  are,  greatly  engorged,  hot,  and  abundantly  provided  with  milk, 
the  quality  of  which  does  not  appear  to  be  altered  or  injurious  to  the 
young,  which  usually  continue  to  suck  as  before.  This  state  continues 
for  forty-eight  hours,  when  death  generally  occurs  from  apoplexy  and 
paralysis  ;  though  by  proper  treatment  the  disease  may  always  be  quickly 
cured.  Zundel's  description  is  almost  the  same,  except  that  he  says  there 
are  tonic  convulsions,  with  clonic  contractions  extending  rapidly  to  the 
whole  of  the  body  ;  that  sometimes  there  is  trismus,  with  grinding  of  the 
teeth  ;  constantly  there  is  a  white  foam  at  the  mouth  and  muscular  trem- 
blings of  the  jaws  ;  the  breathing  is  stertorous,  and  sensibility  much  di- 
minished ;  that  there  are  cases  in  which  the  eclampsia  appears  to  be 
merely  partial,  affecting  only  the  hind-limbs  for  instance,  and  the  animal 
sits,  with  the  head  unaffected,  and  whining  ;  that  the  disease  is  continuous 
and  without  intermittences,  the  attacks  last  for  one  or  two  days  ;  and  if 
no  relief  is  afforded  the  creature  dies  from  total  paralysis,  due  to  conges- 
tion of  the  meninges  of  the  brain,  or  from  asphyxia  after  a  spasm  of  the 
glottis. 

In  the  Sow,  according  to  Ellenberger  and  Wostendorf,  the  symptoms 
are  not  very  unlike  calf-fever  in  the  Cow,  with  which  disease  it  is  de- 
scribed by  Franck,  In  the  cases  Ellenberger  {Gurlt  and  Hertwig's 
Magazin,  1869)  had  an  opportunity  of  seeing,  the  animals  were  attacked 
from  three  to  five  days  after  easy  parturition.  The  appetite  was  partially 
or  totally  lost,  the  young  were  neglected,  and  the  animal  seldom  moved 
about  ;  soon  it  persisted  in  lying,  and  there  was  suppression  of  faeces  and 
urine,  with  diminution  or  cessation  of  milk  secretion.  The  animal  lay  on 
its  side,  the  eyes  closed,  and  the  body  temperature  low ;  at  times  there 
were  feeble  convulsions.  The  respiration  was  irregular,  deep-drawn,  and 
moaning  ;  the  pulse  80  to  90  per  minute  ;  and  great  loss  of  sensibility. 
Nothing  was  observed  about  the  generative  organs.  After  twenty-four 
to  thirty-six  hours  improvement  took  place,  faeces  were  voided,  and  the 
animal  began  to  pay  attention  to  surrounding  objects  ;  the  temperature 
rose  ;  the  pulse  and  breathing  became  normal ;  the  appetite  and  milk 
secretion  returned  ;  and  in  from  three  to  five  days  recovery  was  complete. 
All  the  Sows  survived  the  attack.  In  one  case  reported  by  Seller  {Can- 
statfs  Jahresbericht,  1862,  p.  48),  the  symptoms  were  more  of  a  convul- 
sive or  epileptic  nature. 

Nature,  and  Causes. 

This  disease,  it  appears,  never  attacks  any  but  animals  in  the  parturient 


684  PATHOLOGY  OF  PARTURITION. 

condition,  and  it  has  affected  Bitches,  especially  those  well-fed  and  in  a 
plethoric  state,  after  each  parturition. 

With  regard  to  the  nature  of  the  disease,  much  cannot  be  said,  as  there 
do  not  appear  to  have  been  many  opportunities  for  post-mortem  examina- 
tions. No  albumen  has  been  discovered  in  the  urine,  and  uraemia  has 
not  been  noted.  The  cause  which  has  been  attributed  by  Franck  as 
operating  in  the  production  of  parturient  collapse,  may  be  in  operation  in 
the  development  of  eclampsia — viz.,  increased  pressure  in  the  arterial  or 
aortic  system,  and  brain  anaemia. 

As  occasional  causes,  Hertwig  mentions  for  the  Bitch,  chills  ;  the  loss 
of  the  offspring,  and,  consequently,  "  stagnation  "  of  the  milk  ;  mental 
emotions,  and  especially  those  due  to  loss  of  offspring  or  master.  In  the 
only  case  we  have  observed,  which  was  in  the  Bitch,  we  attributed  it  to 
suckling  too  many  puppies. 

Treatment. 

The  disease  does  not  appear  to  be  at  all  serious,  many  cases  recover 
without  medical  treatment.  Hertwig  recommends  the  abstraction  of 
blood  from  the  jugular,  the  quantity  varying  with  the  size  and  condition 
of  the  animals  ;  and  he  asserts  that  frequently  all  the  symptoms  diminish 
considerably,  or  even  disappear,  while  the  blood  flows.  After  the  bleed- 
ing, he  administers  a  spoonful  of  tea  every  four  or  six  hours,  with  small 
doses  of  nitrate  of  potass.  If  the  bowels  ar^  constipated,  an  enema  is  to 
be  given.  Zundel  has  been  particularly  successful  with  the  syrup  of 
chloroform,  which,  in  small  and  frequent  doses,  keeps  the  animal  in  a 
state  of  semi-anaesthesia  ;  the  cure  being  terminated  by  a  dose  of  laxative 
medicine  and  one  or  two  enemas.  The  syrup  of  ether  produces  the  same 
effect  as  the  chloroform,  though  less  quickly  and  surely.  In  the  case 
which  occurred  in  our  own  experience,  and  which  we  believed  to  be  due 
to  hyper-lactation,  some  of  the  puppies — a  large  litter — were  removed, 
and  the  bitch  had  a  warm  bath  and  a  laxative ;  recovery  quickly  ensued. 

1.  Boissonneau  [Journal  des  Vetermaires  dii  Midi,  1858)  relates  that  a  Cow,  three 
days  after  parturition,  which  had  been  natural  and  spontaneous,  showed  symptoms  of  an 
attack  of  metritis.  The  following  day,  a  quarter  of  an  hour  after  abstracting  blood,  the 
animal  began  to  manifest  great  anxiety ;  the  respiration  became  laborious  and  hurried, 
like  that  of  a  Horse  pris  de  chaleiirs  ;  the  hmbs  were  wide  apart,  as  if  to  prop  up  the 
body,  and  the  head  rested  on  the  manger — the  body  being  balanced  by  a  kind  of 
undulatory  movement.  Soon  the  Cow  fell — an  inert  mass,  the  limbs  rigid  and  immova- 
ble, the  eyes  turned  backwards  and  fixed,  the  mouth  half  open  and  the  tongue  pendent. 
The  animal  bit  at  objects  within  its  reach,  and  the  foaming  saliva  flowed  from  the  com- 
missures of  the  mouth.  This  fit,  during  which  all  the  instinctive  and  sensorial  faculties 
seemed  to  be  in  abeyance,  lasted  about  twenty-five  minutes,  and  five  attacks  occurred 
during  the  day.  Next  day  there  were  three  attacks,  and  the  fourth  day  only  two.  The 
fifth  day  passed  without  any,  and  it  was  thought  that  recovery  had  set  in,  when,  on  the 
sixth  day,  the  fits  re-appeared  with  the  same  intensity  as  at  the  commencement.  In  the 
middle  of  one  of  these  attacks,  the  Cow  got  entangled  in  the  stall  and  was  strangled. 
At  the  autopsy,  dark  blood  was  found  in  the  lateral  ventricles  of  the  brain,  the  envelopes 
of  which  were  congested  and  its  texture  softened.  Death  in  this  case  was  accidental, 
and  the  lesions  may  have  been  due  to  strangulation. 

2.  Mauri  {Revue  Veteri7taire,  1876,  p.  65)  describes  the  case  of  a  Cow,  four  years  old,  and 
aprimipara,  which  had  calved,  and  the  placenta  was  expelled  two  hours  afterwards.  On 
the  following  morning  the  animal  was  seized  with  tremblings,  refused  all  food,  mani- 
fested breathlessness,  and  looked  anxious.  On  being  led  to  the  pasture  to  give  it  more 
air,  it  was  perceived  that  it  was  weak  in  the  hind-quarters,  and  in  the  short  distance  it 
had  to  travel  it  fell  several  times.  It  was  put  in  a  shed  with  a  northern  exposure,  and 
its  calf  being  brought,  it  remained  completely  indifferent  to  it.  At  two  o'clock  it  fell, 
and  Mauri  was  sent  for.     He  found  it  lying  extended  on  the  right  side,  the  respiration 


PARTURIENT  ECLAMPSIA.  685 

appeared  to  be  suspended,  and  it  was  difficult  to  perceive  the  movements  of  the  flanks  ; 
the  pulse  was  imperceptible,  but  the  heart's  beats  were  strong.  The  tongue  hung  out 
of  the  mouth,  and  the  air  expelled  during  perspiration  carried  a  large  quantity  of  foamy 
saliva  with  it.  The  senses  appeared  to  t)e  completely  abolished,  and  the  eyeballs — 
turned  greatly  upwards — looked  fixed  in  a  remarkable  rnanner.  The  limbs  were  rigidly 
extended,  and  they,  with  the  trunk,  jerked  in  such  a  violent  manner,  that  the  whole  body 
was  shaken  without  being  displaced.  The  udder  was  not  flaccid,'and  milk  of  a  good 
quality  was  readily  obtained  from  it. 

Mauri  thought  it  was  a  case  of  vitulary  fever,  and  ordered  the  necessary  treatment. 
After  six  o'clock  in  the  evening,  while  preparations  were  being  made  to  carry  out  his 
prescriptions,  the  Cow  got  up  and  stumbled  towards  the  side  of  the  shed  where  its  calf 
was  standing.  During  the  night  it  ate  and  ruminated.  Next  morning  at  eight  o'clock 
there  was  a  new  attack.  The  premonitory  symptoms  lasted  for  about  half  an  hour,  and 
the  animal  lay  until  half-past  nine.  At  mid-day  it  did  not  present  any  signs  of  disease. 
It  had  no  more  attacks,  but  the  owner,  apprehensive  of  future  danger,  sold  it  two  months 
afterwards,  and  Mauri  lost  sight  of  it. 

3.  Calmettes  (Ibid.,  p.  67)  mentions  that  a  four-year-old  Cow  gave  birth  to  a  calf 
during  the  night  in  quite  a  natural  manner,  and  during  the  following  day  it  ate  and 
ruminated  as  usual.  Towards  six  o'clock  in  the  evening  it  suddenly  commenced  to 
tremble,  and  to  stagger  in  its  hind-limbs,  so  that  it  could  only  walk  with  the  greatest 
difficulty.  At  seven  o'clock  Calmettes  noted  that  the  hind-quarters  were  very  feeble, 
the  general  sensibility  appeared  to  be  increased,  pressure  on  the  dorso-lumbar  region 
caused  much  pain  ;  the  skin  was  very  hot,  and  the  respiration  deep  and  hurried  ;  the 
pulse  was  strong  and  quick,  the  mucous  membranes  somewhat  reddened,  and  the  muffle 
damp.  Counter-irritants  were  applied  to  the  hind-quarters,  and  draughts  and  emollient 
enemas  administered.  At  one  o'clock  in  the  morning  he  was  again  called.  The  animal 
had  fallen  on  its  side  ;  the  general  sensibility  was  diminished,  and  the  skin  was  very 
cold.  From  time  to  time  it  was  remarked  that  all  the  extensor  muscles  of  the  limbs 
were  convulsed,  which  threw  the  latter  into  rigid  extension ;  though,  when  seized  by  the 
hands,  they  could  be  flexed  and  moved  about.  The  sensorial  functions  were  completely 
abolished,  and  the  skin  could  be  pricked  or  incised  without  inducing  the  least  movement ; 
the  eye,  which  was  generally  fixed,  pirouetted  in  its  orbit  from  time  to  time,  while  it 
could  distinguish  nothing,  and  could  be  touched  without  betraying  any  sensation  ;  there 
was  also  loss  of  hearing.  At  this  time  the  respiration  was  about  normal — eighteen  to 
twenty  respirations  in  the  minute  ;  the  pulse  was  small  and  imperceptil)le  ;  the  heart's 
beats  strong  ;  the  mucous  membrane  rather  pale  than  red,  and  the  muffle  dry.  During 
expiration  there  was  a  labial  souffle,  and  an  abundance  of  foamy  saliva  escaped  from  the 
mouth.     The  animal  remained  in  this  condition  for  six  hours. 

Towards  seven  o'clock  next  morning,  when  about  to  send  for  a  butcher,  the  limbs  be- 
came rigid  and  were  seized  with  convulsions,  which  extended  to  the  entire  body.  As 
if  by  enchantment,  the  animal  placed  itself  on  its  sternum,  raised  its  head  in  the  normal 
position,  and  finally  got  up,  though  with  difficulty  ;  it  remained  in  a  somewhat  deep  coma 
for  about  an  hour. 

In  the  evening  it  had  a  second  attack,  there  being  general  agitation,  with  hurried 
respiration  and  weakness  of  the  hind-quarters.  Soon  it  fell,  had  numerous  convulsions, 
and  manifested  the  same  general  insensibility  it  displayed  in  the  morning  ;  remain- 
ing paralyzed,  however,  for  only  three  hours.  Next  morning  it  appeared  to  be  quite 
recovered. 

Fifteen  months  previously,  and  eight  days  after  parturition,  this  Cow  had  another 
attack  when  returning  from  pasture;  being  suddenly  seized  with  tremblings,  it  staggered 
and  fell.  In  half  an  hour  afterwards  it  was  completely  insensible,  and  sensationless  ; 
the  respiration  was  almost  normal,  the  pulse  imperceptible,  though  the  contractions 
of  the  heart  were  powerful,  and  all  the  symptoms  already  enumerated  were  present, 
but  became  more  rapidly  developed.  The  convulsions  continued  for  two  and  a  half 
hours. 

4.  Lafitte  {Ilnd.,  p.  70)  mentions  that  a  Cow  calved  in  the  most  favorable  manner, 
and  four  hours  afterwards  became  agitated  and  restless ;  soon  afterwards,  there  were 
convulsions  of  the  muscles  of  the  trunk  and  limbs,  and  so  much  weakness  set  in  that  the 
animal  could  not  stand.  The  tongue  was  often  projected  from  the  mouth  and  foam 
flowed  therefrom  :  the  Cow  coutd  hear  and  see  during  the  attack.  The  pulse  was 
intermittent,  and  the  respiration  moderately  increased.  In  about  ten  hours  it  arose  and 
gradually  recovered.  Two  days  after,  it  had  another  and  a  final  attack,  which  lasted  for 
three  hours, 

5.  The  same  writer  {Ibid.,  p.  70)  relates  that  a  Cow,  which  had  calved  a  few  hours 
before,  was  seized  with  persistent  convulsions  and  great  general  weakness,  which  ren- 
dered standing  impossible — presenting,  in  fact,  all  the  symptoms  of  the  previous  case. 
This  attack  continued  for  three  hours,  and  another  followed  on  the  same  day.   Then  an 


686  PATHOLOGY  OF  PARTURITION.  i 

interval  of  a  day  elapsed,  when' the  fits  succeeded  each  other  so  frequently,  and  with  so 
much  intensity,  that  the  animal  died  from  asphyxia. 

6.  Lafitte  [Ibid.,  p.  71)  describes  the  case  of  a  Goat  affected  with  metro-peritonitis 
after  parturition,  and  for  which  it  was  treated?  Two  days  afterwards,  the  creature  ap- 
peared to  be  agitated  and  restless ;  convulsions  were  manifested  in  all  the  muscles,  and 
particularly  those  of  the  jaws;  the  eyes  rolled  about;  there  was  abundant  salivation, 
etc. ;  the  animal  could  not  stand.  There  was  only  one  attack,  which  lasted  for  several 
hours. 

7.  Mauri  {Ibid.,  p.  18)  relates  that  a  Bitch,  four  years  old,  and  which  had  been  ill  since 
the  previous  evening,  was  sent  to  the  Toulouse  Veterinary  School.  Fifteen  days  pre- 
viously it  had  given  birth  to  four  puppies,  which  it  suckled.  That  morning,  about  three 
o'clock,  its  owner  was  awoke  by  its  plaintive  cries  and  its  restlessness.  It  was  then 
anxious,  its  mouth  was  open,  and  it  breathed  as  if  it  had  been  running  fast  on  a  hot  day; 
it  also  appeared  to  be  weak  in  its  hind-parts.  On  its  arrival  at  the  school,  it  was  lying 
on  its  side  in  a  large  hamper,  with  its  four  puppies,  which  were  at  the  teat ;  the  respira- 
tion was  very  hurried,  short,  irregular,  and  noisy ;  it  was  executed  in  a  jerking,  irregular 
manner  ;  the  ribs  appeared  to  be  limited  in  their  movements,  as  in  a  horse  affected  with 
tetanus.  The  mouth  was  half  open,  the  tongue  pendent,  and  the  saliva  flowing  in  a 
frothy,  abundant  stream.  The  animal  convulsively  closed  its  jaws,  and  withdrew  its 
tongue  from  time  to  time,  in  order  to  swallow  a  portion  of  the  saliva;  the  buccal  and 
conjunctival  mucous  membrane  was  greatly  injected ;  the  physiognomy  expressed  great 
anxiety  rather  than  pain  ;  the  eye  was  widely  open,  bright  and  animated,  and  the  visual 
axis  was  not  deviated.  The  limbs  were  kept  extended  and  immovable,  without  tetanic 
rigidity.  At  intervals  the  animal  attempted  to  get  up,  and  managed  to  raise  itself  on  its 
fore-limbs;  but  the  hind-legs  moved  in  different  directions,  and  automatically,  so  that 
the  Bitch  could  not  co-ordinate  them  in  a  determinate  manner.  The  joints  could  be  easily 
flexed  on  each  other,  by  seizing  the  bones  like  the  branches  of  a  pair  of  compasses,  but 
when  left  to  themselves  they  immediately  became  extended.  The  pulse  was  strong  and 
quick.  The  senses  were  unimpaired,  and  when  its  name  was  called  the  animal  directed 
its  eyes  towards  its  master,  and  attempted  to  move  its  tail.  This  did  not  always  happen, 
however,  for  the  creature  generally  appeared  to  be  completely  absorbed  by  its  condition 
— a  circumstance  which  might  have  led  to  the  belief  that  its  general  sensibility  was 
diminished.  There  was  no  appetite,  and  the  excretion  of  faeces  and  urine  was  completely 
suppressed  since  the  commencement  of  the  disease. 

Mauri,  never  having  had  an  opportunity  of  witnessing  such  a  malady,  was  much 
troubled  to  give  a  name  to  the  collection  of  symptoms.  As,  however,  paraplegia  ap- 
peared to  be  imminent,  he  ordered  sinapisms  to  the  limbs  and  the  spine,  and  enemas  of 
tepid  water.  In  the  evening  the  symptoms  were  ameliorated ;  the  animal,  instead  of 
lying  extended  on  its  side,  was  curled  round  as  in  health,  and  when  excited  it  got  up, 
staggered,  and  fell  on  the  litter  ;  a  deep  coma  had  given  place  to  the  excitement  observed 
in  the  morning,  and  on  some  bread  and  milk  being  offered,  it  slowly  took  a  small  quan- 
tity. Next  day  all  the  symptoms  disappeared,  and  though  the  animal  remained  for  five 
davs  in  the  hospital  kennels,  no  relapse  occurred. 

S.  Mauri,  in  another  instance  [Ibid..,  p.  20) — that  of  a  two-year-old  Bitch,  which  had 
nursed  two  puppies  for  a  month,  and  during  that  time  seemed  to  be  in  perfect  health, 
but  which  was  suddenly  seized  with  agitation  and  anxiety,  appeared  to  be  suffocated, 
could  scarcely  stand,  and  appeared  to  be  paralyzed  in  its  hind-limbs — noted  the  follow- 
ing symptoms  :  General  agitation  of  all  the  muscles,  anxious  physiognomy,  and  all  the 
characteristic  features  described  in  the  preceding  case.  The  respiration  was  very  labori- 
ous, though  the  ribs  were  immovable.  The  gait  was  unsteady,  and  the  hind  quarters 
were  feeble,  as  in  confirmed  rabies.  The  animal  appeared  to  be  impelled  to  move  about 
incessantly,  and  if  it  stopped  it  fell ;  then  the  limbs  became  rigidly  extended.  In  the 
midst  of  its  convulsions,  it  endeavored  to  rise,  but  could  not  co-ordinate  its  movements 
— it  turned  itself  on  its  back,  so  as  to  lie  alternately  on  the  right  or  left  side.  After 
numerous  attempts  it  sometimes  succeeded  in  getting  up,  and  commenced  to  walk,  but 
only  to  fall  again;  it  could  only  stand  on  its  rigid  paws  by  resting  against  a  wall  or  tree. 
An  hour  after  its  arrival  at  the  school,  it  could  not  rise  unaided.  Its  senses  did  not  ap- 
pear to  be  affected  ;  the  appetite  was  lost,  and  there  was  neither  defecation  nor  micturi- 
tion during  the  attack.  The  case  in  every  respect  appeared  to  be  similar  to  the  preced- 
ing. No  treatment  was  adopted,  and  in  the  evening  the  Bitch  had  almost  completely 
recovered,  though  it  was  rather  sleepy  and  dull.     Next  day  it  was  taken  away  cured. 

9.  The  same  authority  [Ibid..,  p.  22)  records  the  case  of  a  Bitch  brought  to  the 
Toulouse' Veterinary  School,  and  which  caused  anxiety  about  three  hours  previously  by' 
its  agitation,  breathlessness,  and  anxious  look.  It  had  fallen,  was  seized  with  contrac 
tion  of  the  limbs,  got  up,  and  staggered  about  in  different  directions,  until  at  last  it  be- 
came so  weak  that  it  could  not  stand.  When  Mauri  saw  it,  it  was  lying  on  its  side,  the 
limbs  extended,  and  agitated  from  time  to  time  with  clonic  convulsions.     The  animal 


EPILEPSIA   UTERINA.  •  687 

could  not  be  induced  to  get  up,  the  head  only  being  raised  towards  the  shoulder.  The 
symptoms  were  altogether  similar  to  those  observed  in  the  two  preceding  cases.  No 
treatment  was  adopted,  and  next  morning  all  the  symptoms  had  disappeared. 

10.  Lafitte  {Ibid.,  p.  23)  attended  a  Bitch  which,  two  days  previously,  had  brought 
forth  two  puppies  which  it  suckled.  It  appeared  to  be  very  weak  and  staggered  in 
walking.  Soon  after,  the  feebleness  in  the  hind-quarters  was  extreme,  and  clonic  con- 
vulsions affected  all  the  muscles ;  the  eye-balls  pirouetted  in  their  socket,  the  jaws  were 
incessantly  moved,  and  saliva  ran  from  the  mouth  continually  ;  hearing  and  seeing  were 
unaffected.  Two  hours  subsequently  the  animal  could  not  rise.  A  belladonna  draught 
was  given,  narcotic  frictions  were  applied  along  the  spine,  and  emetized  enemata  admin- 
istered. In  the  evening  the  Bitch  was  dull,  weak,  and  stupid.  In  the  morning  every 
trace  of  the  malady  had  disappeared.  Next  day  there  was  another  eclamptic  attack  of 
shorter  duration,  and  on  the  fourth  day  another  still  briefer  and  weaker.  The  puppies 
were  put  to  another  Bitch,  and  in  about  eight  days  they  had  attacks  similar  to  those  of 
their  parent,  though  shorter  and  less  intense.  One,  a  female,  had  three  attacks  on  suc- 
cessive days,  and  then  died — the  other,  a  male,  had  only  two  attacks. 

11.  Laiitte  [Ibid.,  p.  25)  reports  that  a  Bitch,  four  days  after  pupping,  had  clonic  con- 
vulsions in  all  its  muscles ;  its  jaws  were  agitated,  it  was  much  salivated,  and  respired 
with  difficulty.  Its  expression  was  animated,  but  it  could  not  stand,  and  was  compelled 
to  lie.  During  the  night  the  convulsions  ceased,  and  the  animal,  although,  a  little 
somnolescent,  appeared  quite  recovered  ;  at  ten  o'clock  next  morning,  however,  it  had 
another  attack,  and  in  the  evening  it  died. 

12.  The  same  veterinarian  {Ibid.,  p.  25)  alludes  to  the  case  of  a  Bitch  which,  three 
days  after  pupping,  had  convulsions  in  the  muscles  of  the  trunk  and  limbs,  and  the 
hind-legs  were  so  "feeble  that  it  could  not  stand.  Its  gaze  was  unsteady,  and  at  times 
the  eyes  rolled  about  in  the  orbits.  The  masseter  muscles  participated  in  the  convul- 
sive movements  of  the  other  muscles,  so  that  there  was  a  continual  champing  of  the 
jaws,  and  an  abundant  salivation.  The  senses  were  not  impaired,  however.  An  anti- 
spasmodic treatment  was  adopted.  The  attack  lasted  four  hours,  when  recovery  took 
place. 

13.  Mauri  {Ibid.,  p.  201)  reports  another  instance  of  this  malady  occurring  in  a  Bitch, 
eight  years  old,  and  very  fat.  It  had  pupped  twelve  days  before,  and  suckled  four 
puppies.  When  brought  to  the  Veterinary  School  it  was  lying  on  its  side,  though  it 
could  raise  itself  on  its  sternum — it  panted  much,  its  mouth  was  wide  open  and  much 
saliva  flowed  therefrom — the  tongue  was  pendent.  The  respiratory  movements  were 
much  quickened,  but  very  shallow.  The  eyes  were  wide  open  and  slightly  squinted  to 
the  left.  Violent  convulsions,  as  if  produced  by  electric  discharges,  agitated  the  limbs, 
and  threw  them  into  a  state  of  forced  extension;  if  a  group  of  extensor  muscles — such 
as  the  patellar — were  seized  in  the  hand,  the  energetic  contractions,  rapidly  repeated, 
could  be  easily  felt.  Nothing  of  the  kind  could  be  distinguished  in  the  flexor  muscles. 
The  senses  were  not  affected.  The  urine  did  not  offer  any  trace  of  albumen.  In  the 
course  of  the  day  the  symptoms  disappeared,  and  the  animal  recovered. 

Mauri  alludes  to  four  additional  cases  of  eclampsia — two  in  the  Cow  and  two  in  the 
Bitch,  all  presenting  similar  symptoms  to  the  foregoing 


CHAPTER  VII 
Epilepsia  Uterina. — Mania  Puerperalis. 

A  PECULIAR  nervous  affection,  to  which  the  designation  of  "  Epilepsia 
Uterina "  has  been  given  by  Storrar  ( Veterinary  journal.  Vol.  IV.,  p. 
53),  might  be  classed  with  the  disease  which,  in  the  previous  chapter,  has 
been  named  "  Eclampsia,"  did  it  not  differ  somewhat  from  it,  and  rather 
resemble  epilepsy,  or  what  Harms  has  called  "  Mania  puerperalis." 
Until  its  exact  pathology  is  better  defined,  we  think  it  most  convenient  to 
retain  Storrar's  designation 

Symptoms, 

The  disease  appears  to  affect  the  Cow  only,  and  is  marked*  by  great 
agitation,  sometimes  fury.  We  cannot  do  better  than  give  the  symptoms 
in  two  cases,  and  then  refer  to  Storrar's  and  Harms'  evidence. 


688  PA  THOL OG Y  OF  PAR TURITION. 

1.  Rolls  [Veterinary  Journal,  Vol.  II.,  p.  17)  was  sent  for  in  great  haste  to  see  a 
Cow,  five  years  old,  which  had  calved  a  fortnight  previously,  and  had  eaten  the  placenta. 
For  two  days  before  he  was  called  in  the  animal  had  not  been  well,  and  its  elf  had 
been  removed  the  previous  night.  It  had  a  wild  excited  expression  ;  eyes  staring  ;  ears 
warm  ;  pulse  full ;  rather  strong  and  quick ;  jaws  continually  moving,  as  if  in  the  act  of 
biting ;  foaming  at  the  mouth  ;  the  under  part  of  the  tongue  purple  and  livid-looking. 
The  movement  of  the  jaws  could  not  be  stopped  by  holding  them  together,  and  whem 
the  animal  was  left  to  itself  it  was  continually  biting  at  its  fore-legs,  though  without 
making  a  wound ;  when  interrupted  it  gnawed  the  manger,  woodwork  of  the  stall,  or 
any  thing  presented  to  it.  If  hay  was  offered  it  would  seize  it,  masticate  it  with  the  con- 
tinuous and  violent  movement  referred  to,  and  swallow  it.  It  took  some  bran-mash  and 
chilled  water,  and  though  it  partook  of  nothing  else,  it  looked  full,  and  there  was  the 
peculiar  sour  odor  often  met  with  in  cows  suffering  gastric  derangement,  and  especially 
when  it  occurs  soon  after  parturition.  Blood  was  abstracted,  and  belladonna  and  linseed 
oil  administered.  In  about  three  hours  afterwards,  the  convulsive  movements  ceased  and 
the  Cow  appeared  to  be  much  better.  Next  day  the  excited  expression  was  still  appar- 
ent.    Under  further  treatment  it  recovered. 

Thirteen  months  afterwards  it  calved  again,  and  when  a  fortnight  old  the  calf  was 
removed  from  it.  Next  morning  it  was  found  to  be  suffering  from  a  similar  attack  :  the 
jaws  moving  in  the  same  convulsive  manner,  but  not  so  violently.  Rolls  noted  that  the 
Cow  looked  wild  and  excited  ;  the  pupils  of  the  eyes  were  normal ;  ears  warm  ;  pulse 
eighty  per  minute,  and  full  and  strong;  foaming  at  the  mouth;  under  part  of  tongue 
livid  ;  grinding  the  teeth  occasionally  ;  the  fore-legs  were  wet  and  covered  with  saliva, 
from  gnawing  them.  The  animal  was  again  bled  and  had  opiates,  and  recovery  soon 
took  place. 

2.  Robellet  [Rectieil  de  Med.  Veierinaire,  1874)  gives  a  similar  instance,  in  which  the 
symptoms  closely  resembled  those  of  rabies.  The  Cow — four  years  old — calved  four 
days  previously,  parturition  being  normal.  On  the  day  on  which  Robellet  was  sent  for 
it  had  refused  to  eat  at  pasture,  left  its  companions,  and  constantly  licked  its  fore-legs. 
In  the  evening  it  was  restless,  and  bit  every  thing  about  it.  Robellet  found  that  it  had 
bitten  the  manger,  rack,  and  food — allo'wing  the  latter  to  fall  from  its  mouth  without 
masticating  it ;  it  also  seized  its  breast  and  fore-legs,  but  without  breaking  the  skin. 
The  pulse  was  full  and  sixty  per  minute  ;  the  eyes,  unnaturally  open,  were  red, 
fixed,  and  haggard,  and  the  pupils  dilated;  the  buccal  mucous  membrane  was  slightly 
inflamed,  and  a  frothy  saliva  surrounded  the  borders  of  the  lips  ;  the  respiration  was 
normal.  At  times  the  Cow  stretched  out  its  fore-limbs,  bellowed,  pawed  the  ground 
with  the  fore-feet,  and  seemed  to  defy  an  invisible  enemy.  The  handle  of  a  stable- 
fork  being  presented,  the  animal  seized  it  in  a  frantic  manner  and  bit  it,  shaking  the 
head  violently. 

The  symptopis  gave  rise  to  the  suspicion  of  rabies  ;  but  no  evidence  as  to  inoculation 
could  he  obtained.  The  Cow  was  separated  from  the  others,  secured  by  a  double  chain, 
and  an  ounce  and  a  half  of  chloral  administered  in  two  doses  in  tea — a  quarter  of  an 
hour  between  each  dose.  Several  minutes  after  the  second  dose,  the  Cow,  which  had 
continued  to  show  the  same  symptoms,  hung  down  its  head,  and  without  staggering, 
fell  like  an  inert  mass  on  the  ground,  then  rose  at  once  of  its  own  accord.  Ten  minutes 
afterwards  the  same  occurrence  was  again  noted — the  Cow  once  more  falling  and  jump- 
ing up;  it  remained  in  the  excited  condition  already  described.  Next  day  all  the  alarm- 
ing symptoms  had  subsided  ;  there  was  no  fever  or  excitement — nothing  except  slight 
weakness  and  prostration.  It  had  fallen  a  third  time  on  the  previous  day,  then  became 
drowsy,  and  remained  Iving  for  about  three  hours  ;  after  which  it  arose,  apparently  quite 
well. 

Robellet's  father  had  seen  two  similar  cases. 

Storrar  relates  that,  in  one  of  his  cases,  so  savagely  did  the  Cow 
bite  the  timber  fornjing  the  front  of  its  stall,  that  with  one  desperate 
effort  it  broke  all  the  incisor  teeth,  except  one,  entirely  out  of  its  jaw, 
and  fractured  the  alveolar  processes.  Another  Cow,  some  years  before, 
so  severely  injured  the  lower  jaw,  that  the  incisors  could  not  be  employed 
for  some  time  ;  though  the  molars  could  be  used  when  the  food  was 
placed  in  the  mouth. 

Gunther  {Geburtshulfe,  p.  145)  and  Landel  {^Repertorium^  vol.  viii.)  have 
observed  similar  cases.  They  describe  the  animals  as  extremely  excited 
and  violent,  biting  every  thing  around  them — even  people,  climlDing  into 
the  manger,  running  against  the  wall,  roused  to  fits  of  fury  at  the  slight- 


PARTURIENT  LA  MINI T IS.  689 

est  noise,  foaming  at  the  mouth,  and  sometimes  tossing    the    head  and 
bellowing.     The  pulse  is  hard  and  quick,  but  the  heart's  action  is  weak. 

Cause. 

Rolls  thought  that  in  the  case  he  describes,  depriving  the  animal  of 
its  calf  was  the  cause  of  the  attack;  Harms  ascribes  the  symptoms  to 
chills,  which  cause  brain  congestion ;  while  Storrar  looks  upon  the 
malady  as  epileptic,  dyspeptic,  and  uterine.  "  The  animal  affected  has 
calved  some  few  days  previously — say  from  four  to  fourteen,  or  even  more 
days  ;  she  has  been  heartily  eating  her  food  ;  giving  milk  very  largely, 
or,  more  correctly,  her  milk  has  been  remarkably  rich,  and  throwing  up, 
when  left  for  a  time,  a  very  heavy  layer  of  cream  ;  and  the  usual  uterine 
lochial  discharge  has  been  suppressed.  Or  the  case  might  be  thus 
stated  :  An  excessive  drain  upon  the  system  by  the  mammary  glands, 
causing,  perhaps,  the  suppression  of  the  uterine  cleansing,  with  the  pecu- 
liar smell  about  the  animal,  and  more  marked  in  her  milk,  which  is 
referred  to  by  Mr.  Rolls,  followed  by  a  more  or  less  severely  developed 
attack  of  indigestion.  These  causes  act  upon  the  nervous  centres,  so  as 
to  produce  the  extraordinary  excitement  which  has  been  described.  The 
dyspeptic  signs  are  the  more  prominently  shown — such  as  a  desire  to  eat 
any  .thing  unclean  in  preference  to  good  food,  or  coarse  straw  in  prefer- 
ence to  roots  or  hay.  The  bowels  becoftie  torpid,  and  the  supply  of 
milk  nearly  ceases." 

We  can  scarcely  bring  ourselves  to  believe  that  this  condition  is  due  to 
psychical  influences,  and  are  rather  inclined  to  attribute  it  to  cerebral  ir- 
ritation from  some  physical  cause — either  indigestion,  constipation,  or 
deranged  circulation  in  the  brain,  and  connected  with  the  parturient 
state. 

Treatment. 

If  indigestion  or  constipation  are  present,  purgatives  should  be  admin- 
istered, with  stimulant  or  tonic  medicines,  according  to  the  indications. 
When  there  is  much  fury  or  excitement,  narcotics  in  large  doses  may  be 
given — the  best,  perhaps,  being  choral  hydrate.  Great  attention  must  be 
paid  to  the  diet.  Giinther  abstracted  blood  in  large  quantity,  and  gave 
extract  of  stramonium.  He,  also,  on  the  supposition  that  the  brain  was 
congested,  applied  strong  stimulants  to  the  back  of  the  head  and  to  the 
spine. 


CHAPTER   VHI. 

Parturient  Laminitis. 

With  the  Mare,*  a  few  days  after  foaling  or  abortion,  tnere  has  been 
sometimes  observed  an  attack  of  congestion  or  inflammation  of  the  feet, 

*  It  would  appear  that  bovine  animals  are  liable  to  a  foot  inflammation  after  parturition,  as  well  as 
Mares.  Roloff  {Mlttheilungen  aus  der  thierarztlichen  Praxis  in  preuszischen  Staate,  1865,  1866,  p. 
154)  observed  a  jjeculiar  inflammation  of  the  feet  of  Cows,  supervening  on  parturition.  Some  days  after 
that  event,  the  skin  between  the  claws  was  observed  to  be  reddened,  swollen,  and  moist,  and  gradually  the 
inflammation  extended  to  the  coronet  and  heels  (Ballen) ;  the  skin  became  more  tumefied  and  dense,  and 
immediately  above  the  claws  was  uniformly  thick  and  red.  In  some  cases  abscesses  formed  at  the  coronet, 
the  horn  became  separated,  and  finally  the  whole  claw  was  shed.  The  mflammation  extended  to  above 
and  behind  the  fetlock,  and  the  pain  was  so  great  that  the  animals  ate  but  little,  and,  consequently,  they 
soon  lost  condition.  Tiie  hind  limbs  were  most  frequently  affected :  first  one,  then  the  other,  one  being 
always  more  affected  than  the  other.  The  Cows  had  only  calved  a  short  time  previously.  Roloff  supposed 
that  the  disease  was  due  to  contact  of  the  skin,  towards  the  hind  feet,  with  some  substance  which  had 
escaped  from  the  vulva  after  calving.  He,  therefore,  insisted  on  the  utmost  cleanliness  being  observed ; 
had  the  stalls  cleaned  out,  and  sprinkled  with  chloride  of  lime  every  day,  and  the  hind  feet  damped  with 
chlorine  water,  particularly  between  the  claws,  and  afterwards  smeared  with  oil.  By  these  measures,  the 
extension  of  the  disease  was  at  once  checked. 

44 


690  PA  THOL OG  Y  OF  PA R  TURITION. 

which  closely  simulated  the  painful  and  serious  malady  known  as  *'  Lam- 
initis,"  and  appeared  to  be  related  to  the  parturient  state.  The  disease 
does  not  seem  to  be  very  common  ;  though  Obich  (  Wochenschrift  fiir 
Thierhei/kufide,  1869,  p.  105)  asserts  that  it  and  metritis  are  the  most 
frequent  sequelae  of  parturition  in  the  Mare.  It  appears  to  have  been 
first  described  by  Tisserant  in  1846  {J^ournai  des  Veterinaires  du  Midi, 
vol.  ix.,  p.  347)  ;  since  then  it  has  been  alluded  to  by  Gloag  and  Smith  in 
England  {Veterifiarian,  185 1,  pp.  14,  258),  Fabry,  Guilmot,  Lecouturier, 
Windelinck,  and  Deneubourg  in  Belgium  (Atmales  de  Med.  Veteniaire  de 
Bruxelks,  i860,  1861,  18C8),  Obich  in  Germany  {Op.  df.),  and  Ayrault  in 
France  {Recueil  de  Med.  Veierinaire,  1866).  At  page  632  of  this  work,  it 
will  be  found  that  Hudson  alludes  to  this  parturient  laminitis  as  a  com- 
plication of  ruptured  vagina. 

Symptoms. 

The  symptoms  of  the  disease  are  those  of  laminitis  occurring  under 
ordinary  conditions.  They  are  suddenly  developed  on  the  second  or 
third  day  after  foaling,  or  abortion,  more  rarely  on  the  fourth  day,  and 
very  seldom  later.  In  a  small  number  of  cases,  inflammation  of  the  feet 
has  been  noticed  either  during  or  immediately  after  parturition.  Excep- 
tionally, it  has  taken  place  within  twenty-four  hours  after  the  contents  of 
the  uterus  have  been  expelled.  As  a  rule,  there  has  been  nothing  re- 
markable in  the  case — birth  having  taken  place  naturally  ;  sometimes, 
however,  parturition  may  have  been  difficult. 

The  attack  is  either  sudden,  or  only  very  indefinite  premonitory  indi- 
cations are  present.  The  animal  becomes  unusually  restless,  and  moves 
its  limbs — the  fore  one  especially — continually,  while  it  exhibits  signs  of 
great  suffering.  There  is  fever,  quick  and  hard  pulse,  hurried  respiration, 
and  all  the  other  signs  of  this  most  distressing  foot-inflammation,  the 
most  marked  of  which  at  this  time  is  the  disregard  of  the  progeny.  In 
other  cases,  the  attack  is  more  gradual  ;  there  is  loss  of  appetite,  great 
thirst,  depression,  hurried  respi^'ation,  full,  hard,  and  quick  pulse,  consti- 
pation, etc. — premonitory  symptoms  which  may  continue  for  two,  three, 
or  four  days.  The  fore  or  hind  feet  may  be  affected.  Tisserant  and 
Guilmot  say  the  former,  Deneubourg  the  latter ;  though  in  some  in- 
stances all  the  feet  may  be  involved.  The  position  of  the  animal,  if 
standing,  indicates  the  feet  affected,  and  they  are  found  to  be  extremely 
hot,  the  plantar  arteries  throbbing,  and  percussion  of  the  hoof  causes 
intense  pain.  During  the  inflammation,  the  Mare  evinces  the  greatest 
agony.  If  all  the  feet  are  implicated,  standing  may  be  impossible  ;  the 
expression  is  anxious  and  pinched  ;  the  respiration  is  hurried,  jerking 
and  plaintive,  and  the  nostrils  widely  dilated  ;  the  skin  is  usually  cov- 
ered with  perspiration,  and  the  production  of  milk  is  completely  checked. 
Indeed,  the  rapid  disappearance  of  this  secretion  has  attracted  the  atten- 
tion of  nearly  every  observer.  In  the  evening,  perhaps,  there  will  be  an 
abundant  supply  of  milk,  and  in  the  morning  mulsion  or  suction  will 
only  obtain  a  few  drops  of  a  transparent  or  reddish  fluid,  though  the 
mammae  may  look  as  full  and  as  well-developed  as  usual.  This  suppres- 
sion of  its  supply  of  food  is  soon  testified  to  by  the  foal,  which  betrays 
its  sensations  of  hunger  by  becoming  less  timid,  and  making  itself  familiar 
with  those  around  it. 

The  duration  of  the  disease  is  from  four  to  eight  days  ;  Franck  says 
from  eight  to  fourteen  days.     The  symptoms  are  certainly  most  intense 


PARTURIENT  LAMINITIS. 


691 


between  the  fourth  and  eighth  day.  The  termination  is  generally  recov 
ery,  if  proper  treatment  has  been  adopted  ;  though  in  some  cases  the 
malady  assumes  a  chronic  form,  with  the  accompanying  deformity  and 
disorganization  of  the  feet.  In  rare  instances,  death  may  ensue  from 
nervous  exhaustion  caused  by  the  excessive  pain  ;  or  the  inflammation 
may  run  on  to  suppuration,  and  a  fatal  result  arise  from  pyaemia,  with 
purulent  deposits  in  the  lungs,  brain,  or  other  organs. 

A  favorable  or  unfavorable  prognosis  may,  according  to  Guilmot,  be 
drawn  from  the  lacteal  secretion.  If  this  returns  in  the  course  of  a  few 
days,  it  is  a  good  sign. 

Causes. 

The  cause  or  causes  of  parturient  laminitis  are  not  well  known.  The 
predisposing  C2L\1SQ  is  generally  recognized  to  be  the  parturient  state,  though 
there  is  a  wide  divergence  of  opinion  as  to  the  way  in  which  the  disease 
originates.  Tisserant  believes  that  it  is  due  to  a  disturbance  in  the  func- 
tional equilibrium  existing  between  the  various  organs.  After  parturition, 
and  particularly  after  abortion,  there  is  manifestly  a  disturbance  of  this 
kind  ;  there  is,  as  Rainard  correctly  states,  a  general  superabundance  of 
blood,  and  consequently  atende^ncy  to  disease  until  the  equilibrium 
between  production  and  consumption  is  restored.  Guilmot  thinks  that  the" 
space  left  by  the  foetus  must  necessarily  bring  about  a  series  of  exceptional 
phenomena,  whose  point  of  departure  is  perhaps  the  superfluous  supply 
of  blood  thrown  into  the  circulation  after  parturition.  Deneubourg  sees 
in  this  disease  and  the  so-called  vitulary  fever  of  the  Cow,  two  different 
"  modes  of  expression  "  of  the  same  disease  ;  and  while  recognizing  the 
justness  of  the  expression  employed  by  the  old  hippiatrists  that  "  the  fever 
has  fallen  into  the  feet,"  he  is  inclined  to  think  that  the  morbid  localiza- 
tion is  due  to  sudden  suppression  of  the  lochia.  "  The  larger  animals," 
he  writes,  "  are  not  exempt  after  parturition  from  the  depuratory  process 
which  takes  place  on  the  internal  surface  of  the  woman's  uterus  after 
delivery,  and  known  as  the  lochia  ;  and  its  abrupt  suppression  gives  rise 
to  a  disturbance — a  fever^  which  physicians  designate  *  puerperal  fever,' 
and  veterinary  surgeons  '  vitulary  fever.'  The  disease  proper  to  the  Cow 
is,  in  our  opinion,  sirnple  vitulary  fever ^  which,  in  concentrating  itself  on 
the  tendinous,  articular,  and  perhaps  muscular  tissues,  may  become  a 
rhcuniatismal  vitulary  fever.  That  of  the  Mare,  until  now  unrecognized, 
is  evidently  due  to  the  same  cause  ;  we  cannot  deny  it  the  parent  traits 
with  the  vitulary  fevers  which  are  witnessed  in  the  Cow,  and  we  propose 
to  designate  it  by  the  name  of  vitulary  laminitis,  to  distinguish  it  from 
essential  laminitis.''^ 

Bouley,  quoted  by  Saint-Cyr,  is  of  opinion  that  parturient  laminitis  may 
be  allied  to  that  other  form  of  laminitis  which  so  commonly  succeeds 
intestinal  congestions  from  accidental  causes,  or  from  drastic  purgatives ; 
and  that  both  varieties  may  well  be  the  result  of  a  momentary  paralysis 
of  the  vaso-motbr  nerves  of  the  keratogenous  apparatus  of  the  foot,  under 
the  influence  of  a  profoundly  depressing  action. 

The  occasional C2insts  are  quite  as  obscure.  Tisserant  asserts  that  none 
of  the  ordinary  causes  of  laminitis  are  special  in  their  operation  here  ; 
while  Deneubourg  adds  that  it  equally  attacks  Mares  without  distinction 
as  to  age,  constitution,  condition,  or  hygienic  circumstances.  Guilmot, 
however,  remarks  that  Mares  which  are  submitted  to  moderate  work,  and 
which  receive  an  allowance  of  food  in  proportion  thereto,  are  not  attacked 


692  PA THOLOG  Y  OF  PARTURITION. 

by  this  disease ;  while  those  which  are  fed  on  oats  have  always  been  the 
subjects  affected,  so  far  as  he  has  been  able  to  observe. 

There  is  the  same  diversity  of  opinion  with  regard  to  the  influence  of 
parturition  in  the  production  of  parturient  laminitis.  Tisserant  has 
noticed  it  occurring,  in  the  great  majority  or  cases,  in  Mares  which  had 
aborted  at  a  somewhat  advanced  period  of  gestation,  or  whose  delivery 
had  been  laborious  or  very  difficult,  from  the  wrong  position  of  the  foetus, 
or  from  some  maternal  obstacle,  Deneubourg,  on  the  contrar}^,  has 
observed  it  following  parturition  effected  in  the  most  favorable  conditions, 
as  well  as  after  abortion  or  difficult  labor  ;  with  Mares  which  had  expelled 
the  foetal  membranes,  as  well  as  those  which  retained  them  ;  but  never 
after  a  laborious  parturition  which  required  manoeuvres  more  or  less  pro- 
tracted and  cruel ;  though  he  adds  that  his  brother  had  witnessed  a  case 
following  laborious  and  artificial  delivery.  It  may  be  noted  that  Gloag 
gives  an  instance  (^Veterinarian^  185 1,  p.  14)  in  which  it  followed  an  abor- 
tion at  three  months. 

Obich  attributes  the  disease  to  the  action  of  cold  upon  the  skin. 

Treatment, 

In  the  treatment  of  this  disease,  the  rules  observed  in  the  ordinary 
attacks  of  laminitis  are  usually  applicable.  In  the  majority  of  cases 
the  treatment  need  not,  and  should  not,  be  heroic.  If  the  fever  runs 
high,  sedatives — as  the  tincture  of  aconite — should  be  given  ;  and  it  may 
even  be  necessary  to  administer  narcotics — as  chloral  or  opium — if  the 
pain  is  very  great.  Some  authorities  recommend  the  abstraction  of  blood, 
either  generally  or  locally  ;  but  we  are  decidedly  averse  to  this  treatment. 

The  inflamed  feet  should  be  treated  with  the  greatest  care,  and  for  sub- 
duing the  inflammation  nothing  can  equal  cold  applications — either  cold 
water,  cold  poultices,  or  even  ice.  We  prefer  the  continuous  irrigation 
system  ;  the  water  being  applied  to  the  feet  by  means  of  india-rubber 
tubing,  which  carries  the  fluid  direct  from  the  water-tap  to  the  foot.  The 
latter  is  thickly  covered  with  pieces  of  thick  flannel  or  tow,  so  as  to  diffuse 
the  water  around  it.  The  shoes  should  be  previously  removed,  and  the 
wall  of  the  hoof  lowered,  so  as  to  allow  the  sole  and  frog  to  sustain  as 
much  of  the  weight  as  possible.  It  is  a  good  plan  to  litter  the  animal  on 
saw-dust. 

Warm  applications  should  never,  on  any  account,  be  employed  for  the 
feet. 

When  suppuration  is  apprehended  or  has  set  in,  or  even  when  the 
effusion  or  exudation  are  serious,  an  outlet  may  be  made  between  the  sole 
and  wall,  towards  the  toe  of  the  hoof,  for  their  escape.  -Astringent  and 
antiseptic  lotions  or  foot-baths  may  then  be  useful.  At  the  commence- 
ment of  the  disease,  and  sometimes  at  a  later  period,  when  it  threatens  to 
become  chronic,  stimulating  applications — even  blisters — may  be  applied 
with  advantage  to  the  limbs  above  the  fetlocks. 

The  diet  should  be  light,  and  limited  to  mashes,  grass,  a  small  quantity 
of  good  hay,  and  nitrated  water  or  gruel  as  drink.  The  body  should  be 
comfortably,  if  not  warmly,  clothed,  and  friction  to^  the  skin  is  often 
beneficial. 

The  foal  should  be  allowed  to  remarin  with  the  Mare,  as  its  frequent 
sucking  is  likely  to  hasten  the  return  of  the  milk,  which  is,  as  has  been 
already  remarked,  a  most  favorable  sign. 

If  constipation  is  present,  laxatives  should  be  administered,  and  emol- 
lient enemas  are  then,  as  well  as  at  other  times,  most  useful. 


MAMMITIS  OR  MASTITIS.  693 

CHAPTER  IX 

Mammitis  or  Mastitis. 

In  treating  of  pregnancy,  we  alluded  to  the  function  of  the  mammae,  and 
pointed  out  that  this  function — except  in  rare  cases,  when  it  may  be  in 
operation  independent  of  pregnancy  or  the  parturient  period,  and  even 
manifest  itself  in  the  male  sex — is  in  mammals  peculiar  to  the  period  of 
parturition  and  rearing  of  the  young.  Some  time  before  the  progeny  are 
born,  the  mammae  begin  to  enlarge,  to  become  pendulous,  and  their  density 
increases  ;  they  are  more  often  vascular  ;  if  not  marked  by  dark  pigment, 
their  color  is  observed  to  have  changed,  and  the  teats  are  considerably 
developed.  So  that,  at  parturition,  the  glands  have  attained  dimensions 
and  offer  appearances  very  different  to  those  they  exhibited  a  short  time 
previously  ;  while  the  fluid — the  milk — provided  by  Nature  for  the  suste- 
nance of  the  young  creature  after  birth,  is  secreted  in  more  or  less  con- 
siderable quantity — generally  in  proportion  to  the  development  of  the 
mammag. 

With  the  exception  of  some  species — such  as  the  Cow  and  Goat,  some- 
times the  Ewe  and  Ass  (and  also  the  Mare  among  the  Khirgiz),  in  which 
the  secretion  is  maintained  artificially  for  some  time  beyond  its  natural 
duration,  and,  with  the  former  animal  especially,  almost  permanently — 
the  function  is  essentially  intermittent:  being  most  active  during  the 
parturient  or,  if  we  may  use  the  term,  "  puerperal  "  period,  and  ceasing 
^when  the  progeny  no  longer  require  milk.  It  is  during  this  period  that 
the  activity  of  the  mammae  exercise  so  much  influence  on  the  health  of 
parent  and  offspring,  and  it  is  also  at  this  time  that  these  glands  are  most 
liable  to  derangements,  which  are  more  or  less  serious.  Even  their 
normal  physiological  development,  when  it  occurs  rapidly  and  considera- 
bly, under  certain  conditions,  often  occasions  uneasiness  and  pain.  The 
temperature  of  the  glands  is  increased,  and  they  are  much  more  sensitive 
than  usual.  But  this  disturbance  is  usually  ephemeral,  and  rarely  con- 
tinues for  more  than  a  day  or  two.  It  may  be  relieved  by  "  stripping  " 
the  teats — the  importance  of  which,  as  a  preventive  of  parturient  apo- 
plexy in  deep-milkers  and  plethoric  Cows,  we  have  already  pointed  out — 
rubbing  the  udder  with  olive-oil,  or  fomenting  it  with  decoction  of  marsh- 
mallows.  This  might  be  termed  the  nor?na I  ov physiological  ewgoxgQVi\Q.nt 
of  the  mammae  ;  but  there  is  also  a  pathological  engorgement,  to  which 
attention  has  been  drawn  by  various  writers,  and  particularly  by  Ztindel, 
and  to  this  we  will  now  refer,  as  it  is  often  the  commencement  of  inflam- 
mation of  these  glands. 

Pathological  Congestion  of  the  Mamm^. 

Hyperaemia  or  congestion  of  the  mammae  is  not  very  uncommon,  and 
all  female  animals  are  liable  to  it ;  though  it  is  most  frequently  observed 
in  the  Cow,  Mare,  Ewe,  and  Bitch,  in  degrees  varying  rather  with  the 
causes  which  determine,  than  the  phenomena  that  accompany  it. 

Causes. 

Congestion  of  the  mammae  is  due  to  various  causes :  among  which  may 
be  cited  injuries,  exposure  to  cold  air  or  water,  or  over-repletion — the 
stings  of  insects  have  also  been  blamed.  There  is  generally  a  sympa- 
thetic excitement  existing  at   this  time,  either  from   the  animal  having 


694  ^^  THOL OG  Y  OF  PAR TURITION. 

been  immediately  or  recently  delivered,  or  even  when  it  is  in  oestrum. 
Most  frequently,  however,  it  occurs  either  when  the  progeny  cannot 
empty  the  glands,  when  it  has  been  removed  from  the  parent,  or  when 
the  latter  has  not  been  milked  at  the  proper  time.  The  tendency  of  the 
mammas  to  become  engorged  when  the  lacteal  secretion  is  not  removed, 
is  often  made  available  with  a  fraudulent  motive,  when  disposing  of  Cows 
for  milking  purposes.  The  milk  is  not  withdrawn  for  some  time,  the 
glands  become  greatly  distended,  and  assume  an  excessive  development 
("over-stocking"),  which  may  impose  upon  the  unwary,  and  give  rise 
to  the  belief  that  the  animal  possesses  extraordinary  lactiferous  proper- 
ties. Franck  is  of  opinion  that  this  congestion  may  be  due  to  obstruction 
of  the  circulation  in  the  posterior  vena  cava,  towards  the  end  of  pregnancy. 
It  may  also  arise  from  obstruction  in  the  milk  ducts. 

Symptoms. 

When  the  congestion  is  due  to  accumulation  of  milk,  the  symptoms 
are,  of  course,  only  gradually  developed  ;  but  if  arising  from  injury,  then 
they  may  appear  suddenly,  a  certain  part  becoming  all  at  once  swollen, 
hard,  and  tense,  but  without  altogether  losing  its  softness  and  elasticity. 
There  is  neither  redness  nor  great  sensibility  j  the  swelling  is  not  oedem- 
atous,  and  does  not  *'  pit ;  "  there  is  but  little  fever,  and  the  appetite  is  not 
much  affected. 

An  important  consideration  in  these  affections  of  the  mammae,  is  that 
relating  to  their  anatomy.  As  we  have  shown  at  pages  31-34,  in  the 
Mare,  Ewe,  and  Goat,  they  are  formed  of  two  perfectly  distinct  glands 
placed  together  in  the  inguinal  region  ;  while  in  the  Cow  they  are  com- 
. posed  of  at  least  four  glands  or  "quarters  "  in  close  contact,  and  appar- 
ently forming  one  mass  in  the  prepubic  region  ;  and  in  the  Sow,  Bitch, 
and  Cat,  they  are  numerous  and  distinct  from  each  other,  and  extend 
from  the  inguinal  to  the  thoracic  region.  When  we  know  that  all  the 
glands  may  become  congested  or  inflamed,  or  only  one — or  even  only  a 
certain  number  of  acini  in  each  gland — we  see  at  once  that  morbid  con- 
ditions may  give  rise  to  very  diverse  symptoms,  due  to  these  anatomical 
peculiarities. 

With  the  Cow,  congestion  may,  therefore,  be  limited  to  one  gland  or 
"  quarter  ; "  though  at  the  commencement  the  whole  udder  may  be 
swollen,  and  localization  only  occur  at  a  later  period.  The  same  is 
Observed  with  the  Bitch  and  all  the  other  animals  with  numerous  mam- 
mae :  there  is  always  at  first  general  engorgement,  before  it  is  finally 
localized.  The  tumefaction  partakes  somewhat  of  oedema,  from  its  read- 
iness to  pit  on  pressure,  and  there  is  often  a  doughy  swelling  around  the 
udder,  which,  in  some  instances,  extends  to  the  other  parts  of  the  abdo- 
men. The  latter  symptom  is  most  noticeable  in  Mares,  in  which,  in  the 
course  of  a  few  days,  the  mammary  swelling  altogether  disappears,  leav- 
ing only  an  oedematous  tumor  towards  the  umbilicus. 

The  secretion  of  milk  is  diminished  ;  at  first  it  may  be  normal  in  con- 
sistence, and  exceptionally  it  may  offer  streaks  of  blood,  which  give  it 
more  or  less  of  a  rose  tint.  When  this  condition  continues,  however,  its 
degree  of  fluidity  is  changed,  and  it  becomes  lumpy  and  clotted,  being 
partially  coagulated  in  the  lactiferous  sinuses  and  canals,  and  the  coag- 
ula  of  casein  are  evacuated  at  the  same  time  as  the  other  portions  of  the 
milk,  which  is  sometimes  nothing  but  pure  viscid,  yellowish  serum,  hav- 
ing a  sweet  taste  j  sometimes  these  coagula — round  or  cylindrical  masses 


MAMMITIS  OR  MASTITIS. 


695 


— obstruct  the  canals,  and  prevent  the  escape  of  the  milk.  Ftirstenberg 
states  that  he  has  sometimes  found  casts  of  epithelial  cells  in  them,  and 
that  about  the  third  or  fourth  day  there  are  globules  of  colostrum.  This 
alteration  in  the  milk  may  be  limited  to  that  from  the  affected  gland  or 
quarter  ;  in  the  others  the  secretion  may  be  healthy,  though  less  abun- 
dant. 

This  condition  most  frequently  terminates  by  resolution,  and  very  often 
without  treatment — the  tumefaction  disappearing  in  a  very  brief  time,  or 
in  the  course  of  four  to  eight  days  ;  though  the  milk  may  remain  less 
plentiful  for  some  time,  and  up  to  the  eighth  or  twelfth  day  may  still 
contain  colostrum  corpuscles.  In  other  cases,  the  quantity  of  milk 
remains  less  than  usual  ;  and  when  relief  is  not  afforded,  we  may  have 
inflammation  supervening,  and  the  formation  of  one  or  more  abscesses. 

In  the  great  majority  of  cases,  it  is  probable  that  this  condition  com- 
mences in,  or  is  limited  to,  the  parenchyma  of  the  gland,  which  receives 
an  inordinate  supply  of  food.  This  leads  to  a  congested  condition,  and 
consequent  diminished  lacteal  secretion,  with  serous  infiltration  into  the 
interlobular  connective  tissue.  According  to  Ftirstenberg  {Milchdrusen 
der  Kuhe\  the  milk  contains  more  particularly  the  solid  elements  of  this 
fluid,  and  also  the  epithelium  yet  undergoing  that  change  which  should 
be  completed  in  the  acini. 

This  condition  has  often  been  confounded  with  inflammation  of  the 
udder,  though  it  must  be  admitted  that  it  sometimes  constitutes  the  in- 
itial stage  of  mammitis.  It  may  be  distinguished  from  the  latter  by  the 
non-existence  of  general  symptoms,  and  also  locally  by  the  absence  of 
the  peculiar  density  or  hardness,  and  the  extreme  painfulness  and  sen- 
sibility, which  mark  the  presence  of  the  latter. 

According  to  Franck,  this  mammary  oedema  (or  Floss)  is  peculiar  to 
many  parts  of  the  Bavarian  Alps,  and  he  appears  to  consider  it  as  in- 
flammation of  the  skin  and  connective  tissue  of  the  gland  {E?itzundung 
der  Ueberzuge  des  Enters  und  des  Zellgewebes).  It  always  appears  some 
days,  on  occasions  some  weeks,  before  parturition,  and  the  whole  udder 
is  involved  ;  though  one  side  may  be  more  affected  than  the  other.  The 
swelling  sometimes  extends  as  high  as  the  vulva,  and  even  beyond  it. 
Sometimes  the  skin  is  reddened,  tense,  and  shining  {Eryt/iema  mammil- 
arutn)  ;  in  other  instances  it  is  normal  The  health  is  seldom  unaf- 
fected, and  this  is  a  characteristic  feature  of  the  disease  ;  there  is  also 
rarely  any  pain,  or  alteration  in  the  secretion — colostrum  or  ordinary 
milk  flowing  from  the  teat.  When,  however,  the  connective  tissue  is  in- 
volved, there  is  swelling  and  "  pitting  "  on  pressure,  the  skin  is  red- 
dened, and  the  finger  indentations  last  for  some  time  ;  there  is  also  more 
pain.  This  latter  condition  has  sometimes  been  designated  the  "  ery- 
sipelatous "  form  of  mastitis  ;  though  it  must  be  observed  that  the  secre- 
tion of  milk  is  unaltered  to  any  extent.  It  continues  for  about  eight 
days. 

When  the  skin  is  much  inflamed,  as  in  the  erysipelatous  form,  Franck 
thinks  it  probable  that  a  special  cause — a  kind  of  infection  of  the  skin — 
is  in  operation. 

Treatment. 

This  malady,  in  the  greater  number  of  cases,  does  not  require  any 
special  treatment.  If  the  animal  eats  well  and  is  not  much  inconven- 
ienced, the  mammae  should  be  relieved  of  their  contents  either  by  al- 


696  PATHOLOGY  OF  PARTURITION. 

lowing  the  offspring  to  suck,  milking  by  hand  every  two  hours,  or  drain- 
ing of  the  fluid  by  the  teat-syphon.  When  the  swelling  is  great  and  the 
skin  tense,  smearing  with  lard,  butter,  or  olive-oil  will  often  give  relief, 
and  aid  in  dispersing  the  tumefaction. 

When  mammitis  is  apprehended,  Ziindel  highly  recommends  inunction 
with  camphorated  pomade,  which,  he  asserts,  is  almost  specific  in  its  de- 
obstruent  action.  At  the  same  time  salines,  and  particularly  the  bicar- 
bonate of  soda,  are  to  be  administered  internally  ;  while  a  moderate 
quantity  of  easily-digested  food  is  to  be  given. 

When  the  redness  or  inflammation  of  the  skin  has  a  tendency  to  be- 
come erysipelatous,  Franck  prescribes  an  ointment  composed  of  sulphate 
of  iron  (one  part)  and  lard  (eight  parts)  ;  or,  a  liniment  of  carbolic  acid 
(one  part)  and  olive-oil  (thirty  to  forty  parts). 

Inflammation  of  the  Mamm^. 

All  the  domestic  animals  are  liable  to  inflammation  of  the  mammae  ; 
and  it  is  somewhat  frequent  after  parturition,  though  it  also  appears 
after  abortion.  The  Cow  is  oftenest  attacked,  and  from  the  importance 
of  the  lacteal  secretion  in  this  animal,  it  is  always  more  or  less  serious, 
especially  as  it  may  continue  during  the  whole  period  of  lactation,  and 
generally  affects  the  best  milk-producers.  It  is  not  so  common  in  the 
Goat  and  Sheep,  and  is  still  more  rare  in  the  Mare.  It  is  seldom  wit- 
nessed in  the  Bitch,  Sow,  or  Cat ;  though  when  it  does  occur  in  the 
former,  it  is  liable  to  lead  to  the  formation  of  neoplasms  of  different 
characters  in  the  glands. 

Various  kinds  of  inflammation  of  the  mammary  glands  have  been  de- 
scribed— such  as  superficial  or  subcutaneous^  and  deep  ;  acute  and  c/iro?tic, 
active  and  passive  or  latent,  and  a  rheumatismal  form  j  while  Saint-Cyr 
gives  a  catarrhal.  7i  phlegmonous,  and  2i  parenchymatous. 

The  catarrhaliorm  is — so  far  as  its  symptoms  are  concerned — allied 
to  that  which  we  have  described  as  due  to  congestion,  and  consists  in  an 
inflammation  of  the  mucous  membrane  lining  the  teats  and  lactiferous 
sinuses.  This  inflammation  is  generally  caused  by  the  retention  of  the 
milk  in  the  gland ;  this  fluid  becomes  altered  and  coagulated,  and  the 
clots  irritate  the  membrane  and  inflame  it,  the  inflammation  extending 
to  the  acini  after  a  time.  In  the  Cow  the  inflammation  usually  com- 
mences in  one  quarter  or  gland,  and  may  remain  limited  to  it ;  or  it  may 
extend  to  the  other  quarter  of  the  same  side,  and  even  to  one  or  both  of 
the  opposite  side — though  this  is  rare — by  an  extension  of  the  morbid 
process  from  the  acini  to  the  interstitial  and  interglandular  connective 
tissue.  When  more  than  one-quarter  is  involved,  then  the  disease  in 
each  varies  in  intensity. 

When  limited  to  the  mucous  membrane,  the  inflammation  induces  a 
kind  of  catarrh  or  special  galactorrhoea  which,  according  to  Gerlach,  is 
not  at  all  uncommon,  and  accounts  for  the  serous  or  watery  milk  some- 
times given  by  Cows  ;  and  the  same  agency  may  lead  to  the  spontaneous 
coagulation  of  the  milk,  without  any  acidity  being  present. 

Symptoms. 

The  animal  does  not  at  first  appear  to  be  much  affected,  and  the 
swollen  gland  or  glands  are  evidently  not  very  painful,  the  pain  being 
probably  of  a  dull  character.  The  skin  is  tense  and  shining,  though 
perhaps  not  reddened  ;  the  teat  is  greatly  enlarged,  hard,  and  somewhat 


MAMMITIS  OR  MASTITIS.  697 

sensitive  to  manipulation.  The  swelling  is  rather  ceclematous  super- 
ficially, but  deeper  the  tissue  of  the  gland  is  found  to  be  somewhat 
harder,  and  towards  the  teat  rather  lumpy,  from  the  presence  of  coagula 
of  casein. 

By  mulsion,  a  rose  or  red-tinted  fluid  is  obtained,  which  looks  like 
decomposed  clotted  milk. 

With  careful  and  frequent  milking,  and  attention  to  diet  and  hygiene, 
complete  resolution  may  take  place  within  three  or  four  days  ;  the  secre- 
tion gradually  becomes  normal  in  quantity  and  quality,  though  for  more 
days  it  may  contain  numerous  colostrum  and  pus  globules.  If  neglected, 
however,  or  mismanaged  in  treatment,  the  inflammation  may  become 
more  serious,  and  attack  the  milk  vesicles  and  their  parenchyma — the 
real  glandular  tissues — giving  rise  to  parenchymatous  mammitis  ;  or  it 
may  remain  localized,  though  increasing  in  intensity.  Then  the  secre- 
tion of  milk  is  greatly  diminished  in  the  gland,  and  what  is  withdrawn 
by  mulsion  is  altered — containing,  as  it  does,  mucus,  pus,  and  clots,  all 
emitting  a  highly  ammoniacal  odor. 

This  catarrhal  condition  may  continue  for  a  considerable  time,  and  it 
may  happen  that  the  matter  contained  in  the  sinuses  and  ducts,  becom- 
ing inspissated,  escapes  from  the  teat  with  difficulty,  or  not  at  all ;  so 
that,  in  accumulating  in  these  cavities,  it  forms  deposits — half  milk,  half 
pus — which  are  oftentimes  considerable.  When  they  have  acquired  a 
certain  volume,  these  deposits  break  up  and  escape,  either  through  the 
teats,  or  by  ulceration  of  the  walls  of  the  duct.  When  opened  by  means 
of  the  lancet,  these  "lacteal  abscesses  "  discharge  a  large  quantity  of 
foetid  matter.  Then  the  general  phenomena  disappear,  the  tumefaction 
and  sensibility  diminish,  the  suppuration — though  it  may  persist  for  some 
time — gradually  decreases,  and  the  normal  secretion  of  milk  is  finally 
established.  In  other  instances,  all  the  symptoms  disappear  except  the 
clotted  character  of  the  milk,  and  the  tendency  of  this  fluid  to  coagulate 
in  the  ducts  and  sinuses.  There  it  may  form  solid  masses  or  concre- 
tions of  variable  size — from  a  pea  to  that  of  a  nut — which  become  dense 
as  dried  cheese,  or  hard  almost  as  a  stone.  They  are  sometimes  cylin- 
drical in  shape,  at  other  times  elongated,  being  moulded  by  the  part  in 
which  they  are  formed  ;  they  are  usually  movable,  and  may  be  displaced 
in  the  operation  of  milking  ;  but  they  always  constitute  a  more  or  less 
serious  obstacle  to  the  flow  of  milk.  When  situated  at  the  lower  end  of 
the  teat,  they  almost  entirely  obstruct  the  canal  ;  higher,  they  render  the 
flow  of  milk  more  or  less  difficult,  and  in  all  cases  they  may  give  rise  to 
extreme  distention  of  the  gland,  and  lead  to  the  formation  of  abscesses 
or  parenchymatous  inflammation. 

The.  phlegmonous  mammitis  described  by  Saint-Cyr,  is  always  more  seri- 
ous than  the  catarrhal  form.  It  commences  with  several  generally  very 
well-marked  febrile  symptoms  :  the  animal  is  dull,  loses  its  appetite,  and 
ceases  to  ruminate  ;  the  temperature  is  elevated,  the  pulse  becomes  fre- 
quent and  quick,  etc.  These  symptoms  of  general  disturbance,  accord- 
ing to  some  authorities,  may  manifest  themselves  three  or  four  days 
before  the  local  disorder,  and  occasionally  diminish  considerably  when 
the  latter  appears  ;  though  Saint-Cyr  correctly  states  that  this  rule  has 
numerous  exceptions.  What  is  certain,  is  that  there  are  rigors  and  un- 
mistakable indications  of  general  febrile  reaction  at  the  very  commence- 
ment of  phlegmonous  mammitis. 

In  a  very  brief  period  the  udder  acquires  a  considerable,  sometimes  a 


698  J'A THOL OGY  OF  PAR TURITION. 

great  volume — in  the  Cow  often  reaching  as  low  as  the  hocks,  or  even 
lower;  the  swelling  is  (Edematous,  "pitting"  deeply  on  pressure,  but  it 
is  hot,  inflammatory,  and  very  painful,  and  extends  beyond  the  gland — 
at  times  towards  the  vulva  and  umbilicus  or  sternum  with  the  Mare  and 
Ewe.  Beneath  the  cedematory  tumefaction,  the  gland  texture  can  be 
felt  hard,  tense,  and  nodulated  in  places  ;  while  the  skin  is  red,  stretched, 
and  shining,  and  extremely  painful  to  the  touch.  This  painfulness  causes 
an  animal,  at  other  times  quiet  and  docile,  to  be  irritable  and  fidgety, 
and  averse  to  have  the  part  touched,  either  for  examination  or  milking. 
Progression,  or  even  standing,  is  painful,  the  animal  being  evidently 
afraid  of  the  hind-limbs  coming  in  contact  with  the  gland  ;  so  that  it 
either  stands  or  walks  with  them  wide  apart,  especially  on  the  affected 
side  of  the  gland.  The  creature,  for  the  same  reason,  seldom,  if  ever, 
lies  down ;  when  it  does  so,  it  is  on  the  side  on  which  the  gland  is  least 
affected.  There  is  often  much  restlessness  and  anxiety,  and  the  Mare 
may  show  symptoms  of  colic.  The  secretion  of  milk  suddenly  ceases, 
and  pressure  on  the  teat  only  causes  a  small  quantity  of  reddish-colored 
grumous  fluid  to  flov/. 

All  these  symptoms  may  become  aggravated  in  four,  six,  or  eight  days, 
when  the  malady  may  terminate  by  resolution,  suppuration,  gangrene,  or 
induration,  according  to  circumstances. 

Parenchymatous  mammitis,  or  inflammation  of  the  proper  glandular  and 
connective-tissue  structures  of  the  udder,  is  not,  as  a  rule,  so  acute  in  its 
manifestations  as  the  preceding,  nor  yet  does  it  differ  materially,  so  far 
as  the  general  symptoms  are  concerned.  The  appetite  is  diminished,  but 
not  altogether  suspended  ;  there  is  much  thirst,  and  rumination  is  irregu- 
lar ;  the  physiognomy  betrays  suffering,  though  not  of  a  very  acute  kind  ; 
the  pulse  is  full  and  quick,  respiration  short  and  hurried,  and  constipa- 
tion is  frequently  present,  while  the  urine  is  less  abundant  and  dark  ; 
the  temperature  of  the  surface  of  the  body  is  variable,  and  the  muffle 
hot  and  dry;  there  are  rigors,  and  muscular  twitchings  or  tremblings, 
particularly  towards  the  shoulders  and  flanks.  The  conjunctivae  are  in- 
jected, the  skin  more  sensitive  than  usual,  and  the  Cow  manifests  pain 
when  the  loins  are  pressed  upon  ;  with  the  Mare  the  loins  appear  to  be 
stiff  and  sore.  There  also  appears  to  be  lameness  of  the  hind-limb  of 
the  affected  side,  due  to  the  cause  before-mentioned  ;  and  when  more 
than  one  quarter  is  attacked,  the  Cow  seldom  lies  down. 

The  swelling  of  the  gland  is  very  hard  and  hot,  but  not  oedematous,  as 
in  the  other  forms,  and  the  skin  preserves  somewhat  of  its  natural  hue, 
and  is  not  thickened  ^  the  subcutaneous  veins  are  much  distended  over 
the  whole  surface  of  the  gland.  The  intense  hardness  of  the  inflamed 
mass  is  very  characteristic,  and  is  noted  throughout  the  whole  mammas  ; 
though  it  is  always  greater  on  one  side  than  another,  and  sometimes  only 
in  one  quarter — most  frequently  a  posterior  one  in  the  Cow,  both  mammaa 
in  the  Mare.  When  the  inflammation  is  intense,  and  it  has  commenced 
in  a  particular  part  of  the  gland,  it  generally  spreads  rapidly  until  the 
whole  quarter,  frequently  the  entire  mass  of  glands,  is  involved. 

From  the  commencement  the  secretion  of  milk  is  almost,  if  not  quite 
suspended  in  the  diseased  gland,  and  much  diminished  in  the  others : 
mulsion  only  yielding  a  very  small  quantity  of  a  red  clotty  fluid,  mixed 
with  blood  ;  in  very  acute  cases  almost  blood  alone  may  escape.  In 
other  cases  the  fluid  is  composed  of  transuded  serum,  and  small  pieces 
of  coagulated  casein.     In  a  short  time  this  fluid  becomes  of  a  purulent 


MAMMITIS  OR  MASTITIS.  699 

character,  at  other  times  it  is  putrescent  and  foetid.  Microscopically,  it 
is  found  to  be  composed  of  particles  of  solidified  casein,  a  few  fat 
globules,  epithelium  from  the  milk-vesicles  and  ducts,  but  especially  pus 
and  red  blood-corpuscles  ;  sometimes  bacteria  and  micrococci  are  noticed 
to  be  in  considerable  numbers.  When  abscess  forms  and  ulceration  takes 
place,  bundles  of  fibres  of  elastic  tissue  are  often  discovered  in  this  fluid. 
Chemically,  it  contains  but  little  casein,  milk,  sugai^  or  fat,  but  much 
water  and  albumen. 

The  progress  of  the  disease  is  very  rapid — more  so  than  in  either  of 
the  other  forms  ;  in  twenty-four,  thirty-six,  or  forty-eight  hours — some- 
times even  in  less  than  the  first-named  period — the  disease  has  reached 
its  greatest  intensity.  The  attack  is  generally  very  sudden — the  animal 
being  apparently  quite  well  when  left  for  the  night,  and  perhaps  present- 
ing all  the  symptoms  described  when  seen  again  next  morning.  When  it 
has  reached  its  culminating  point,  it  may  remain  stationary  for  two,  three, 
or  four  days  before  passing  to  one  of  its  ordinary  terminations.  Towards 
the  third  or  fourth  day  the  vicinity  of  the  gland  becomes  oedematous,  and 
this  oedema  may  extend  to  beneath  the  chest  and  as  high  as  the  vulva : 
in  the  Mare  to  the  inside  of  the  thighs,  and  down  the  hind-legs. 

Course  and  Terminations. 

The  course  and  terminations  of  mammitis  is  a  matter  of  much  impor- 
tance. It,  as  we  have  seen,  rapidly  passes  through  its  different  phases 
until  the  fourth,  rarely  until  the  sixth  day,  when  it  terminates  either  by 
resolution  —  which  seldom  indeed  occurs  without  prompt  treatment; 
atrophy;  induration;  suppuration ;  gangrene ;  or  even  the  death  of  the 
animal. 

Resolution  is,  of  course,  by  far  the  most  favorable  termination.  In  the 
parenchymatous  form  it  can  rarely  be  rendered  complete,  even  by  the 
most  rational  and  vigorous  treatment,  after  the  second  or  third  day  ;  in 
the  phlegmonous  form  it  may  occur  so  late  as  the  fourth  to  the  sixth  day, 
but  seldom  after  the  eighth.  It  is  marked  by  a  gradual  diminution  in 
the  intensity  of  the  symptoms — general  and  local,  and  particularly  in  the 
pain,  which  first  disappears,  then  the  tumefaction  and  solidity. 

Saint-Cyr  lays  much  stress  on  the  decrease  in  density  with  regard  to 
prognosis.  If  it  persists  beyond  the  time  stated  above  :  if  after  forty-eight 
hours  in  parenchymatous  mammitis,  or  six  days  in  the  phlegmonous  form, 
the  gland  has  not,  to  any  marked  extent,  lost  something  of  its  woody 
hardness,  there  is  great  reason  to  fear  that  resolution  will  not  be  complete, 
and  that  some  portions  will  remain  indurated,  or  that  the  mass  will 
become  either  partially  or  totally  atrophied. 

Though  the  subsidence  of  the  fever  and  diminution  of  the  swelling  are 
in  themselves  favorable  signs,  yet  they  may  be  deceptive  with  regard  to 
thorough  resolution  ;  and  it  must  be  recognized  as  more  favorable  when 
the  tissue  of  the  gland  resumes  its  softness  and  suppleness,  rather  than 
when  the  swelling  subsides  rapidly  and  the  hardness  remains  but  little 
altered. 

It  is  scarcely  necessary  to  mention  that  the  return  of  the  normal  secre- 
tion to  the  affected  gland  is  a  most  favorable  sign,  though  this  does  not 
occur  very  rapidly.  For  several  days — from  ten  to  twenty,  or  even  more 
— the  fluid  obtained  from  the  teat  of  the  affected  quarter  remains  watery, 
or  rather  serous,  curdled,  contains  numerous  colostrum  cells,  and  is  more 
albuminous    than  caseous — coagulating  readily  by  heat ;  it  contains  but 


700  PA  THOLOG  Y  OF  PARTURITION, 

little  cream  or  sugar.  But  it  gradually  recovers  its  usual  composition 
and  increases  in  quantity,  until,  at  last,  in  amount  and  quality,  it  does 
not  differ  from  that  furnished  by  the  other  quarters  of  the  mammae.  It 
sometimes  happens,  however,  that  with  regard  to  the  lacteal  secretion, 
though  the  gland  regains  its  normal  size  and  softness,  it  does  not  acquire 
its  full  functional  activity  until  the  next  pregnancy  and  the  next  period 
of  lactation.  Complete  recovery  appears  to  take  place  during  the  period 
when  the  Cow  is  "dry." 

With  the  Cow,  it  generally  requires  four  to  five  weeks  before  resolution 
is  complete  ;  with  the  Goat  the  period  is  less,  and  it  is  still  less  with  the 
Mare. 

Atrophy  of  the  gland  occurs  generally  when  resolution  is  not  complete. 
All  the  indications  of  that  change  are  present,  though  they  occur  more 
slowly  ;  but  the  lacteal  secretion  does  not  return — recovery  is  not  perfect. 

The  glandular  acini,  obliterated  by  the  proliferation  of  the  interstitial 
connective  tissue  or  the  inflammatory  exudate  which  took  place  in  their 
interior,  are  no  longer  capable  of  performing  their  function  ;  and  in 
proportion  as  these  products  of  inflammation  are  absorbed  after  its 
subsidence,  so  does  the  diseased  gland  diminish  in  volume,  the  mammae 
become  deformed  and  asymmetrical,  the  teat  retracts  and  assumes  an 
abnormal  direction,  and  but  little,  if  any,  milk  can  be  obtained  from  it. 
On  manipulation,  instead  of  the  gland  structure,  nothing  can  be  felt  save 
a  very  firm,  dense  mass,  which  feels  like  indurated  connective  tissue,  with, 
in  its  texture,  some  isolated  nodules  which  appear  to  be,  and  really  are, 
lobules  of  the  gland  which  have  remained  intact  and  yet  secrete  the  little 
milk  that  is  yielded.  The  loss  of  a  quarter  of  the  mammas  in  Milch 
Cows  is,  of  course,  a  somewhat  serious  termination,  so  far  as  the  supply 
of  milk  is  concerned,  as  this  is  materially  diminished.  Nevertheless,  the 
other  quarters  sometimes  partially  compensate,  by  their  increased  activity, 
for  the  injury,  and  the  animal  is  otherwise  in  good  health. 

Induration  is  not  at  all  an  uncommon  teimination  of  mammitis, 
especially  in  the  Cow  and  Bitch,  and  is  often  the  point  of  departure,  in 
the  latter  animal,  of  various  and  serious  degenerations  of  the  glandular 
tissue. 

This  termination  is  to  be  apprehended,  in  the  Cow,  when  the  inflam- 
mation persists  in  a  somewhat  acute  manner  beyond  the  sixth  or  eighth 
day.  Then  the  general  symptoms  diminish,  the  animal  suffers  less  pain, 
the  appetite  returns,  as  well  as  rumination,  if  any  oedema  was  present  it 
has  disappeared,  but  yet  the  gland  does  not  regain  its  healthy  character. 
The  inflammation  has  gone,  the  morbid  products  are  partly  absorbed,  but 
in  different  parts  of  the  substance  of  the  gland  there  are  more  or  less 
voluminous,  well-defined,  and  rounded  masses  which  have  an  almost 
stony  hardness,  and  are  apparently  adherent  to  the  surrounding  tissues. 
These  are  evidently  indurated  lobules  which  have  not  undergone  resolu- 
tion, and  their  secretory  power  is  therefore  lost. 

In  other  instances  in  which  the  inflammation  has  been  very  intense, 
recovery  does  not  even  proceed  so  far.  The  febrile  symptoms  disappear, 
and  the  pain  in  the  udder  to  some  extent  diminishes,  as  well  as  the  swel- 
ling ;  though  for  a  long  time  the  local  temperature  is  higher  than  usual, 
and  the  animal  evinces  uneasiness  when  it  lies  down.  The  induration  of 
the  swollen  gland,  often  visible  externally,  instead  of  diminishing,  appears 
to  increase,  owing  to  the  progressive  organization  of  the  inflammatory 
products,  and  from   the  teat  there  can  only  be  obtained  a  small  quantity 


MAMMITJS  OR  MASTITIS.  701 

of  yellowish  turbid  serum,  with  perhaps  a  few  coagula  of  casein,  epithe- 
lium casts,  and  sometimes  even  veritable  diphtheritic  false  membranes. 
In  such  a  case,  all  the  parts  of  the  gland  so  altered  are  irrevocably 
destroyed,  so  far  as  the  lacteal  secretion  is  concerned. 

It  is  from  this  indurated  condition  that  those  degenerations  and  neo- 
plasms arise,  which  are  met  with  in  the  mammae  of  animals,  but  especially 
the  Bitch.  These  are  the  adenomatous,  sarcomatous,  carcinomatous,  en- 
chondromatous.  and  fibromatous  growths  which  have  been  described  so 
often  as  found  in  the  mammas  of  this  animal  ;  but  a  consideration  of 
which  we  cannot  enter  upon  here. 

Suppuration — by  which  we  mean  the  formation  of  abscess — is  a  rather 
frequent  termination  of  mammitis,  and  particularly  of  the  phlegmonous 
form.  The  abscess  may  be  single  or  multiple,  and  vary  in  size  as  well  as 
situation.  Sometimes  they  appear  immediately  beneath  the  skin,  and 
between  it  and  the  tunic  of  yellow  fibrous  tissue  covering  the  gland  ;  in 
other  cases  they  are  formed  in  the  interstitial  connective  tissue  separating 
the  glands,  or  even  in  the  interlobular  tissue  ;  while,  though  rarely,  they 
may  be  found  in  the  connective  tissue  between  the  mammae  and  the 
abdominal  wall. 

Suppuration  generally  sets  in  from  the  eighth  to  the  twelfth  day,  and  is 
marked  by  an  increase,  instead  of  a  diminution,  in  the  symptoms — 
augmentation  of  the  fever,  swelling,  and  pain.  If  the  abscess  in  process 
of  formation  is  superficial,  the  pain  and  redness  appear  to  be  greatest  at 
a  certain  point ;  there  the  skin  is  at  first  of  a  bright  red,  but  changes  to 
a  violet  hue,  and  at  the  same  time  this  part  becomes  more  prominent  and 
circumscribed.  Soon  there  is  fluctuation,  and  the  other  indication  of 
abscess,  and  if  not  artificially  opened  this  takes  place  spontaneously,  and 
the  contained  pus  escapes.  Then  the  febrile  symptoms  diminish,  and 
the  general  condition  improves  ;  the  swelling  in  the  gland  subsides,  along 
with  the  pain  ;  pus  escapes  from  the  opening  for  two  or  three  weeks,  and 
finally  ceases,  the  wound  becoming  cicatrized.  Recovery  has  now  been 
accomplished,  and  nothing  remains,  save  perhaps  a  small  mass  of  indu- 
rated gland  where  the  abscess  has  been.  This  subcutaneous  or  superfi- 
cial abscess  is  not  generally  very  injurious  or  serious. 

It  is  not  so,  however,  when  the  abscess  is  developed  in  the  intergland- 
ular  connective  tissue,  or  in  that  between  the  mammae  and  the  abdomen. 
Here  the  pus  is  deep-seated,  and  burrows  or  spreads  wherever  the  resist- 
ance is  least ;  in  this  way  it  leads  to  the  formation  of  sinuses,  sloughing 
of  the  skin  over  a  wide  surface,  isolates  masses  of  the  glands — thus 
destroying  their  relations  with  neighboring  parts,  and  causing  their  mor- 
tification and  total  destruction.  This  mammary  suppuration  is  always 
serious,  as,  under  the  most  favorable  circumstances,  it  generally  ends  in 
the  animal  losing  more  or  less  of  the  gland  ;  while  in  some  cases  it  may 
cause  death  from  the  violence  of  the  inflammation  and  intensity  of  the 
pain,  or  through  exhaustion  from  the  long-continued  and  profuse  sup- 
puration. 

When  the  abscess  is  situated  in  the  interstitial  or  lobular  connective 
tissue,  the  case  is  no  better,  but  perhaps  worse,  Ow-ing  to  the  nature 
and  disposition  of  the  tissues,  which  resist  distention,  the  pain  produced 
by  the  inflammation  is  most  accute  and  distracting  ;  while  the  process 
of  suppuration  destroys  a  greater  or  less  number  of  the  aci7ii,  and  the 
pus,  deep-seated,  is  long  before  it  reaches  the  surface  of  the  gland,  caus- 
ing great  havoc  in  doing  so.-    Sometimes  the  interstitial  abscess,  opens 


702  PATHOLOGY  OF  PARTURITION. 

into  a  milk  sinus,  and  partly  escapes  by  the  teat  during  milking.  The 
pus  is  then  mixed  with  the  serum  of  the  milk,  and  perhaps  clots  of  casein 
and  shreds  of  glandular  tissue,  the  fluid  having  a  highly  ammoniacal 
odor.  The  pain  is  less,  but  does  not  cease,  and  it  is  generally  necessary 
to  make  an  external  opening  for  the  readier  and  more  complete  evacu- 
ation of  the  matter.  There  is  generally  much  destruction  of  tissue,  and 
cicatrization  is  difficult  and  tedious,  particularly  when  there  are  lacteal 
fistulas.  Not  unfrequently  the  abscesses  are  multiple,  and  in  some  in- 
stances there  are  as  many  as  there  are  inflamed  lobules.  In  other  cases 
one  abscess  succeeds  another,  owing  to  the  presence  of  dead  tissue  in 
the  mass  of  the  gland. 

Even  when  the  abscess  opens  externally,  and  the  other  quarters  yield 
milk,  the  pus  is,  of  course,  liable  to  pass  into  it,  an'd  to  render  it  most 
objectionable  as  food.  So  that  during  the  whole  of  the  suppurative 
period,  the  services  of  the  Cow  as  a  producer  of  milk  are  lost.  Such 
milk  has  usually  a  greyish  tint,  and  often  a  peculiar  odor — sometimes 
similar  to  that  of  pus. 

Fiirstenberg  has  drawn  attention  to  a  cold  abscess,  often  observed  in 
the  udder  of  Cows  more  particularly,  and  due  to  the  spontaneous  soften- 
ing of  a  chronic  tumor  or  induration — the  softening  being  the  result  of 
fatty  degeneration.  The  tumor  loses  its  hardness,  and  the  softening 
process  gradually  extends  ;  the  skin  covering  the  mass  becomes  pulpy 
and  thin,  and  often  the  tumor  opens  spontaneously  and  externally,  a 
thick,  yellowish  kind  of  pus  escaping;  or  it  may  evacuate  its  contents 
into  one  of  the  milk  sinuses. 

The .  secretory  function  of  one  or  more  quarters  of  the  mammae  may 
be  quite  destroyed — a  serious  result  with  valuable  Milch  Cows. 

Gangrene  of  the  whole  or  a  portion  of  the  udder,  is  not  an  unusual 
termination  of  mammitis,  and  is,  of  course,  the  most  serious  one,  except 
the  death  of  the  animal.  It  may  be  limited  or  diffused.  The  first  fre- 
quently succeeds  phlegmonous  mammitis,  and  particularly  when  suppura- 
tion and  diffuse  or  deep-seated  abscess  exists.  In  such  a  case  the  sup- 
purative process  has  isolated  a  large  portion — say  a  quarter — of  the 
mammae  by  the  pus  burrowing  around  it,  and  thils  cutting  off  its  nutri- 
tion— the  blood-vessels  being  the  last  to  give  way  to  ulceration.  The 
dead  gland  is  encapsuled  by  its  fibrous  covering,  and  there  it  may  re- 
main for  some  time  unless  removed  by  a  large  opening — though  some- 
times the  capsule  gives  way,  and  the  mortified  mass  is  found  lying  on  the 
ground  among  the  feet  of  the  animal.  In  this  way  Nature  gets  rid  of 
the  diseased  portion,  and  recovery  becomes  possible.  The  gangrene  is 
generally  limited  by  a  dense  band  of  fibrous  tissue.  In  many  cases  sur- 
gical interference  is  necessary,  when  the  mammae  mortify  ;  and  when 
this  is  judicious,  and  the  animal  is  not  too  weak  or  exhausted,  success  is 
complete  ;  though,  of  course,  the  lacteal  apparatus  is  mutilated  and 
greatly  damaged. 

When  diffuse,  gangrene  of  the  mammae  is  generally  fatal.  All  the 
domestic  animals  appear  to  be  liable  to  gangrenous  mammitis,  but  more 
especially  the  Cow,  Mare,  and  Sheep,  the  latter  being  oftenest  attacked. 

The  symptoms  are  described  as  extraordinarily  intense  from  the  very 
commencement.  There  is  great  depression  of  strength,  and  the  animal 
looks  prostrated  ;  the  appetite  is  lost,  rumination  ceases,  the  heart  beats 
loud  and  frequently,  and  there  is  grinding  of  the  teeth  and  convulsive 
tremors.     At  the  same  time  the  udder  swells  enormously,  the  tumefaction 


MAMMITIS  OR  MASTITIS  703 

extending  along  the  abdomen  and  up  the  perinaeum.  At  first  oedematous, 
hot,  and  extremely  painful,  the  swelling  soon  becomes  emphysematous, 
cold,  and  insensible  ;  the  skin,  which  was  previously  intensely  red,  as- 
sumes a  violet,  then  a  grey,  leaden,  or  dark  hue,  and  is  cold  and  clammy 
— vesicles  containing  a  limpid  or  reddish  serosity  appearing  on  its  sur- 
face— the  mammary  gland  can  now  be  readily  enucleated  by  making  an 
incision  through  the  skin. 

The  general  symptoms  become  more  grave  ;  the  animal  appears  to  be 
completely  exhausted,  trembles  continually,  and  the  pulse  becomes  im- 
perceptible ;  at  last  the  creature  falls  extended  on  the  ground  and  dies — 
sometimes  within  ten  or  twelve  hours,  rarely  longer  than  a  few  days,  after 
the  commencement  of  the  attack. 

Death  sometimes  occurs  in  phlegmonous  and  interstitial  suppuration. 
Then  the  intense  pain  continues,  or  becomes  still  more  excruciating ;  the 
animal  is  continually  moaning,  lying  down  and  getting  up  again,  as  the 
recumbent  posture  increases  the  agony,  by  making  pressure  on  the  mam- 
mae ;  the  temperature  is  elevated ;  attempts  to  milk,  which*  cause  the  ut- 
most distress,  only  result  in  obtaining  a  few  drops  of  reddish  or  semi- 
purulent  fluid  from  the  teat.  All  food  and  drink  is  refused  ;  emaciation 
sets  in  rapidly  ;  the  animal  is  indifferent  to  every  thing  around  it ;  the 
expression  is  haggard  and  anxious  ;  the  conjunctivas  are  livid  ;  the  res- 
piration is  quickened  and  often  noisy  ;  the  muffle  is  dry  and  sometimes 
cracked  ;  the  pulse  is  thready  or  imperceptible,  and  there  are  constant 
tremblings  ;  the  prostration  is  soon  so  extreme  that  the  animal  falls,  per- 
haps turns  its  head  towards  its  shoulder,  and  dies  without  a  struggle. 

Ewes  are  very  liable  to  mammitis  during  the  "yeaning  "  or  lambing 
period,  and  in  very  many  instances  it  assumes  an  almost  epizootic  preva- 
lence, and  the  fatal  gangrenous  form.  This  is  more  particularly  observed 
in  large  flocks,  where  gangrenous  mastitis  may  be  said  to  be  the  rule.  Of 
this  there  are  many  instances  to  be  found  in  veterinary  literature,  and 
particularly  those  given  by  Toggia,  Yvart,  D'Arboval,  Roche-Lubin,  and 
others.  That  recorded  by  Yvart,  as  occurring  in  the  Alfort  flock  in 
1833,  is  interesting.  YjdX.^\vci2iWX\.  (^Zeitschrift  fiir  die  p.  Thierheilkunde  von 
Nebel  afid  Vix,  1836,  p.  423)  gives  a  very  good  description  of  the  disease, 
as  he  observed  it.  In  the  majority  of  cases,  he  saw  only  one-half  of  the 
udder  affected,  and  generally  first  around  the  teat,  extending  thence  in 
every  direction.  The  seat  of  the  inflammation  was  in  the  substance  of 
the  udder — the  gland  parenchyma,  the  swelling  being  hard,  and  the  skin 
covering  it  light  red  ;  the  pain  was  very  great.  Before  the  inflammation 
had  reached  its  culminating  point,  a  thin  serous  fluid  {ftiilclnuasser)  drop- 
ped from  the  teat,  and  when  the  latter  was  squeezed,  curdled  milk,  or 
milk  in  firm  clots,  about  the  size  of  a  pea,  was  obtained.  The  affected 
Ewe  kept  apart  from  its  companions,  did  not  eat,  looked  very  dull,  head 
and  ears  drooping,  back  arched,  hind-limbs  widely  separated,  and  move- 
ment difficult,  the  hind-leg  towards  the  inflamed  side  of  the  udder  being 
most  slowly  and  cautiously  extended,  as  if  lame ;  when  both  mammae 
were  affected,  the  gait  was  markedly  straddling,  and  the  steps  short. 
When  the  lamb  attempted  to  suck,  the  Ewe  sank  to  the  ground  from  pain, 
and  could  not  rise  again  without  assistance.  Sometimes  in  the  evening 
the  quarter  yielded  good  milk,  and  in  the  morning  blood  or  reddish-col- 
ored serum  would  be  found  dropping  from  the  teat.  In  twenty-four  hours 
from  the  commencement  of  the  disease,  death  not  unfrequently  ensued. 
If,  in  the  first  twelve  hours,  the  malady  did  not  yield  to  antiphlogistic 


7 o4  PA  THOL OG  Y  OF  PAR TURITION. 

treatment,  the  skin  covering  the  part  and  the  hard  gland,  hitherto  hot, 
became  cold,  painless  to  the  touch,  and  assumed  a  dark-blue,  glazed 
appearance.  Then  an  oedematous  swelling  showed  itself  in  front  of  the 
udder,  and  which  soon  extended  to  the  umbilicus  and  sternum,  along  the 
side  of  the  body,  and  down  the  thigh  to  the  hocks.  The  development  of 
this  oedema  was  a  sure  sign  that  gangrene  had  commenced  in  the  mass 
of  the  diseased  gland,  and  the  sanious  fluid  which  could  be  drawn  from 
the  now  insensitive  teat  was  a  further  proof  of  this  condition.  When 
this  change  took  place,  the  animal  seemed  to  be  much  easier ;  it  looked 
livelier,  began  to  graze  and  eat,  and  even  to  ruminate.  But  the  dark- 
blue  color  of  the  udder,  and  the  oedema  extending  therefrom,  were  un- 
mistiakable  signs  of  approaching  death,  which  usually  occurred  in  thirty-six 
hours,  when  operations  on  the  udder  and  scarification  of  the  swelling  did 
not  avail. 

This  form  of  mammitis  attacked  young  and  old,  good  and  bad,  among 
the  Ewes,  but  more  particularly  those  of  the  improved  foreign  breeds — 
the  Ewes  that  reared  weakly  lambs  which  could  not  sufficiently  empty 
the  udder,  and  which  were  well  fed. 

Kotelmann  believed  that  this  insufficient  evacuation  of  the  mammas, 
mechanical  injury  to  the  teat,  etc.,  was  the  cause. 

Prognosis. 

The  prognosis  of  mammitis  is  generally  unfavorable,  unless  the  inflam- 
mation is  superficial  and  limited,  not  severe,  and  treatment  is  adopted 
early. 

When  the  inflammation,  and  particularly  in  the  Cow,  attacks  the  whole 
of  the  mammae,  it  is  then  most  serious,  and  rarely  indeed  can  a  favor- 
able result  be  prognosticated.  When  the  inflammation  is  localized  and 
not  likely  to  extend,  and  particularly  w^hen  the  suppuration  is  superficial, 
the  results  may  be  trifling — provided  always  that  judicious  treatment  is 
early  adopted  and  energetically  carried  out.  With  cattle  and  sheep  at 
pasture,  mammitis  is  often  a  most  serious  disease,  from  the  fact  that  its 
existence  is  generally  not  perceived  in  time  to  check  it,  and  the  causes 
which  produced  it  are  perhaps  still  in  operation.  The  permanent  in- 
duration or  sloughing  a  way  of  one  or  more  quarters  of  the  mammae,  are 
always  to  be  apprehended  when  the  inflammation  is  interglandular  or 
interstitial,  and  especially  when  it  is  acute.  Gangrene,  and  even  death, 
may  result  ;  indeed,  the  gangrenous  termination  of  mammitis  is  fatal  in 
nearly  every  case. 

Complications. 

With  ruminants,  the  digestive  organs  are  generally  involved  in  the 
disturbance  and  require  attention.  Inflammation  of  the  joints  (arthritis) 
is  a  frequent  complication  of  mammitis;  any  of  the  articulations  may 
become  affected,  but  the  patellar  and  tarsal  appear  to  be  the  most  pre- 
disposed. Septic  infection  and  pyaemia  are  grave  complications,  and 
appear  when  gangrene  or  extensive  suppuration  is  present.  There  are 
also  the  degenerations  and  new  formations  in  the  mammae  w^hich  com- 
plicate the  malady  when  chronic,  or  subsequently. 

Pathological  Anatomy. 
In  the  majority  of  instances,  the  interlobular  connective  tissue  is  the 
principal  seat  of  the  inflammation,  particularly  when  the  disease  has 
been  neglected.     The  layers  of  this  tissue  enveloping  the  lobules  and 


MAMMITIS  OR  MASTITIS  705 

acini  are  swollen  and  infiltrated,  and  compress,  or  even  efface,  the  proper 
substance  of  the  gland,  as  well  as  the  vessels  of  the  part.  It  is  this 
swelling  and  infiltration  which  causes  the  tumefaction  of  the  mammie  ; 
though  the  inflammation  of  the  proper  gland-tissue  will  bring  about  the 
same  results.  Retention  of  the  milk  is  caused  by  the  inflammatory  in- 
filtration of  the  connective  tissue  surrounding  the  milk-ducts  and  canals. 
When  inflammation  has  gone  on  to  suppuration,  we  find,  on  section  of 
the  affected  gland,  the  gland-tissue  more  or  less  occupied  by  large  and 
small  abscesses,  adjoining  healthy  connective  tissue  ;  these  abscesses 
may  be  isolated,  or  communicate  with  each  other  and  form  one  large 
irregular  cavity.  Sometimes  there  is  necrosis  of  the  ligamentous  bands 
which  form  the  principal  septa  between  the  glands,  and  in  this  way  are 
produced  fistulae  or  secondary  abscesses,  which  may  open  externally  or 
into  the  milk  sinuses.  These  latter  are  generally  lined  with  a  large 
number  of  cylindrical  epithelium  ;  in  severe  cases  their  walls  are  thick- 
ened and  of  a  dark  color,  their  cavity,  as  well  as  that  of  the  teat,  being 
dilated  with  the  altered  fluid.  The  matter  in  the  abscesses  varies  ex- 
ceedingly in  its  composition.  Along  with  cylindrical  epithelium  are 
blood-corpuscles,  fat-crystals,  fragments  of  yellow  elastic  tissue,  colos- 
trum corpuscles,  and  an  extraordinary  quantity  of  micrococci  of  various 
shapes. 

The  interlobular  connective  tissue  is  thickened,  dense,  and  like  ten- 
don or  cartilage  (sclerosis).  The  gland  tissue  itself  has,  instead  of  a 
yellow  tint,  a  marbled  aspect  ;  in  chronic  cases  calcareous  salts  may 
even  be  found  in  the  textures. 

When  circumscribed  gangrene  has  occurred,  and  elimination  of  the 
diseased  part  is  accomplished,  the  dead  mass  may  weigh  as  much  as  five 
or  six  pounds  in  the  Cow ;  it  is  somewhat  regularly  oval,  but  rather  flat- 
tened and  discoid  in  the  Mare  ;  the  color  is  a  light  or  pale  yellow,  and 
in  consistence  it  is  pulpy  but  not  elastic,  and  the  finger  cannot  be  easily 
passed  into  its  substance  ;  traces  of  its  lobulated  structure  can  still  be 
perceived,  and  if  a  section  be  made  of  it,  all  the  characters  of  the  mam- 
mary gland  can  be  made  out  in  its  interior. 

In  diffused  gangrene,  however,  the  glandular  tissue  is  deep-red  in 
color,  softened,  and  filled  with  pulpy  cavities  ;  the  ducts  and  sinuses  are 
filled  or  choked  with  coagulated  milk,  pus  and  serum,  the  whole  .forming 
a  diversely-colored  fluid.  In  the  veins  are  sometimes  blood-clots,  varia- 
ble in  color  and  consistence  ;  gas  and  foetid  fluids  escape  from  the  tissue 
on  section  ';  and  the  oedema  is  found  to  be  due  to  infiltrations  of  yellow 
serum  in  which  are  brown  and  greenish  streaks.  This  fluid,  examined 
microscopically,  has  much  the  appearance  of  that  found  in  animals  which 
have  died  from  septikaemia.     Shreds  of  necrotic  tissue  are  also  met  with. 

Causes. 

Mammitis  appears  to  be  due  to  the  most  diverse  causes.  Among  the 
principal  predisposing  causes,  the  first  is  lactation — the  disease  appear- 
ing immediately  before  or  soon  after  parturition  ;  and  those  animals 
whose  mammae  are  most  active  at  this  period,  are  those  most  frequently 
attacked.  In  the  great  majority  of  cases  in  the  Cow — in  which  animal  it 
is  most  serious — it  follows  within  a  month  after  parturition.  It  is  true 
that,  in  certain  maladies — as  foot-and-mouth  disease,  cow-pox,  sheep-pox, 
etc. — the  udder  may  be  affected  at  any  time ;  yet  the  lactation  period, 

45 


7o6  PA  THOLOG Y  OF  PARTURITION 

that  when  the  mammae  are  at  the  height  of  their  function,  is  the  time 
when  this  inflammation  is  generally  met  with.  With  those  animals 
whose  milk  is  only  utilised  to  rear  their  progeny,  the  sudden  sej3aration 
of  their  young  without  any  precautions  is  often  noted  as  an  exciting  or 
predisposing  cause.  The  great  activity  of  these  glands  in  the  Cow,  and 
the  long  time  during  which  this  activity  is  maintained,  is,  there  can  be 
no  doubt,  one  of  the  chief  reasons  why  this  animal  so  often  suffers  from 
this  affection. 

Mechanical  causes  may  produce  this  inflammation — such  as  contusions, 
wounds,*  injuries  in  milkingf  or  sucking,  blows  from  the  head  of  the 
young  creature,  etc.  Parenchymatous  inflammation  of  the  gland  may 
also  be  due,  according  to  Franck,  to  a  deep  purulent  wound  in  the  canal 
of  the  teat,  especially  that  produced  in  dilating  this  channel,  or  in 
the  removal  of  papillomatous  tumours  from  this  part. 

Noquet  [Reaieil  de  Med.  Veterinaires,  185 1 )  alludes  to  a  Cow  in  which,  in  con- 
sequence of  mammitis,  for  six  months  the  two  posterior  quarters  of  the  udder  lost  their 
power  of  secreting  milk.  It  afterwards  calved,  and  the  sinuses  of  these  quarters  were 
filled  with  milk  ;  but  none  could  escape,  owing  to  the  teat-canals  being  closed.  By 
means  of  a  knitting  needle,  artificial  passages  were  made,  but  these  became  deep 
purulent  fissures.  When  Noquet  first  saw  the  Cow,  three-quarters  of  the  mammae 
were  enormously  swollen  and  gangrenous.  Deep  scarifications  were  made,  and 
repeated  dressings  applied  ;  while  camphorated  draughts  were  administered  internally. 
The  three  quarters  were  destroyed,  leaving  only  the  left  anterior  quarter.  Half  a  year 
afterwards  all  had  cicatrised,  and  there  only  remained  a  fistula.  The  animal  was 
in  good  condition,  and  was  therefore  slaughtered. 

In  these  cases  infection  may  occur  from  the  wound  itself,  or  through  a 
ferment  passing  into  the  canals  from  without.  In  support  of  the  latter 
view,  which  will  be  referred  to  again,  we  may  mention  that  Viseur  has 
attributed  catarrh  of  the  membrane  lining  the  milk-ducts  and  sinuses  to 
the  too  frequent  employment  of  the  teat-tube  or  syphon,  which  more  or 
less  paralyses  the  sphincter  of  the  teat,  and  through  the  relaxed  aperture 
the  air,  charged  with  germs,  irritates  and  inflames  this  membrane. 

"Overstocking"  of  the  udder  with  milk  has  generally  been  considered 
a  very  likely  cause  in  the  production  of  inflammation.  The  sudden 
removal  of  the  young,  imperfect  milking,  etc.,  have  also  been  blamed. 
Franck,  however,  appears  to  doubt  the  influence  of  mammary  distention, 
and  some  observations  and  experiments  would  tend  to  prove  that  this 
does  not  always  cause  inflammation.  For  instance,  Cows  which  had 
suffered  from  mammitis,  and  had  temporarily  lost  the  function  of  one  or 
two  quarters  of  the  mammae,  were  found  at  the  next  lactation  period  to 
have  recovered  the  secretory  power  of  these  glands,  but  the  excretory 
canal  in  the  teat  was  obliterated.  Consequently,  great  distention  oc- 
curred, and  this  was  not  relieved  by  an  artificial  opening.  Nevertheless, 
no  inflammation  ensued  ;  after  the  third  day  there  was  a  marked  diminu- 
tion in  the  turgescence  of  the  quarters,  and  in  about  eight  days  they  had 
assumed  their  normal  volume.  And  Kehrer  has  experimentally  shown 
that  extreme  distention  may  not  cause  inflammation,  by  closing  two  teats 

*  Gotze  (Sachs  Jahresbericht,  1867,  p.  92),  quoted  by  Franck,  mentions  an  instance  in  which  the 
posterior  part  of  the  udder  of  a  Cow  becamed  inflamed,  and  soon  there  was  a  severe  attack  of  mammitis. 
When  the  animal  was  killed,  a  large  abscess  was  found  in  the  gland,  and  in  it  two  common  pins,  which 
Gotze  thought  might  have  penetrated  there  from  the  rumen. 

t  In  those  countries  where  the  milk  of  Ewes  is  utilised  like  that  of  Cows,  in  the  production  of  cheese 
—as  at  Roquefort,  where  cheese  bearing  this  name  is  largely  manufactured— mammitis  appears  to  be  very 
frequent,  and  has  been  attributed  very  often  to  the  rough  handling  the  teats  and  udder  receive  in  milking. 

Roche-Lubin  says  that  he  has  often  witnessed  shepherds  acting  so  violently  in  milking  that  the  Ewes 
could  scarcely  breathe,  staggered  in  their  hind-limbs,  and  sometimes  fell  from  the  pain  and  shock. 


MAMMITIS  OR  MASTITIS.  707 

of  a  pregnant  Bitch  with  collodion,  and  so  securely  that  at  birth  the  pup- 
pies could  not  remove  it.  The  corresponding  glands  were  much  dis- 
tended with  milk,  but  no  inflammatory  action  was  set  up. 

The  influence  of  cold  and  wet,  and  especially  the  former — particularly 
when  animals  rest  with  the  udder  on  the  ground — has  also  been  largely 
ascribed  as  a  cause  of  mammary  inflammation,  but  probably  there  is 
some  exaggeration  in  this  ;  as  Cows  which  are  seldom  housed  suffer  less, 
perhaps,  from  this  malady  than  those  kept  in  warm  cowsheds.  Cold 
winds  or  draughts  in  cowsheds  have  been  especially  alluded  to  as  op- 
erating powerfully  in  its  production ;  and  though  we  are  inclined  to 
think  that  these  and  lying  on  cold  ground  do  not  produce  the  disorder  so 
frequently  as  is  imagined,  yet  there  can  be  no  doubt  that  while  the  udder 
is  very  active,  and  is  in  a  state  of  almost  constant  hyperaemia,  it  will  be 
more  susceptible  to  alternations  of  temperature,  particularly  if  the  animal 
is  rendered  delicate  by  high  feeding  and  an  artificial  existence. 

Certain  atmospherical  conditions — as  electrical  storms — have  been 
supposed  to  exert  some  influence  also ;  and  extensive  outbreaks  of 
mammitis  have  certainly  been  observed  to  coincide  with  these  disturb- 
ances— the  udder  being  attacked  with  a  kind  of  phlegmonous  erysipelas. 

Hygiene  has  been  looked  upon  as  aiding  in  the  development  of 
mammitis;  filthy  and  badly  ventilated  dwellings  being  greatly  blamed  as 
tending  to  generate  a  miasma,  which  exerts  a  special  influence  on  the 
udder. 

Plethora  has  been  imagined  to  be,  if  not  an  exciting,  at  least  a  predis- 
posing cause,  and  so  has  hot  weather.  Bardy,  quoted  by  Rainard  and 
Saint-Cyr,  gives  a  description  of  an  epizooty  of  mammitis  which  was  said 
to  be  due  to  the  Cows  consuming  ranunculaceous  plants,  which  were 
very  abundant  in  the  fields  where  the  animals  grazed.  The  people  in  the 
locality  assured  him  that  this  always  occurred  when  these  plants  were 
most  plentiful  in  certain  years. 

Mammitis  sometimes  complicates  or  accompanies  vaginitis,  metritis, 
peritonitis,  etc.,  according  to  some  authorities. 

There  is  much  reason  to  believe  that  a  particular  form  of  mammitis  is 
due  to  a  putrid  or  septic  infection,  and  Franck  is  one  of  the  strongest 
supporters  of  this  view.  Indeed,  he  asserts  that  the  majority  of  cases  of 
mammitis  are  of  septic  origin  ;  and  he  has  experimentally  proved  the 
correctness  of  his  statement.  For  instance,  he  has  repeatedly  injected  into 
the  teats  of  healthy  Cows,  pus  from  the  udder  of  those  affected  with 
mammitis,  or  fluid  from  putrid  flesh,  as  well  as  putrid  blood,  and  within 
twenty-four  hours  an  acute  inflammation  of  the  corresponding  quarters 
has  been  observed.  This  inflammation  occurred  with  Cows  whose  udder 
was  in  active  function,  as  well  as  those  which  were  "  dry."  The  unin- 
jured epithelium  of  the  milk  sinuses  and  vesicles  are,  therefore,  not 
protective  of  the  gland  like  the  pavement  epithelium  of  the  vagina  ;  for  it 
has  been  shown  that  when  putrid  flesh  or  blood-fluid  was  injected  into 
the  uninjured  vagina  of  Ewes  and  Cows,  no  inflammation  was  set  up. 

One  of  Franck's  experiments  is  instructive.  A  Cow  which  gave  only  a  small  quantity  of 
milk,  had,  on  February  26,  1875,  a  quantity  of  fresh  pus  from  the  udder  of  another  Cow 
suffering  from  mammitis,  and  diluted  with  ten  times  its  bulk  of  water,  injected  into  the 
teat  of  the  left  anterior  quarter.  Next  day  this  quarter  had  all  the  appearance  of  being 
affected  with  parenchymatous  inflammation.  The  other  three  quarters  were  generally 
intact.  The  secretion  from  the  diseased  quarter  was  yellow,  creamy,  and  pus-like.  It 
only  contained  pus-globules  in  great  quantity,  and  these  wei;e  studdied  with  micrococci : 


7 o8  PA THOL OGY  OF  PAR TURITION. 

there  were  also  some  epithelial  cells,  milk-globules  and  small  masses  of  coagulated 
casein.     On  February  28,  the  inflammation  had  extended  to  the  left  posterior  quarter. 

In  another  experiment  he  injected  some  putrid-flesh  fluid  into  the  milk  duct  of  a  teat. 
Next  day  this  quarter  of  the  udder  was  affected  with  acute  parenchymatous  inflamma- 
tion ;  the  milk  was  curdled,  purulent,  and  contained  large  numbers  of  pus-corpuscles 
and  micrococci.     In  a  few  days  the  adjoining  quarter  was  likewise  involved. 

The  structure  of  the  teat  and  arrangement  of  the  milk-sinuses  and 
ducts  in  the  Mare,  ruminants,  and  Swine,  are,  in  the  opinion  of  Franck, 
favorable  for  the  reception  of  infection  ;  and  this  accounts  for  the  read- 
iness with  which  parenchymatous  inflammation  of  the  udder  occurs  early 
in  foot-and-mouth-disease,  the  virus  of  this  specific  malady  finding  its 
way  from  the  surface  of  the  gland  into  the  teat.  The  wider  prevalence 
of  mammitis  in  close  sultry  weather  during  summer,  than  in  cold  winter 
weather,  may  be  accounted  for  by  the  readiness  with  which  organic  mat- 
ters putrefy.  By  the  way  of  infection,  those  extensive  outbreaks  of  mam- 
mitis which  occur  among  flocks  of  sheep  may  also  be  explained.  Those 
cases  of  the  disease  which  follow  abortion,  or  accompany  metritis  or  va- 
ginitis, may  also  be  attributed  to  self-infection,  instead  of  metastasis  ;  in- 
deed, in  Franck's  view  those  maladies  which  lead  to  the  formation  of 
putrid  or  septic  matter — such  as  parturient  fever,  omphalitis  in  the  prog- 
eny, retention  and  putrefaction  of  the  after-birth,  etc. — may  all  be  pro- 
ductive of  mammitis  in  this  way.  Disease  of  the  progeny  may  also  give 
rise  to  it,  the  infection  being  conveyed  to  the  teat  by  the  young  in  the 
act  of  sucking.  The  hands  of  milkers  or  others,  or  soiled  litter  or  ground 
on  which  the  animal  lies,  may  also  be  the  means  of  conveying  the  infec- 
tion. Franck  believes  that  the  column  of  milk  in  the  sinuses  and  ducts 
is  first  tainted,  and  that  this  is  effected  through  the  milk  at  the  end  of 
the  teat — a  drop  or  two  of  which  maybe  suspended  therefrom.  A  chem- 
ical change  is  thereby  brought  about  in  the  milk,  and  this  altered  secre- 
tion leads  to  the  inflammation,  which  is  secondary.  An  alteration  in  the' 
character  of  the  milk  is,  it  w^ill  be  remembered,  one  of  the  first  symptoms 
— if  not  the  first — of  mammitis.  Consequently,  "dry"  Cows,  or  those  to 
which  the  infection  cannot  obtain  access,  are  not  attacked  by  the  mal- 
ady ;  and  "  dry  "  Cows  suffering  from  foot-and-mouth-disease  never  have 
parenchymatous  mammitis. 

In  the  veterinary  journal  of  the  University  of  Y\%2>.  [Giornale  di  Anatomia,  etc.,dcgli 
Animali,  1875)  Professor  Rivolta  describes  a  form  of  mammitis  prevailing  among  sheep 
in  the  neighborhood  of  Pisa,  towards  the  end  of  winter  and  commencement  of  spring, 
and  to  which  he  has  prefixed  the  designation  of  "  septic."  He  gives  it  this  designation 
because,  when  it  begins  at  a  certain  part  of  the  mammary  gland,  there  is  noted  a  kind 
of  putrefaction  of  the  juices  of  the  skin,  as  well  as  of  the  gland  itself;  and  besides,  in  the 
sero-sanguinolent  fluid  in  the  connective  tissue  of  the  gland  are  remarked  a  very  active 
element  in  the  process  of  putrefaction,  in  the  presence  of  micrococci  and  bacteria. 

The  disease  appears  to  be  perfectly  distinct  from  the  gangrenous  mammitis,  and  the 
gangrenous,  or  anthracoid  erysipelas,  described  by  various  writers.  It  is  a  local  malady 
which  usually  invades  the  gland,  extending  at  a  certain  rate  of  progress,  and  most  fre- 
quently proving  fatal.  It  ordinarily  commences  in  the  neighborhood  of,  or  in,  one  of 
the  teats ;  if  the  latter,  it  offers  a  circumscribed  (Edematous  tumefaction,  while  the  sur- 
face of  the  skin  thereon  is  intensely  red.  This  red  patch  rapidly  assumes  a  grey  color, 
and  finally  becomes  almost  black.'  Sometimes  blood  escapes  from  the  affected  teat. 
This  cedematous  swelling  and  discoloration  gradually  extend,  and  in  a  more  or  less  brief 
period  of  time  has  invaded  one-third  or  one-half  of  the  udder — not  even  sparing  the 
tissue  of  the  gland.  The  whole  of  the  affected  part  is  then  tumefied,  doughy,  somewhat 
consistent,  slightly  or  not  at  all  sensitive,  and  dark  or  black  in  hue.  The  line  of  demar- 
cation between  the  healthy  and  diseased  portion  is  perfectly  defined;  the  former  being 
of  a  rosy  color,  and  normal  in  size  and  consistency.  The  diseased  condition  spreads 
beyond  the  udder  to  beneath  the  abdomen,  and  when  an  ulcer  appears  on  the  gland, 


MAMMITIS  OR  MASTITIS.  709 

discharging  a  foetid  sanguinolent  fluid,  tlie  animal  then  becomes  depressed  and  feverish, 
debility  and  emaciation  set  in,  and  the  creature  succumbs  to  an  attack  of  septikaemia. 

The  numerous  necroscopical  examinations  made  by  Rivolta  confirm,  in  his  opinion, 
the  distinction  he  has  established  between  this  special  malady  and  erysipelatous  mam- 
mitis.  With  regard  to  the  causes,  the  shepherds  affirm  that  the  malady  attacks  those 
sheep  which  are  kept  for  a  long  time  on  a  thick  bed  of  litter ;  others,  again,  assert  that 
it  appears  when  they  are  allowed  to  pasture  in  the  open  air,  and  are  not  confined.  The 
same  uncertainty  prevails  with  regard  to  its  contagiousness.  The  shepherds  carefully 
isolate  the  affected  animals :  and  it  would  seem  that,  by  their  doing  so,  the  disease  is 
limited  to  those  first  attacked. 

Rivolta  is  of  opinion  that  this  form  of  mammitis  is  produced  and  maintained  by 
special  micrococci  and  bacteria,  which  penetrate  by  the  teats,  or  at  some  part  of  the  skin 
covering  the  gland. 

Tuberculosis  of  the  udder  is  sometimes  a  cause  of  mammitis,  and  in 
all  cases,  when  severe,  diminishes  the  secretion  of  milk.  The  mammae 
are  gt-eatly  enlarged,  hard,  and  nodulated,  and  softening  of  the  tubercular 
masses  may  give  rise  to  isolated  or  diffused  abscesses.* 

Several  Italian  authorities,  and  among  them  Brusasco,  Oreste,  Metaxa, 
and  Provinzano,  have  drawn  attention  to  a  peculiar  disease  of  Goats  and 
Sheep,  accompanied  by  the  gradual  loss  of  milk.  Often  lameness  is 
observed,  and  within  fourteen  days  the  quantity  of  milk  is  reduced  to 
one-fifth  of  the  usual  quantity.  This  fluid  soon  becomes  sour.  The 
disease  appears  to  be  contagious,  for  it  could  be  produced  by  injecting 
the  milk  from  affected  Sheep  into  the  teats  of  healthy  Sheep  and  Goats. 
All  the  animals  so  experimented  upon  became  affected,  the  period  of  in- 
cubation being  six,  twelve,  fifteen,  or  twenty  days.  The  secretion  of  milk 
ceases  in  from  eighteen  to  thirty  days. 

Treatment. 

However  slight  the  attack  or  mild  the  form  of  mammitis  may  be,  in 
view  of  the  serious  consequences  which  it  may  entail,  treatment  should 
be  prompt  and  judicious ;  as  in  two  or  three  days  alterations  may  be  pro- 
duced in  the  secretofy  apparatus  of  the  gland,  which  medical  skill  may 
be  unable  to  amend. 

When  the  udder  or  quarter  is  simply  engorged  with  milk,  nothing  more 
has  to  be  done  than  to  thoroughly  remove  this  fluid.  This,  of  course, 
cannot  be  accomplished  at  once,  and  it  maybe  necessary  to  milk  the  ani- 
mal several  times  during  the  day — five  or  six  times,  or  even  every  one 
or  two  hours.  When  this  causes  pain,  the  milking  should  be  gently  per- 
formed ;  and  if  pressure  on  the  teat  causes  so  much  disturbance  that  the 
fluid  cannot  be  withdrawn  by  hand,  then  the  teat-syphon  (Fig.  207),  well 
oiled,  should  be  passed  into  the  milk  duct ;  should  it  be  necessary  to  re- 
tain it  there,  then  the  ring-syphon  (Fig.  208)  may  be  employed,  its  reten- 
tion being  effected  by  a  cord  or  tape  through  the  rings  and  tied  over  the 
animal's  loins.  In  all  cases  in  which  hand-milking  causes  pain,  and  is 
likely  to  increase  the  evil  it  is  intended  to  avert,  the  teat-syphon  should 
be  resorted  to.f  It  may  be  necessary  to  remove  the  progeny  for  a  day 
or  two,  or  allow  it  access   only  to   the  healthy  quarters,  if  the   animal 

*  This  tubercular  affection  of  the  udder  is  very  important,  when  it  is  borne  in  mind  that  the  milk  of 
animals  suffering  from  tuberculosis  will,  if  experimental  results  be  accepted  as  proof,  produce  the  disease 
in  those  creatures  who  partake  of  it ;  and  that,  when  the  mammag  themselves  are  involved,  the  viruliferous 
qualities  of  this  fluid  may  be  greatly  increased.  Is  the  more  and  more  frequent  occurrence  of  the  disease 
to  be  attributed  to  this  cause  ?  ,  •    .    •  • 

t  Franck  very  properly  draws  attention  to  the  necessity  for  thoroughly  cleansing  these  syphons  m  boihng 
water  or  carbolic  acid  solution.  The  danger  of  conveying  infection  to  other  quarters  of  the  mammae,  or  to 
the  udder  of  healthy  animals,  is  obvious  unless  this  precaution  is  adopted. 


7IO  PA THOLOGY  OF  PARTURITION. 

is  suckling ;  and  should  it  be  required  to  lessen  the  secretion  of  milk 
until  the  gland  has  recovered  its  normal  condition,  this  may  be  effected 
by  a  suitable  diet,  and  perhaps  a  dose  of  laxative  or  purgative  medicine. 
Saint-Cyr  recommends  applications  of  vinegar  to  the  gland. 

Should  the  gland  remain  hard,  tense,  and  painful,  and  the  superficial 
veins  be  gorged  with  blood,  much  relief  will  be  afforded  by  bleeding  from 
the  corresponding  mammary  or  "  milk  "  vein,  if  a  Cow. 

The  animal  should  not  be  exposed  to  cold  or  draughts,  and  it  may  be 
advisable  to  cover  the  body  with  a  large  blanket.  If  fever  is  apprehended, 
enemas  may  be  administered,  in  addition  to  the  exhibition  of  nitrated 
gruel. 


*iAfcKV.eeLLdi«i.H» 


^ 1 


Fig.  207. 
Teat-syphon. 


Should  coagula  or  solid  caseous  concretions  have  formed,  they  must  be 
removed.  This  may  be  accomplished  by  moving  the  masses  up  and  down, 
when  possible,  by  careful  and  gentle  pressure.  When  it  can  be  easily 
displaced,  it  may  then  be  pushed  down  to  the  end  of  the  teat,  and  pressed 
through.  A  coagulum  or  concretion  of  this  kind,  as  large  as  a  nut,  has 
been  extracted  in  this  manner.  When  it  is  too  voluminous,  however,  it 
may  be  necessary  to  introduce  a  sound  carefully  into  the  canal,  in  order 
to  break  it  up  ;  or  it  may  even  be  required  to  incise  the  teat,  when  the 
mass  is  too  large  and  dense  to  be  got  rid  of  in  this  way. 

Retention  of  the  milk  is  sometimes  due  to  atresia  or  obliteration  of  the 
milk  canal  in  the  teat,  and  will  then  demand  an  operation  which  we  will 
refer  to  presently. 


^^aas 


(CKEY.StULEI 


Fig.  208. 
Ring  Teat-syphon. 


When  phlegmonous  or  parenchymatous  mammatis  is  present,  the  treat- 
ment must  be  energetic,  and  adopted  early,  in  order  to  prevent  those 
serious  alterations  in  the  gland  which  take  place  so  rapidly. 

In  the  Cow,  bleeding  from  the  corresponding  mammary  vein  has  been 
recommended  by  many  excellent  authorities,  from  the  speedy  relief  it 
gives  to  the  congested  gland  ;  in  the  Mare,  if  bleeding  is  necessary,  the 
blood  must  be  abstracted  from  the  jugular,  though  this  can  rarely  be  pro- 
ductive of  much  benefit.  Leeches  maybe  most  usefully  employed,  locally, 
for  the  smaller  animals,  and  Bouley  has  even  had  recourse  to  them  with 
great  advantage  in  the  Cow.  • 

In  inflammation  of  the  gland,  emptying  it  of  its  secretion  or  removing 
from  it  the  products  of  the  inflammation,  must  be  scrupulously  observed. 
Milking  by  hand  must  be  persisted  in  for  brief  but  frequent  periods,  even 
though  only  a  few  drops  of  serum  be  withdrawn  each  time.     The  teat- 


MAMMITIS  OR  MASTITIS. 


711 


syphon  may  sometimes  be  usefully  introduced  ;  but  its  employment  re- 
quires much  circumspection  when  the  inflammation  is  acute.  With  the 
smaller  animals,  as  the  Bitch,  milkmg  is  not  so  urgent. 

The  general  treatment  must  depend  upon  the  condition  of  the  animal 
and  the  nature  and  degree  of  the  disturbance,  and  must  be,  in  principle, 
that  of  all  inflammation.  The  local  treatment  is  a  matter  of  much  impor- 
tance, and  here  we  find  the  most  diverse  recommendations. 

Zundel,  Baumeister  and  Rueff,  Gillibert,  and  others,  have  lauded  the 
advantages  to  be  obtained  from  the  application  of  collodion,  particularly 
with  small  animals.  With  the  larger  animals,  as  Mares  and  Heifers,  it 
has  been  most  successfully  employed  by  Zundel,  who  adds  a  few  drops  of 
castor-oil  to  the  collodion,  which  is  applied  either  over  the  whole  gland 
or  the  inflamed  quarter  or  quarters,  commencing  at  the  teat,  the  orifice  of 
which  must  not  be  covered  ;  a  second  or  a  third  application  may  be 
made.  The  evaporation  of  the  ether  produces  a  salutary  degree  of  cold, 
while  the  continuous  layer  of  cotton  closely  adhering  to  the  surface  of  the 
skin,  affords  equable  compression  and  support  by  its  contraction  when 
the  ether  evaporates. 

Astringent  and  refrigerant  applications  have  always  held  a  high  place 
in  the  treatment  of  mammitis,  and  every  authority  has  his  own  favorite  ap- 
plication. In  this  way  we  have  cold  water,  either  alone  or  with  the  addi- 
tion of  ice,  acetate  of  lead,  or  Goulard's  extract  ;  clay  tempered  with 
vinegar  or  salt  water  ;  evaporating  lotions  of  various  kinds,  etc.  These 
applications  may  be  usefully  and  safely  employed  when  there  is  merely 
congestion,  or  at  the  commencement  of  slight  inflammation  ;  but  when 
the  inflammation  has  become  fairly  established,  and  there  is  exudation, 
they  increase  the  tension,  and,  without  allaying  the  pain,  promote  indura 
tion.  So  that,  as  a  rule,  they  are  to  be  avoided  until  the  inflammation 
has  been  greatly  subdued,  when  they  may  be  resorted  to  with  some  ad- 
vantage. 

Emollient  applications,  and  especially  when  warm,  afford  more  satis- 
factory results.  In  this  direction  warm  fomentations  and  poultices  ap- 
pear to  be  most  grateful  to  the  animal,  and  to  dissipate  the  inflammation 
most  readily.  They  must  not  be  too  hot,  as  the  skin  of  the  udder  is  so 
thin  that  it  is  easily  injured  by  inordinate  heat.  Poultices  of  linseed-meal, 
oatmeal,  marsh-mallows,  dough,  etc.,  covered  with  olive-oil.  laudanum, 
opium,  or  extract  of  belladonna,  are  especially  to  be  recommended,  in 
preference  to  fomentations,  which  require  much  time  ;  and  as  they  can- 
not be  applied  continually,  the  udder  often  suffers  from  the  reaction — 
the  change  from  heat  to  cold,  though  this  may  to  some  extent  be  ob- 
viated by  drying  the  parts  well,  and  smearing  them  with  lard.  An  ex- 
cellent poultice  is  furnished  by  spongio piline,  which,  if  covered  externally 
by  oiled  silk,  and  holes  made  in  it  for  the  teats  to  pass  through,  makes 
an  excellent  and  clean  cataplasm  when  steeped  in  warm  water  and  ap- 
plied to  the  udder.  Williams  recommends  "  spent "  hops,  which  are 
very  light,  contain  much  moisture,  are  soothing,  and  do  not  irritate  when 
they  become  dry.  The  drying  of  a  poultice  can  be  averted  by  placing  it 
in  a  piece  of  waterproof  material  or  oiled  silk.  Poultices  and  other  ap- 
plications of  this  kind  are  best  retained  by  a  wide  and  tailed  bandage, 
in  which  are  holes  for  the  teats,  and  which,  passing  upwards  on  each 
side  at  the  flank,  and  back  between  the  thighs,  is  secured  over  the  loins 
and  croup.  This  bandage  is  at  all  times  beneficial  in  relieving  the  pain 
and  congestion,  by  the  support  it  affords  the  swollen  organ.  It  should 
therefore  be  adopted  early. 


712  PA  THOL  OG  Y  OF  PA  R  TURITION^ 

Lotions  of  belladonna,  opium,  tincture  of  camphor,  poppy  heads,  etc., 
are  convenient  applications,  and  if  warm  do  good  ;  but  to  prove  effica- 
cious, they  must  be  applied  frequently,  and  at  the  commencement  of  the 
disease.  A  sponge,  or  rubbing  in  with  the  hand,  are  the  best  means  of 
applying  them.  Ftirstenberg  recommends  continuous  tepid  alkaline  lo- 
tions applied  by  the  hand  for  twenty-four  to  thirty-six  hours  ;  and 
Schaack,  quoted  by  Saint-Cyr,  asserts  that,  employed  at  the  commence- 
ment, they  have  a  remarkable  effect — often  arresting  the  inflammation  in 
that  interval,  the  swelling  disappearing  in  one  or  two  days. 

_  Rychner  states  that  nothing  can  equal  the  success  resulting  from  the 
employment  of  alkaline  lotions.  The  owners  of  cattle  in  Switzerland 
are  well  aware  of  this,  and  as  soon  as  they  observe  the  slightest  alteration 
in  the  milk  of  a  Cow,  they  take  a  handful  of  wood-ashes,  which  they 
moisten  with  milk,  and  making  a  lotion  of  the  mixture,  they  rub  it  on  the 
udder.  Rychner  is  of  opinion  that  the  potash  in  the  ashes  prevents  the 
coagulation  of  the  milk  in  the  udder^this  coagulation  being,  according 
to  him,  the  point  of  departure  or  initial  phenomenon  of  mastitis.  For 
this  reason  he  gives  the  following  recipe,  which  has  obtained  more  suc- 
cess than  any  other,  when  applied  before  the  inflammation  had  attained 
its  greatest  intensity : 

Potass     -         -         -         -                  -       I  part. 
Water      -         -         -         -         -  •      -       2  parts. . 
Olive-oil 5     " 

These  are  to  be  well  mixed,  and  then  four  or  five  parts  more  water  are 
to  be  added.  Often,  after  five  or  six  hours,  during  which  nothing  could 
ike  drawn  from  the  teat  except  a  small  quantity  of  thin  curdled  milk, 
there  is  obtained  a  whitish-yellow  fluid,  more  like  pus  than  milk,  which 
is  a  very  favorable  sign. 

Ointments  and  embrocations  of  various  kinds  are  also  employed — as 
those  of  belladonna,  henbane,  morphia,  camphor,  laurel,  etc.  In  Eng- 
land, the  extract  of  belladonna  is  much  used  as  an  application  to  the  in- 
flamed gland.  Rychner  recommends  an  ointment  made  with  soft  soap 
and  this  extract ;  Hertwig  gives  his  testimony  in  favor  of  camphorated 
pomade  ;  while  some  prefer  simple  lard.  Strong  mercurial  ointment  has 
been  greatly  extolled  as  an  anodyne  and  relaxer  of  the  tissues,  and  justly 
so.  Its  constitutional  effects  should  be  watched,  and  care  must  be  taken 
that  the  progeny  is  not  allowed  to  suck  the  teat. 

Stimulating  applications  should  not  be  employed,  unless  the  disease  is 
in  a  chronic  form,  and  then  their  effect  must  be  noted. 

When  suppuration  appears  to  be  inevitable,  this  process  should  be  ex- 
pedited by  every  means,  so  as  to  concentrate  the  pus  at  one  point,  if 
possible.  The  warm  poultice  or  fomentations  should  be  continued,  and 
it  may  even  be  advantageous  to  apply  mercurial  ointment,  ammoniacal 
liniments,  and  such  other  "maturatives  "  as  blisters.  The  abscess  is  to 
be  treated  according  to  general  principles  :  it  should  be  opened  as  soon 
as  fluctuation  can  be  detected,  and  for  thi^i  purpose  the  bistoury  or  lan- 
cet may  be  employed  ;  though  some  practitioners  prefer  the  actual  cau- 
tery, which,  they  believe,  does  not  entail  so  much  risk  of  haemorrhage, 
favors  the  exit  of  indurated  parts,  affords  a  better  means  for  the  escape 
of  pus,  and  the  resulting  wound  heals  up  more  readily.  When  opened, 
the  wound  demands  only  ordinary  treatment — cleanliness,  detersive  or 
stimulant  dressings,  carbolic  oil  or  lotion,  etc.     To  prevent  the  opening 


MAMMITIS  OR  MASTITIS.  713 

closing  too  early — which  it  may  do  when  the  abscess  has  been  opened  by 
the  bistoury,  it  will  be  necessary  to  introduce  a  small  tent  of  lint  or  fine 
tow. 

Sometimes  several  abscesses  are  developed  simultaneously  or  succes- 
sively in  the  tumor,  and  are  separated  from  each  other  by  thin  septa.  In 
such  a  case,  having  opened  the  largest  abscess,  it  often  happens  that  the 
pus  from  the  others  drains  through  the  opening,  converting  it  into  a  fistula. 
In  such  circumstances,  a  counter-opening  must  be  made  ;  and  if  there  is 
any  necrotic  tissue  to  be  found,  it  should  be  removed.  In  all  operations 
on  the  mammary  glands,  the  incisions  should  be  carefully  made,  and  no 
larger  than  is  absolutely  necessary. 

When  the  abscesses  are  deep-seated  in  the  texture  of  the  gland  or  the 
connective  tissue,  it  frequently  happens  that,  in  opening  them,  one  or 
perhaps  more  of  the  milk  ducts  are  wounded,  and  then  we  may  have 
"  lacteal  fistulte."  From  these  the  milk  escapes,  and  renders  their  cica- 
trization difficult  and  tedious,  if  the  gland  is  active.  The  treatment  must 
chiefly  consist  in  the  application  of  caustics  to  the  walls  of  the  fistulae, 
in  order  to  hasten  granulation — the  nitrate  of  silver,  chloride  of  zinc, 
tincture  of  iodine,  or  even  the  actual  cautery,  being  generally  resorted  to. 
Soriietimes  a  cure  cannot  be  effected  until  the  gland  hae  become  "  dry." 
In  some  cases  a  pitch  plaster  or  one  of  marine  glue  is  useful,  or  the 
pressure  of  a  broad  elastic  band  when  the  fistula  is  situated  at  the  base 
of  the  teat. 

The  occurrence  of  gangrene  is  always  serious,  though  of  course  it  is 
not  so  grave  when  limited  than  when  diffuse.  It  generally  leads  to  the 
loss  of  one  or  more  quarters,  or  even  to  the  death  of  the  animal  from 
icorrhaemia  or  septikaemia.  When  limited,  little  can  be  done,  and  in 
some  cases  it  is  best  to  wait  for  the  spontaneous  elimination  of  the  dead 
portion  :  waiting  and  watching  the  process,  supporting  the  strength  of  the 
animal,  accelerating  the  separation  of  the  dead  from  the  living  tissues, 
favoring  the  free  escape  of  pus  and  putrid  matters,  so  as  to  hinder  their 
absorption,  making  counter-openings,  and  applying  antiseptic  dressings 
— as  chloride  of  zinc,  carbolic  acid,  permanganate  of  potash. 

In  other  cases,  it  may  be  necessary  to  expedite  recovery  by  excision  of 
the  mortified  mass.  In  order  to  do  this,  it  is  sometimes,  but  not  always, 
requisite  to  cast  the  animal,  and  to  fix  it  as  for  castration.  The  opening 
by  which  the  pus  escapes  is  enlarged,  and  the  tissues  still  adhering  to  the 
living  parts  of  the  gland  are  separated  from  it  by  the  fingers,  keeping 
clear  as  much  as  possible  of  the  arteries,  which  should  be  ligatured,  if 
injured.  When  the  separation  is  complete,  ligatures  may  be  placed 
round  the  principal  vessels — the  ligature  being  a  piece  of  narrow  tape  or 
ribbon,  as  their  walls  are  fragile  and  easily  torn.  If  any  haemorrhage  oc- 
curs, the  actual  cautery  or  perchloride  of  iron  may  be  employed  to  sub- 
due it.  The  wound  is  then  to  be  dressed  with  disinfecting  and  stimula- 
ting applications,  until  it  ceases  to  give  off  a  bad  odor,  and  is  throwing 
out  healthy  granulations.  The  animal  must  be  well  fed,  and  its  strength 
sustained  by  stimulants  and  tonics  if  necessary. 

When  the  gangrene  threatens  to  become  diffuse,  there  must  be  no  hesi- 
tation in  resorting  to  deep  scarifications,  in  order  to  limit  its  ravages  ; 
these  allow  the  escape  of  the  septic  fluids,  which  would  impregnate  the 
healthy  tissues  if  permitted  to  remain  ;  and  the  isolation  of  the  diseased 
parts  may  be  still  further  secured  by  plunging  the  actual  cautery  deeply 
into  them,  and  applying  oil  of  turpentine,  carbolic  acid,  perchloride  of  iron, 


714 


PATHOLOGY  OF  PARTURITION. 


or  tincture  of  camphor  to  them  and  into  the  wounds.  It  is  often  advisable 
to  trace  a  line  around  the  gangrene,  so  as  to  circumscribe  it.  When  it  is 
surrounded  by  a  ring  of  inflammation,  then  emollient  poultices  may  be 
applied  to  hasten  its  separation  ;  indeed,  if  the  part  is  quite  dead,  it  may 
be  judicious  to  cut  into  and  remove  as  much  of  it  as  can  be  done — cau- 
terizing the  wound  well  with  the  hot  iron  or  perchloride  of  iron,  and  after- 
wards dressing  it  with  chloride  of  lime,  carbolic  acid,  and  other  antiseptics. 
At  the  same  time,  antiseptic  medicines,  tonics,  and  stimulants,  should  be 
administered  internally.  It  migl>t  be  well  worth  trying  the  injection  of 
antiseptic  agents — such  as  carbolic  acid,  tincture  of  iodine,  etc.,  into  the 
gangrenous  tissues,  by  means  of  deep  incisions  and  a  Pravaz  syringe. 

Induration  following  mastitis  can  rarely  be  remedied,  but  it  may  be 
useful  to  continue  the  inunction  of  ointments  which  contain  preparations 
of  mercury — as  the  iodide — or  iodine  for  a  certain  time.  Armatage 
recommends  the  following  ointment  to  be  applied  once  a  day,  with  smart 
friction  : 

Soft  soap     - }^  lb. 

Mercurial  ointment     -         -         -         -     i  oz. 

Camphor  ointment      -         -         -         -     4  " 

Extract  of  belladonna  -         -  -     4  drams. 

Or  the  following  tincture  : 

Tincture  of  iodine       -         -         -         -     6  oz. 
Tincture  of  opium       -         -         -         -     2  " 
Soap  liniment      -        -         -         -         -     4  " 

Frequent  and  gentle  milking  may  also  prove  serviceable,  as  well  as  dry 
friction. 

As  a  preventive  measure  when  infection  is  apprehended — as  in  reten- 
tion of  the  placenta,  metritis  or  vaginitis,  etc. — it  is  advisable  to  inject  a 
weak  solution  of  carbolic  acid  (2^  per  cent.)  or  alum  (2  per  cent.),  up 
the  teat  by  means  of  a  glass  syringe,  always  after  milking  ;  the  fluid 
should  be  at  a  temperature  of  95°  Fahr.  Franck  has  proved  the  value 
of  this  precaution,  and  also  its  utility  as  a  remedial  measure  ;  indeed, 
Armatage  had  previously  recommended  the  injection  of  weak  solutions 
of  carbonate  of  soda  or  potash  in  mastitis.  Franck  has  employed  a  ten 
per  cent,  emulsion  of  carbolic  acid  as  an  injection  in  artificially-produced 
mastitis  (sixty  grammes  daily),  and  by  this  means  suppressed  the  develop- 
ment of  micrococci  and  bacteria  in  the  milk,  as  well  as  prevented  curd- 
ling of  that  fluid  in  the  ducts  and  sinuses.  Solutions  of  alum — ten  per 
cent.,  100  grammes  injected  daily — appeared  to  be  also  beneficial  in  this 
direction. 

Armatage  recommends  that  animals  suffering  from  gangrene  of  the 
mammae  should  be  removed  from  those  which  are  pregnant,  "  as  great 
excitement  will  be  produced  by  the  odor  of  decomposition,"  and  abor- 
tion is  probable. 


CHAPTER  X. 

Agalactia. 

"  Agalactia,"  or  absence  of  milk  in  the  mammae,  is  not  uncommon  in 
animals,  particularly  the   Mare  and  Cow,  and   more   especially  in  those 


INJURIES  TO  THE  TEATS,  715 

which  have  not  been  bred  from  for  a  long  time,  or  which  have  brought 
forth  their  first  young,  though  themselves  aged.  This  absence  of  secre- 
tion may  occur,  even  though  pregnancy  has  been  normal  and  has  reached 
its  full  limit.  The  udder  is  small  and  soft,  and  attempts  at  milking  only 
result  in  the  production  of  some  drops  of  yellowish  fluid,  followed  some- 
times by  a  few  drops  of  white  watery  fluid.  There  appears  to  be  a  want 
of  development  in  the  lacteal  apparatus,  which  various  causes  concur  in 
producing.  The  principal  of  these  causes  are  :  previous  or  present 
chronic  disease  in  the  mammae  ;  atrophy  of  these  glands  ;  exhaustion  fol- 
lowing disease  ;  severe  labor  ;  insufficient  food,  either  during  or  immedi- 
ately after  pregnancy;  natural  debility,  emaciation,  etc.  In  some  in- 
stances the  milk  gradually  appears  some  time  after  parturition,  and  a 
tolerable  quantity  is  secreted  ;  but  in  the  majority  of  cases  it  is  either 
not  produced  at  all,  or  only  in  very  small  quantity.  This  condition  is 
very  unfortunate  for  its  young,  which  must  suffer  from  hunger  if  not 
observed,  and  must  either  be  artificially  reared,  or  put  to  another  animal 
to  be  suckled. 

The  treatment  of  this  condition  must  frequently  prove  unsuccessful.  It 
must  chiefly  consist  in  giving  good  food,  particularly  of  a  leguminous 
kind,  with  aniseed  and  fennel,  fennel-seeds,  water  fennel,  Mcum  mutel- 
linum,  antimonials,  and  other  agents  which  are  likely  to  stimulate  the 
secretory  function  of  the  mammae.  Great  attention  must  be  paid  to  the 
digestive  organs,  and  the  teats  should  be  frequently  stripped  and  the 
mammae  rubbed,  either  dry,  or  with  some  stimulating  application. 

Macorps  (Canstatt's  jfahresbericht,  i860)  records  a  case  in  which  the 
udder  was  rubbed  with  brandy,  friction  applied  to  the  abdomen,  and 
warm  milk  and  fennel-seeds  administered ;  in  two  days  the  milk  began  to 
appear. 

When  the  absence  of  milk  is  due  to  disease  of  the  gland,  this  must  be 
combated  according  to  the  indications. 


CHAPTER  XI. 
Injuries  to  the  Teats. 

Fissures. 

The  chief  injuries  to  the  teats  consist  of  wounds,  in  the  form  of  fissures 
or  "  cracks,"  which  are  most  frequently  witnessed  in  the  Cow  a  few  days 
after  parturition  ;  and  though  apparently  unimportant,  they  nevertheless 
may  become  very  troublesome  and  serious  if  neglected,  and  even  lead  to 
mastitis  and  icorrhaemia  or  septikaemia  ;  while  they  render  the  animal 
fidgety  and  averse  to  being  milked  or  suckled — the  latter  being  especially 
inconvenient,  particularly  in  the  case  of  the  foal. 

Causes. 
These  injuries  are  generally  produced  by  the  powerful  traction  of  the 
young  creature  on  the  teat  while  sucking,  and  mainly  when  the  teat  is 
empty,  the  milk  scanty,  and  the  skin  very  thin  and  fine — as  in  primiparas. 
Even  when  the  milk  is  abundant,  but  the  skin  thin,  these  fissures  may 
occur.  The  teat  is  alternately  distended  by  milk — when  it  is  covered 
and  softened  by  the  externally  warm  saliva  and  buccal  secretions  of  the 


7 16  PA  THOLOGY  OF  PARTURITION, 

progeny,  in  the  act  of  sucking — then  retracted  and  corrugated  when 
emptied.  At  the  bottom  of  the  folds,  the  epidermis  is  rendered  soft,  and 
its  cells  loose  and  swollen  ;  these  finally,  instead  of  forming  a  continuous 
layer  capable  of  protecting  the  subjacent  derm,' give  rise  to  a  whitish 
unctuous  pulp,  which  accumulates  at  the  bottom  of  the  corrugations. 
When  this  is  removed,  a  sore  is  left,  and  the  development  of  this  sore  is 
hastened  by  cold,  which  still  further  corrugates  the  part,  as  well  as  by 
want  of  cleanliness,  contact  with  dirty  litter  or  manure,  which  irritate  the 
organ,  besides  the  act  of  milking  or  suction,  which  extend  the  sore  in 
length  and  depth.  It  may  be  that  certain  conditions  of  the  saliva  in  the 
young  creature  also  lead  to  irritation.  Cows  with  voluminous  udders 
and  long  teats,  are  often  the  subjects  of  this  injury. 

Symptoms. 

The  sore  appears  as  a  more  or  less  deep,  narrow,  and  sinuous  ulcer, 
running  transversely  around  the  teat,  and  having  indurated,  thickened, 
raised  margins,  greyish  at  the  bottom,  or  very  red  and  erythematous,  and 
containing  a  variable  quantity  of  the  thick  unctuous  matter  just  men- 
tioned. The  teat  is  apparently  not  much  deformed — at  least  after  milk- 
ing, when  it  is  retracted  ;  and  the  fissures  might  readily  pass  unperceived. 
Then  it  is  necessary  to  draw  the  end  of  the  teat  gently,  in  order  to  dis- 
cover them. 

When  superficial,  they  are  not  so  troublesome  as  when  deep,  irritable, 
and  bleeding  ;  then  they  are  extremely  painful,  and  the  animal  refuses  to 
be  suckled  or  milked,  while  attempts  to  handle  the  teat  cause  the  crea- 
ture to  offer  great  resistance. 

These  fissures  have  an  almost  natural  tendency  to  increase  in  depth, 
so  long  as  the  young  creature  is  suckled.  Sometimes  they  form  at  the 
very  extremity  of  the  teat,  and  the  sinus  and  milk  ducts  become  inflamed, 
the  viscid  matter  secreted  becomes  firm  and  blocks  up  the  canal,  which 
may  ultimately  be  completely  obliterated,  causing  retention  of  the  milk, 
inflammation  of  the  gland,  and  perhaps  lead  to  a  fatal  termination. 

Treatment. 

Fissur-es  in  the  teat  should  not  be  neglected,  however  slight  they  may 
appear  to  be.  They  might  be  prevented  by  cleanliness  and  care,  and 
keeping  the  animal  from  draughts  of  cold  air.  It  is  a  good  plan,  par- 
ticularly with  primiparae,  and  especially  the  finer  bred  Cows,  to  examine 
and  wash  the  teats  for  a  short  time  after  parturition,  and  if  there  is  a 
tendency  to  sores,  to  dress  them  with  some  bland  substance — as  lard, 
glycerine,  or  olive-oil. 

When  fissures  are  present,  and  especially  when  they  are  deep,  an  es- 
sential condition  for  their  recovery  is  preventing  the  progeny  from  using 
the  affected  teat  or  teats.  By  this  abstention,  and  the  use  of  the  teat- 
syphon  (well  disinfected  every  time)  to  empty  the  gland,  recovery  in  the 
most  serious  cases  is  comparatively  rapid,  and  sometimes  even  sponta- 
neous. 

P^mollient  lotions  are  generally  recommended,  and  the  ordinary  fluid 
is  the  milk  drawn  from  the  teat,  which  is  frequently  applied  during  the 
day,  the  part  being  well  cleaned  with  a  soft  cloth  after  each  application. 
This  and  other  mild  emollients  may  be  useful  when  the  injuries  are  very 
slight  and  superficial  ;  but  when  they  are  more  serious,  or  a  rapid  recov- 
ery is  important,  then  recourse  must  be  had  to  more  efficient  remedies. 


INJURIES  TO  THE  TEATS.  yiy 

For  this  purpose,  perhaps  nothing  is  better  than  carbolized  glycerine 
(i  to  20),  or,  in  very  severe  cases,  to  watery  solution  of  silicate  of 
soda.  It  may  expedite  recovery  to  touch  the  fissures  lightly  with  nitrate 
of  silver,  and  to  cover  the  teat  with  an  india-rubber  capsule  or  ring. 

Obliteration  of  the  Galactophorus  Sinus. 
This  may  result  from  fissures,  disease,  or  growths  of  various  kinds,  or 
it  may  be   congenital  (atresia),  and   is   most  frequently  observed  in  the 
Cow.     It  may  be  either  partial  or  complete. 

Symptoms. 

When  due  to  fissures  or  disease,  the  symptoms  are  gradually  developed  ; 
but  when  the  occlusion  is  congenital,  they  suddenly  appear  either  imme- 
diately before  or  after  parturition,  when  the  gland  becomes  active.  Then 
the  udder  is  distended,  but  no  milk  issues  from  the  teat;  the  distention 
increases,  and  if  relief  is  not  afforded,  inflammation  and  suppuration  may 
result.  On  examination  of  the  end  of  the  teat  in  congenital  atresia,  pres- 
sure, as  if  in  milking,  and  if  the  skin  alone  be  the  obstacle,  will  cause  a 
slight  prominence  where  the  opening  of  the  sinus  should  be,  the  milk 
being  felt  in  the  sinus.  Should  the  occlusion  extend  higher,  and  the 
whole  or  a  portion  of  the  sinus  be  obliterated,  then  this  prominence  will 
not  be  produced,  and  the  obstacle  will  be  discovered  towards  the  base  of 
the  teat. 

Occlusion  brought  about  by  inflammation,  hypertrophy  of  the  mucous 
membrane  lining  the  sinus,  or  the  development  of  any  growth — as  a  wart 
— does  not  occur  suddenly  ;  and  in  milking  it  will  be  observed  that  the 
stream  of  fluid  gradually  becomes  smaller,  until  at  last  it  can  only  be 
drawn  drop  by  drop,  or  its  flow  has  completely  ceased. 

Treati7ient. 

When  the  occlusion  is  only  due  to  the  skin — which  is  not  uncommon 
in  primiparae — a  small  crucial  incision  made  through  it  by  the  bistoury 
or  lancet,  is  generally  ail  that  is  necessary.  The  sinus  of  the  teat  is  dis- 
tended with  milk  by  pressure  from  the  base,  and  the  prominence  at  the 
end  is  then  incised.  To  prevent  the  wound  closing,  a  small  bougie  is  in- 
troduced into  the  sinus  for  four  or  five  days  until  the  wound  has  cica- 
trized j  it  should  only  be  taken  out  at  milking  time.  Fiirstenberg  states 
that  he  has  seen  the  opening  thus  made  remain  permeable  during  the 
whole  period  of  lactation,  but  close  again  when  this  period  expired  ;  and 
a  second  operation  had  to  be  performed  at  the  next  calving. 

When  the  obstacle  is  in  the  sinus  of  the  teat,  at  the  narrow  part  of  the 
canal,  and  immediately  above  the  sphincter,  a  fine  trocar  or  stocking- 
needle,  previously  cleaned  in  boiling  water  and  dipped  in  carbolic  acid 
solution,  must  be  passed  into  it  and  through  the  obstruction,  when  the 
milk  will  flow.  To  prevent  closure,  the  cannula  of  the  trocar  or  a  teat- 
syphon  may  be  inserted  for  some  days,  the  opening  being  closed  by  a 
cork  except  at  milking-time.  Or  a  solid  gutta-percha  sound  may  be  em- 
ployed until  an  artificial  mucous  membrane  is  found,  removing  it  when 
milking. 

When  the  canal  is  only  partially  obstructed,  and  the  milk  yet  flows,  the 
introduction  of  a  small  feather — pigeon's — or  a  piece  of  thick  catgut,  will, 
with  a  little  patience,  gradually  effect  dilatation.  But  should  it  not  suffice, 
and  particularly  if  a  wart  is  the  cause  of  obstruction,  ao  incision  will  be 


7 18  PA  THOLOG Y  OF  PARTURITION. 

necessary.  Various  instruments  have  been  proposed  for  this  operation, 
but  Ltithi's  sound  is  perhaps  the  best.  This  is  an  iron  wire  about  eight 
millimetres  long  and  two  in  diameter,  having  a  ring  at  one  end,  and  at 
the  other  a  steel  cone  screwed  on  to  it.  This  cone  has  a  very  sharp 
point,  and  both  sides  have  cutting  edges  at  the  base  or  widest  part.  It  is 
passed  into  the  opening  of  the  teat,  pushed  through  the  obstacle,  and  then 
gently  turned  round  from  side  to  side  until  no  resistance  is  felt.  Then 
it  is  withdrawn,  and  a  bougie  or  teat-syphon,  or  a  piece  of  thick  earbol- 
ized  catgut  introduced.  Zundel  mentions  that  Ltithi  and  Strebel  have 
been  very  successful  by  this  method  of  operating. 


B 

Fig.  209, 

LuTHi's  Perforating  Sound. 
A.  Half  the  Natural  Size.        B.  Natural  Size  and  Section  of  the  Cone. 

In  all  cutting  operations  on  the  teat,  every  precaution  must  be  adopt- 
ed for  the  prevention  of  mastitis ;  and  this  must  chiefly  consist  in  follow- 
ing out  the  antiseptic  method  of  treatment  of  the  incisions  as  closely  as 
possible. 

Fistula  of  the  Teat. 

We  have  seen  several  cases  of  fistula  of  the  teat  which  proved  very 
troublesome  to  cure  during  the  period  of  lactation.  From  injury  or 
disease,  an  opening  is  established  between  the  milk  sinus  and  the  side  of 
the  teat ;  so  that  the  milk,  instead  of  passing  through  the  canal  in  the 
extremity,  escapes  in  a  jet  at  the  side,  and  its  flow  is  nearly  constant. 
This  is  a  source  of  loss,  and  has  often  an  unpleasant  appearance.  If  it 
is  decided  to  cure  the  fistula  during  the  lactation  period,  and  the  opening 
is  towards  the  middle  of  the  teat,  then  the  ring  teat-syphon  must  be  kept 
in  the  sinus  for  some  time,  and  the  fistula  treated  according  to  surgical 
principles.  When  the  fistula  is  towards  the  extremity  of  the  teat,  how- 
ever, the  case  is  more  difficult,  and  the  teat-syphon  only  too  often  renders 
it  worse.  Then  it  is  generally  necessary  to  wait  until  the  Cow  is  "  dry," 
when,  with  a  little  attention,  the  fistula  is  readily  cured. 


A  SPHP  VIA  OF  THE  NE  W-BORN  A  NIMAL.  7 19 

BOOK   VI. 

DISEASES  AND  ABNORMALITIES  OF  THE  YOUNG  ANIMAL. 

The  diseases  and  abnormalities  of  the  young  animal,  gbserved  immedi- 
ately after  birth,  are,  many  of  them,  of  the  greatest  importance,  and 
deserve  far  more  attention  than  they  have  yet  received  in  England. 
Their  consideration  forms  an  appropriate  complement  to  what  has  been 
said  as  to  the  pathology  of  the  parturient  state  of  the  female  parent ;  and 
a  notice  of  them,  however  brief  and  imperfect  it  may  be,  is  all  the  more 
necessary,  as  few,  if  any  of  them,  are  referred  to  in  works  on  veterinary 
medicine  or  surgery.  We  will  describe  them  in  the  following  order  : — 
(i)  Asphyxia,  (2)  Umbilical  Hcemorrhage,  (3)  Persistence  of  the  l/rachus, 
(4)  Umbilical  Hernia,  (5)  CEdema  of  the  Umbilicus,  (6)  Inflammation  of 
the  Umbilical  Cord,  (7)  Arthritis,  (8)  Indigestion,  (9)  Diarrhoea,  (10)  Re- 
tention of  Meconium,  (11)  Skiti  dryness,  (12)  Imperf oration  of  the  Anus, 
(13)  Imperforation  of  the  Vulva,  (14)  Imperforation  of  the  Prepuce,  {\^ 
Cyanosis. 


% 

CHAPTER  I. 

Asphyxia  of  the  New-born  Animal. 

At  page  247,  under  the  head  of  "  Suspended  Animation,"  we  alluded  to 
asphyxia  of  the  new-born  animal — a  condition  similar  to  that  of  the  new- 
born child,  and  briefly  alluded  to  the  measures  necessary  for  restoration. 
We  have  likewise  referred  to  the  immediate  cause  of  this  condition.  It 
has  been  recognized  that  when  animals  are  submitted  during  pregnancy 
to  insufficient  food,  to  severe  exertion,  have  suffered  from  chest  disease, 
or  from  colic  a  short  time  before  parturition,  or  when  labor  has  been 
difficult  and  protracted,  the  young  creature  at  birth  is  so  exhausted  that 
it  lies  apparently  dead — all  the  tissues  being  pale  and  flaccid,  the  body 
low  in  temperature,  and  the  heart's  beats  and  the  respiratory  movements 
are  very  feeble  or  quite  imperceptible. 

There  may  also  be  syncope  or  asphyxia  from  plethora  or  cyanosis  ; 
asphyxia  may  likewise  be  due  to  interrupted  circulation  in  the  umbilical 
cord,  and  intra-uterine  respiration. 

Apparent  death,  or  suspended  animation,  must  be  treated  in  the 
manner  indicated  at  page  247.  The  mouth  and  trachea  should  be 
cleared  of  mucus  and  amniotic  fluid,  if  any  of  the  latter  has  passed  into 
the  air  passages,  as  it  may  give  rise  to  pneumonia,  should  the  creature 
be  resuscitated  and  live  for  a  short  time.  With  the  calf  or  foal,  it  is 
possible  to  pass  an  elastic  tube  or  catheter  through  the  nostril  into  the 
trachea,  and  by  means  of  a  syringe  to  remove  much  of  the  fluid  there- 
from. 

Aspersion  of  the  skin  with  cold  water  may  also  be  useful  in  stimula- 
ting the  respiratory  nerve-centre,  by  the  reflex  action  it  induces.  This  is 
more  particularly  indicated  when  asphyxia  is  due  to  an  excess  of  carbonic 
acid  in  the  blood.  Stimulation  of  the  skin  may  also  be  useful  in  this 
direction.      Direct  electric  stimulation  of  the  phrenic  nerve  should  be 


720 


DISEASES  AND  ABNORMALITIES. 


attempted.  Artificial  inflation  of  the  lungs  should  not  be  tried  until  the 
mouth  and  fauces  have  been  cleared  of  mucus ;  this  may  be  effected  by 
suction,  which  has  a  very  beneficial  action  otherwise.  Indeed,  some 
authorities  prefer  aspiration  to  inspiration  or  blowing  into  the  mouth  ; 
and  Albert  (Henke's  Zeitschrift  fur  Staatqrzneikiinde^\o\.  xxiii,,  p.  279) 
has  restored  41  out  of  47  cases  of  apparently  dead  animals,  by  aspiration 
or  Suction. 

Transfusion  of  blood  by  the  umbilical  vein  might  prove  useful  ;  be- 
tween one-half  and  a  litre  of  blood  should  be  sufficient  for  a  foal  or  calf, 
according  to  Franck.  The  fumes  of  ammonia  or  some  other  powerful 
volatile  irritant  may  be  applied  to  the  nostrils.  A  few  drops  of  brandy 
may  also  be  poured  into  the  nostril. 


CHAPTER  II. 

Umbilical  Haemorrhage. 

HEMORRHAGE  from  the  umbilical  cord  does  not  appear  to  be  a  very 
common  accident  ;  nevertheless,  it  does  sometimes  occur,  and  in  some 
cases  so  copiously  as  to  cause  death.  It  rq^ay  ensue  immediately  after 
birth,  rarely  after  some  days  ;  and  it  may  continue  for  a  short  or  long 
period — producing  great  debility,  and  even  dissolution.  The  haemor- 
rhage is  generally  due  to  imprudence  in  cutting  the  umbilical  cord  too 
near  the  abdomen,  or  to  laceration  of  the  vessels  of  which  it  is  composed 
during  difficult  parturition,  when  violent  traction  tears  it  close  to  the 
abdominal  ring  ;  in  very  rare  instances  it  may  be  due  to  a  varicose  con- 
dition of  the  vessels.  Zundel  alludes  to  a  predisposition  to  umbilical 
haemorrhage — a  kind  of  haemophilus.  In  one  or  two  instances  the  bleed- 
ing has  been  induced  by  either  the  mother,  the  young  creature,  or  its 
companions  sucking  or  pulling  at  the  remains  of  the  cord. 

In  the  foal,  the  haemorrhage  may  take  place  from  the  artery,  as  that 
vessel  is  firmly  attached  to  the  umlDilical  ring ;  with  ruminants  it  takes 
place  from  the  vein,  because  of  the  existence  of  the  Ductus  Arantii,  and 
the  retraction  of  the  artery  within  the  abdomen. 

Treatment. 

When  the  bleeding  is  trifling  and  not  likely  to  continue  long,  little,  if 
any  thing,  requires  to  be  done  ;  but  when  it  is  copious  and  continuous, 
active  and  prompt  treatment  must  be  adopted. 

When  the  cord  is  extremely  short,  astringents — as  alum,  tannic  acid, 
etc.,  may  be  tried,  or  such  haemostatic  agents  as  the  sesquichloride  of 
iron,  nitrate  of  silver,  etc.,  or  even  the  actual  cautery  in  a  fine  point.  If, 
however,  the  cord  is  sufficiently  long,  it  is  better  to  apply  a  ligature  ;  this 
will  check  the  bleeding,  and  the  cord  will  slough  away  in  four  or  five 
days.  In  applying  the  ligature,  however,  the  operator  must  be  careful 
not  to  include  a  portion  of  intestine  within  it ;  and  when  there  is  much 
infiltration  of  the  cord,  as  sometimes  happens,  the  serum  should  be  got 
rid  of,  as  much  as  possible,  by  squeezing  with  the  fingers  or  sacrifica- 
tion,  in  order  that  the  ligature  may  exercise  sufficient  compression  after- 
wards. 


PERSISTENCE  OF  THE  URACHUS.  721 

Artificial  respiration  is  sometimes  required  when   syncope  or  asphyxia 
is  present,  and  this  alone  often  suppresses  the  haemorrhage. 

The  transfusion  of  blood  may  be  urgently  demanded  in  extreme  cases. 


CHAPTER  HI. 

Persistence  of  the  Urachus. 

In  studying  the  development  of  the  foetus,  we  described  the  urachus 
(pp.  77,  87),  and  pointed  out  that  it  was  a  canal  formed  by  the  middle 
portion  of  the  allantois,  which  passed  through  the  umbilical  ring,  and 
during  fcetal  life  communicated  with  the  bladder,  from  which  it  conveyed 
the  urine  into  the  allantoid  sac.  After  birth  this  canal  is  obliterated,  its 
walls  become  a  thin  cord,  and  the  bladder  is  retracted  within  the  pelvic 
cavity,  the  urine  then  passing  through  the  urethra.  It  not  unfrequently 
happens,  however,  that  from  accidental  circumstances  or  some  malforma- 
tion, the  canal  of  the  urachus  is  only  partially  or  not  at  all  obliterated 
after  birth  ;  consequently,  the  urine  continues  to  escape  by  drops  or  in  a 
thin  stream  from  the  umbilicus  or  umbilical  cord.  This  condition  is  far 
more  frequent  in  solipeds  than  ruminants,  owing  to  the  urachus — like  the 
umbilical  artery — being  firmly  attached  to  the  umbilical  ring  in  the  for- 
mer, and  therefore  not  at  oace  withdrawn  into  the  abdomen,  as  in  the 
latter,  when  the  umbilical  cord  is  divided  at  birth.  Therefore  it  is,  that 
escape  of  urine  from  the  navel  is  very  seldom  noticed  in  the  calf  ;  while 
in  the  foal  it  is  often  witnessed,  particularly  when  the  abdominal  ring  re- 
mains very  open,  or  the  cord  is  excised  close  to  the  body.  This  condi- 
tion has,  however,  been  seen  in  calves. 

It  appears  to  be  more  frequent  in  male  than  female  animals,  and  is 
most  dangerous  in  the  former  ;  in  the  latter,  the  discharge  of  urine  by 
this  abnormal  channel  often  ceases  spontaneously,  only  passing  at  first 
in  drops  ;  whereas,  in  the  male,  it  generally  escapes  in  a  stream,  little  or 
no  urine  being  discharged  from  the  urethra. 

Treatment, 

In  some  cases  scarcely  any  treatment  is  necessary,  the  escape  of  urine 
ceasing  in  a  few  days  after  birth  ;  and  when  interference  is  demanded,  a 
cure  can  generally  be  effected  in  a  short  time,  if  the  urethra  is  pervious. 
Be'nard  {Recueil  de  Med.  Veterinaire,  1828)  mentions  an  instance  of  this 
accident,  in  which  death  occurred  two  days  after  applying  a  ligature  to 
the  urachus ;  it  was  then  discovered  that  the  urethra  was  imperforate,  so 
that  the  urine  could  not  be  expelled  at  all.  It  is  therefore  necessary, 
before  adopting  remedial  measures,  to  ascertain  that  the  urethra  is 
patent. 

When  the  urachus  protrudes  sufficiently  from  the  umbilical  ring,  a  lig- 
ature may  be  fastened  firmly  around  it. 

When  it  is  close  to  the  abdominal  ring,  and  consequently  too  short  to 
be  secured  by  the  ordinary  ligature,  it  must  be  secured  by  a  curved 
needle.  The  foal  is  thrown  on  its  left  side,  and  the  operator,  holding 
the  nejedle  armed  with  the  thread  in  his  right  hand,  seizes  the  urachus, 
which  is  covered  by  the  skin,  between  the  thumb  and  index-finger  of  the 
left  hand,  and  pulls  it  outwards  ;  the  needle  is  then  passed  through  be- 

46 


722  DISEASES  AND  ABNORMALITIES. 

hind  the  canal,  induding  as  little  of  the  skin  as  possible,  and  the  ends 
tied.  If  there  is  any  doubt  as  to  the  patency  of  the  urethra,  the  ligature 
should  only  be  partially  tightened,  until  the  nature  of  the  obstruction  is 
ascertained  and  removed.  When  this  is  done,  then  the  ligature  may  be 
firmly  tied  when  the  urine  escapes  freely  by  the  natural  channel. 

In  those  cases  in  which  the  urachus  cannot  be  secured  by  this  pro- 
cedure, astringents  or  caustics — such  as  the  sulphate  of  copper — may  be 
successfully  employed.  Beneficial  results  have  been  obtained  by  the  ap- 
plication of  a  strong  vesicant  around  the  umbilical  ring,  the  tumefaction 
caused  by  it  closing  the  opening.  The  actual  cautery  has  also  been  most 
successfully  employed,  particularly  in  a  fine  point. 

In  the  foal  this  accident  is  not  uncommon  ;  in  the  calf  it  is  so. 

1.  Ercolani  {Osservazioni  di  Anatomia  PatJiolo^s[ica  Cotnparata,  Bologna,  1872)  gives  an 
interesting  relation  of  this  accident  in  a  calf  about  thirty  xlays  old. 

2.  Cingolani  {Gichrnale  di  Med.  Fratica  della  Societa  Vet.  Torino.,  1876,  p.  214)  relates 
that  a  Cow  brought  forth  a  well-developed  female  calf  which,  five  hours  after  birth, 
was  observed  to  pass  its  urine,  not  in  the  ordinary  way,  through  the  urethra,  but  in  con- 
tinual drops  from  the  navel.  Cingolani  examined  the  creature  carefully,  and  could  not 
discover  any  indications  of  atresia  of  the  urethra;  but  nothing  was  done  for  fifteen  days, 
during  which  time  the  urine  escaped  by  the  same  channel,  and  the  urachus  protruded 
like  a  tap.  A  ligature  was  then  applied,  and  the  opening  closed.  On  the  succeeding 
evening  serious   symptoms  ensued;  the  belly  was   much 'retracted,  and  great  pain  was 

'caused  by  pressure  ;  there  was  intense  fever,  and  the  calf  was  comatose.  The  operation 
being  suspected  as  the  cause  of  these  symptoms,  the  ligature  was  untied,  but  no  urine 
now  passed  from  the  navel ;  neither  did  any  pass  from  the  urethra,  though  on  a  catheter 
being  introduced,  between  100  to  120  grammes  were  Withdrawn.  No  relief  was  afforded  ; 
the  abdomen  became  greatly  enlarged,  and  the  pain  increased ;  the  pulse  was  small, 
the  extremities  were  cold,  and  tetanoid  spasms  were  noticed.  In  two  days  the  calf  died. 
An  examination  revealed  obliteration  of  the  urachus  by  plastic  exudation,  the  kidneys 
were  hyperaemic,  the  ureters  opened  into  a  small  cylindrical  reservoir  about  14  or  15 
centimetres  long,  which  contained  only  about  100  to  120  grammes  of  urine  ;  this  appeared 
to  be  the  bladder,  and  from  it  passed  the  urethra,  while  underneath  was  a  wide  opening 
into  the  urachus.  In  the  abdominal  cavity  was  about  a  litre  of  urine.  The  symptoms 
presented  by  the  animal  during  life  were  evidently  due  to  uraemia. 


CHAPTER  IV. 


Umbilical    Hernia. 


ExoMPHALUS  omphalocele,  or  umbilical  ox  navel  hernia  is  not  at  all  rare  in 
young  animals,  and  is  perhaps  most  frequently  observed  in  foals  and  pup- 
pies ;  it  does  not  appear  to  be  so  common  in  calves,  and  in  pigs  and  lambs 
it  is  seldom  seen.  It  would  seem  to  be  more  prevalent  in  some  countries 
or  regions  than  in  others.  Marlot  states  that  in  every  score  of  foals  or 
mules  bred  in  France,  one  is  so  affected.  The  hernia  or  rupture  may  ap- 
pear at  birth  or  some  time  after,  and  may  continue  during  the  life  of  the 
animal  if  no  measures  are  adopted  to  cure  it ;  it  may  be  congenital  or  ac- 
quired. The  congenital  form  is  produced  during  foetal  life,  when  a  portion 
of  the  digestive  and  biliary  apparatus  is  contained  in  the  umbilical  cord, 
the  anatomy  of  which  has  been  described  at  page  86.  The  embryonic 
connective  tissue  or  Whartonian  gelatine,  in  which  are  imbedded  the  two 
umbilical  arteries  and  vein  (two  in  the  calf  and  pig),  is  very  abundant  at 
the  elliptical  opening  named  the  umbilical  ring,  through  which  also  pass 
the  urachus,  the  omphalo-mesenteric  vessels,  and  a  portion  of  intestine. 
After  birth  the  u'mbilical  cord  withers,  and  the  Whartonian  gelatine  be- 


i':::uLiCAL  hernia.  723 

comes  condensed  and  organized,  forming  a  fibrous  membrane  which 
closes  the  umbilical  opening,  and  gradually  contracting,  brings  the  two 
edges  together  ;  these  unite,  and  soon  nothing  is  left  to  mark  the  situa- 
tion of  the  opening,  except  a  short  lozenge-shaped  fibrous  cicatrix  :  the 
intestine  had  previously  been  retracted  within  the  abdomen,  and  the 
urachus,  becoming  contracted  after  birth  into  a  thin  ligament,  while  the 
blood-vessels  are  obliterated. 

It  sometimes  happens,  however,  that  the  process  of  cicatrization  is 
either  prevented,  retarded,  or  interrupted  ;  consequently,  the  umbilical 
ring  remains  more  or  less  patent,  and  certain  viscera  either  remain  in  it, 
or  are  pushed  into  it  by  an  internal  pressure,  and  lodged  in  the  pouch 
formed  externally  by  the  skin.  In  this  congenital  hernia,  the  vein  or 
veins  and  the  arteries  are  separated  by  the  misplaced  viscera,  the  former 
being  usually  in  front,  the  latter  behind. 

The  lesion  may  be  observed  at  the  moment  the  animal  is  born ;  and 
after  the  cord  is  ruptured  it  may  happen  that  the  abdomen  remains  open, 
the  viscera  being  exposed  ;  the  creature  then  generally  succumbs  quickly. 

Acquired  or  accidental  umbilical  hernia  usually  appears  soon  after  the 
cord  has  withered,  or  within  a  few  months  after  birth. 

A  true  and  false  exomphalus  have  been  described  :  the  first  being  that 
just  mentioned,  in  which  hernia  takes  place  through  the  umbilical  ring ; 
while  the  second  occurs  through  an  accidental  opening  in  the  neighboring 
aponeurotic  or  muscular  tunics  of  the  abdomen,  and  is  in  reality  ventral 
hernia — occurring,  as  it  generally  does,  after  birth  and  in  adult  animals. 
Various  kinds  of  umbilical  herniae  have  also  been  alluded  to,  according  as 
the  viscus  is  intestine  or  omentum,  or  both  ;  thus  we  have  enter omphalus^ 
mesentero  or  epiplomphalus,  and  entero-epiplomphalus.  The  last  is  most 
frequently  observed  in  carnivorous  animals. 

Causes. 

We  have  just  alluded  to  the  cause  of  congenital  hernia.  Acquired  or 
accidental  hernia  may  be  due  to  severe  or  sudden  muscular  exertion  ;  as 
when  the  foal  or  calf  runs  or  jumps  very  actively  during  its  gambols  or 
when  pursued,  or  in  falls.  It  is  sometimes  produced  when  the  young 
creature  is  separated  from  its  parent,  and  being  kept  in  an  isolated  place,, 
it  rushes  about  and  cries  energetically.  Umbilical  hernia  has  also  been 
known  to  follow  an  attack  of  colic,  and  after  constipation  or  diarrhoea. 

There  appears  to  be  generally  present,  in  umbilical  hernia,  a  certain 
organic  predisposition,  due  to  the  suppressed  or  imperfect  organization  of 
the  Whartonian^  gelatine  ;  and  it  has  been  remarked  that  common-bred 
animals  are  more  liable  to  it  than  those  of  the  higher  breeds.  Neverthe- 
less, in  all  those  in  which  it  manifests  itself — no  matter  what  the  breed 
may  be — there  is  usually  constitutional  debility  present,  due  in  many  in- 
stances to  the  mother  having  been  ill-fed  and  badly  cared  for  during- 
pregnancy.  Zundel  says  that  there  are  years  in  which  the  accident  is 
usually  frequent,  and  particularly  ^vhen  much  rain  prevails,  as  then  the 
food  of  herbivorous  animals  is  more  aqueous  than  usual.  Low,  wet,  marshy 
pastures  are  also  believed  to  predispose  to  hernia ;  as  in  them  the  tissues 
become  soft  and  relaxed,  and  the  digestive  organs  inordinately  bulky  ; 
foals  and  calves  kept  in  these  situations  have  the  belly  voluminous,  and 
the  extrinsic  pressure  v/eakens  the  abdominal  walls.  Benard,  Hamon, 
Cruzel,  Bouley,  and  others  believe  in  heredity  as  a  predisposing  cai>se : 


724  DISEASES  AND  ABNORMALITIES. 

Mares  which  were  affected  with  umbilical  hernia  when  young,  have  pro- 
duced foals  which  presented  this  lesion. 

Pathological  Anatomy. 

The  hernial  pouch  or  sac  is  nearly  always  lined  by  peritoneum — the 
peritoneal  investment  being  produced  at  the  same  time  as  the  hernia.  In 
some  instances,  however,  the  peritoneum  gives  way  to  the  pressure  of  the 
viscera,  and  then  the  walls  of  the  sac  are  composed  only  of  connective 
tissue  and  skin.  The  latter  is  frequently  so  much  stretched  that  it 
becomes  thinner,  and  in  puppies  is  generally  quite  transparent. 

Marlot  says  that  the  sac  is  usually  composed  of  five  layers :  i.  The 
parietal  peritoneum  ;  2.  A  very  fine  fibrous  layer  constituted  by  the 
fascia  transversalis ;  3.  A  kind  of  dartos  formed  by  the  tunica  abdomi- 
nalis  ;  4.  The  panniculus  carnosus  muscle  ;  5.  The  skin  :  the  whole 
being  connected  by  connective  tissue.  But  this  arrangement  is  far  from 
being  constant.  The  opening  of  the  hernial  sac  corresponds  to  the 
umbilical  opening,  which  is  elongated,  and  measures  in  the  foal  from  i^ 
to  3^  inches  in  length,  its  width  being  variable,  but  never  exceeding  two 
inches.  The  viscera  contained  in  the  sac  are  usually  the  small  intestine, 
omentum,  free  colon,  and  the  point  of  the  caecum.  Lanclot,  Be'nard, 
Delafond,  Hertwig,  and  others  have  sometimes  found  the  urachus  in  the 
sac,  as  well  as  intestine ;  but  in  congenital  hernia,  the  urachus  can 
scarcely  fail  to  be  absent,  and  we  may  also  have  the  umbilical  veins.  It 
rarely  happens  that  there  is  any  adhesion  between  the  hernied  organs 
and  the  sac  containing  them,  inflammation  being  rare  ;  the  sac  seldom 
indeed  contains  any  serum,  and  is  therefore  in  immediate  contact  with 
the  misplaced  viscera.  When  ascites  is  present,  however,  serous  fluid 
may  then  be  present,  and  constitute  the  diseased  condition  termed 
"  hydro-enteromphalus." 

Symptoms. 

The  symptoms  of  umbilical  hernia  are,  as  a  rule,  entirely  local.  There 
is  a  round  or  pyriform  tumor  situated  in  the  region  of  the  umbilicus  or 
*'  navel,"  varying  in  size  in  different  individuals  and  species — from  that 
of  a  pigeon's  egg  to  a  child's  head,  or  even  larger.  The  siz-e  also  varies 
in  the  same  individual  at  different  times,  according  as  the  digestive 
organs  are  full  or  empty,  the  attitude  standing  or  recumbent,  at  rest  or 
undergoing  active  exertion,  or  the  duration  of  the  hernia — the  older  it  is, 
the  larger  the  tumor.  It  is  usually  soft,  fluctuating,  easily  depressed  by 
the  finger,  and  as  readily  resuming  its  ordinary  size  and  shape  ;  when 
recent,  however,  it  is  often  tense  and  not  depressible.  Sometimes  it  has 
a  doughy  feel  and  fluctuates  much,  and  at  other  times  it  is  flaccid,  accord- 
ing as  the  portion  of  intestine  which  it  contains  is  empty  or  filled  with 
alimentary  matters.  It  is  nearly  always  indolent,  and  in  the  large 
majority  of  cases  can  be  reduced  by  throwing  the  animal  on  its  back,  by 
manipulation  externally,  or  by  taxis  internally.  The  tumor  soon  returns, 
however,  particularly  when  the  animal  lies  down  or  moves  about  ;  closing 
the  nostrils  or  causing  the  animal  to  cough,  will  also  produce  its  imme- 
diate appearance. 

When  the  sac  has  been  emptied  by  pressure  or  taxis,  the  opening  in  the 
abdomen  can  then  be  perceived.  As  a  general  rule,  the  volume  of  the 
tumor  corresponds  to  the  dimensions  of  this  opening,  which  is  sometimes 
elliptical,  at  other  times  nearly  or  completely  circular  ;  in  false  or  acci- 


UMBILICAL  HERNIA. 


725 


dental  hernia,  it  is  usually  irregular  in  outline.  The  borders  of  the 
opening  feel  tense  and  resisting. 

On  applying  the  open  hand  against  the  tumor,  the  vermicular  move- 
ment of  the  intestine  can  be  ascertained  \  careful  taxis  may  lead  to  the 
discovery  of  a  loop  of  intestine  in  the  sac  ;  while  auscultation  may  detect 
the  rumbling  of  the  displaced  viscus. 

When  the  tumor  is  not  reducible,  this  is  generally  due  to  the  presence 
of  an  accumulation  of  f^cal  matters  or  other  substances  in  the  intestine. 
Inflammation  is  rare,  and  is  ordinarily  due  to  contusions  or  other  exter- 
nal influences.     Strangulation  of  the  intestine  is  likewise  far  from  frequent. 

Prognosis. 

Umbilical  hernia  is  not  a  serious  condition  in  young  animals,  except  in 
rare  cases.  Sometimes  spontaneous  recovery  takes  place  ;  in  the  great 
majority  of  instances  a  cure  is  easily  effected  ;  and  even  when  the  hernia 
persists  there  is  but  little  danger,  health  and  utility  being  seldom  inter- 
fered with.  When  the  hernial  sac  is  occupied  by  omentum  only,  and  the 
abdominal  opening  is  small,  there  is  much  less  danger  than  when  the 
intestine  is  involved,  while  spontaneous  recovery  is  much  more  probable. 
In  adult  animals  umbilical  hernia  is  often  a  serious  accident  ;  and  its 
gravity  generally  depends  on  the  volume  of  the  tumor.  Complicated 
hernia  is  always  dangerous. 

Though  not  at  all  serious  in  itself,  when  affecting  young  animals,  yet 
from  their  diminished  value,  and  the  expense  of  treatment,  umbilical 
hernia  may  become  a  cause  of  much  loss. 

Marlot  estimates  that  in  France  this  accident  causes  a  loss  of  more  than 
a  million  francs  to  French  agriculture.  We  know  nothing  as  to  its  prev- 
alence in  Britain. 

Diagnosis. 

The  diagnosis  of  umbilical  hernia  is  not  difficult,  so  long  as  it  is  uncom- 
plicated. If,  however,  the  tumor  is  hot,  painful,  and  oedematous,  it  may 
be  mistaken  for  an  abscess  or  a  recent  traumatic  hernia  ;  it  may  also 
assume  the  appearance  of  an  indolent  fibrous  tumor  or  a  "  cold  abscess," 
when  the  contained  intestine  is  filled  with  faeces. 

It  is  not  easy  to  distinguish  between  enteromphalusand  epiplomphalus, 
even  when  there  is  no  complication.  Causing  the  animal  to  cough  may 
enable  the  expert  not  only  to  diagnose  the  presence  of  umbilical  hernia, 
but  also  whether  it  is  of  the  omentum  or  intestine,  the  effort  producing 
enlargement  of  the  tumor  when  the  intestine  is  misplaced. 

Treatment. 

We  have  stated  that  umbilical  hernia  in  young  animals  often  disappears 
spontaneously ;  and  though  there  are  several  ways  in  which  it  can  be 
remedied  artificially,  yet  unless  there  are  reasons  to  fear  complications, 
or  a  cure  is  desired  early,  it  may  be  well  to  consider  whether  it  is  not 
advisable  to  wait — at  least  for  some  time,  to  see  if  spontaneous  recovery 
will  take  place.  It  is  well  known  that  during  the  lactation  period,  the 
small  intestine,  which  is  at  this  time  the  most  developed  portion  of  the 
alimentary  canal — instead  of  occupying  the  left  flank,  lies  immediately  on 
the  floor  of  the  abdomen  ;  but  as  the  young  creature  grows  and  its  diet 
is  changed  from  milk  to  the  food  on  which  it  is  for  the  future  to  subsist, 
this    intestine   is  gradually  removed  from'  the   umbilical  region  by  the 


726  DISEASES  AND  ABNORMALITIES. 

development  of  the  caeco-colic  mass,  which  occupies  its  place.  In  this 
manner,  the  natural  changes  occurring  in  the  digestive  apparatus  may 
bring  about  a  spontaneous  cure  of  the  hernia. 

It  may  be,  therefore,  advantageous  to  wait  for  some  time  before  resort- 
ing to  treatment :  allowing  the  young  animals  good  tonic  food,  in  small 
quantity  at  a  time,  to  prevent  undue  development  of  the  abdomen  after 
weaning,  and  bathing  the  tumor  with  cold  water  or  some  mild  astringent 
lotion. 

When  treatment  has  to  be  resorted  to,  it  is  generally  recognized  that, 
for  the  foal  and  calf,  autumn  is  the  best  season,  as  the  animal  is  older  and 
stronger,  and  less  likely  to  suffer  from  the  necessary  operations.  The 
methods  of  treatment  comprise  (i)  bandaging,  (2)  topical  applications,  (3) 
constriction^  (4)  operations  for  complications. 

I.  Bandages. — A  truss  or  retaining  bandage  for  the  cure  of  umbilical 
hernia,  consists  essentially  of  a  wide  girth  or  roller  placed  around  the 
body,  and  by  the  aid  of  which  there  is  maintained  over  the  tumor,  and 
against  the  umbilical  opening,  a  pad  intended  to  prevent  the  viscera  from 
again  descending,  when  the  hernia  has  been  reduced.     By  this  means 


Fig.  2 10. 
Armatage's  Truss  applied  for  Umbilical  Hernia. 

temporary  mechanical  occlusion  of  the  opening  is  obtained,  until  the 
physiological  and  permanent  closure  of  the  latter  can  be  effected,  and  its 
borders  are  firmly  united. 

There  are  various  bandages  which  may  be  usefully  employed  with  this 
object — the  chief  desideratum  being  sufficient  solidity,  simplicity,  fixity, 
and  ease  for  the  animal.  Marlot  has  proposed  a  truss,  for  which  he  claims 
solidity,  fixity,  and  elasticity.  This  consists  of  a  kind  of  well-stuffed  sad- 
dle, from  the  four  corners  of  which  pass  leather  straps,  which  are  buckled 
to  two  girths — one  of  which  is  of  canvas  webbing,  and  passes  round  the 
chest ;  the  other,  of  india-rubber  webbing,  goes  round  the  belly,  and  main- 
tains a  pad  against  the  umbilicus.  This  pad  is  a  wide,  but  not  very  thick, 
cushion  stuffed  with  horse-hair,  and  which  a  broad  longitudinal  band 
uniting  the  pectoral  and  abdominal  girths  prevents  from  slipping  back- 
wards. In  Italy,  the  Massiera  truss  is  employed.  This  is  also  a  kind  of 
smajl  saddle  with  two  wide  girths  passing  under  the  chest,  and  pressing 
against  the  sternum  and  epigastrium  a  plate  of  iron,  the  posterior  ex- 
tremity of  which,  corresponding  to  the  umbilical  ring,  and  covered  by  a 
leather  cushion  stuffed  with -horse-hair,  is  applied  to  the  seat  of  hernia. 


UMBILICAL  HERNIA.  727 

In  Germany,  Strauss's  apparatus  is  in  vogue.  This  likewise  consists  of 
girths  disposed  in  a  similar  manner,  with  a  kind  of  martingale  to  prevent 
them  gliding  backwards.  If  a  pad  is  used,  Lafosse  recommends  that  it 
should  not  be  too  convex  or  elevated  in  the  middle. 

Armatage  advises  the  employment  of  a  similar  arrangement  or  harness, 
which  furnishes  a  compress  at  the  proper  part;  it  is  merely  a  number  of 
straps,  capable  of  being  shortened  or  lengthened,  as  may  be  necessary  in 
order  to  fit  animals  of  different  sizes  (Fig.  210). 

It  usually  requires  from  one  to  three  months  to  effect  a  cure,  the  period 
depending  chiefly  on  the  size  of  the  hernia.  A  tonic  regime  hastens  re- 
covery. 

Some  veterinary  surgeons  combine  agglutinative  agents  with  the  use  of 
the  truss — employing,  for  instance,  a  pad  steeped  in  a  mixture  of  pitch 
and  turpentine. 

Before  the  truss  is  applied,  it  is,  of  course,  necessary  to  reduce  the 
hernia,  and  place  the  pad  exactly  over  the  umbilical  opening. 

Trusses  are  chiefly  objectionable  from  the  long  time  they  must  remain 
on  the  animal,  and  the  tightness  with  which  they  must  be  applied  in  or- 
der to  act  beneficially.  This  inconveniences  and  often  injures  the  young 
creature,  and  not  unfrequently  causes  it  to  fret,  impairs  its  appetite,  and 
induces  loss  of  condition  ;  and  though  highly  recommended  by  Marlot, 
Lafosse,  Perosino,  Schreger,  Strauss,  Ungefrohrn,  and  many  others,  they 
are  not  always  to  be  preferred  to  other  methods  of  treatment. 

2.  Topical  Applications. — Topical  applications  have  been  for  cen- 
turies employed  for  the  cure  of  hernia,  Celsus  having  recommended  the 
use  of  sulphuric  acid,  which  was  resorted  to  at  a  later  period  by  the  early 
hippiatrists  :  and  since  1833,  when  it  was  brought  to  notice  by  Hertwig, 
it  has  been  used  in  Germany,  being  applied  to  the  tumor  every  two  or 
three  days.  The  subcutaneous  serous  infiltration,  and  the  plastic  exuda- 
tion in  the  hernial  sac,  drive  the  misplaced  viscera  into  the  abdomen,  and 
in  becoming  absorbed  afterwards,  produce  obliteration  of  the  cavity  and 
its  opening.  Blisters  act  in  the  same  way  ;  and  applications  of  alcohol, 
creosote  water,  and  other  agents,  have  been  largely  resorted  to.  But  Gi- 
rard,  D'Arboval,  Benard,  and  Mignon  have  asserted  that  these  topical  ap- 
plications were  very  uncertain,  and  even  dangerous,  as  the  irritation  they 
produced  readily  causes  adhesion  between  the  w^all  of  the  sac  and  the  or- 
gans it  contained,  and  thus  rendered  reduction  impossible. 

But  in  1848,  Dayot,  and  more  recently  other  veterinarians,  had  drawn 
attention  to  the  value  of  nitric  acid  cauterization  in  umbilical  hernia. 
The  acid  is  applied  to  the  skin  covering  the  tumor  until  at  first  an  eschar 
is  formed,  and,  finally,  detachment  of  the  cutaneous  hernial  sac  is  achieved. 
In  order  to  effect  this,  the  hair  is  removed  from  the  skin,  and  by  means 
of  a  spun-glass  brush  or  cotton-wool  fixed  on  a  glass  rod,  nitric  acid  of 
commerce  is  applied  around  the  base  of  the  tumor  at  first ;  then  over  the 
other  part  it  is  used  in  sufficient  quantity,  and  with  friction,  so  as  to  de- 
stroy the  skin  and  ensure  its  speedy  mortification  and  sloughing.  Expe- 
rience has  proved  that  the  more  profound  the  disorganization,  the  more 
certain  is  the  beneficial  action.  According  to  Lafosse,  it  requires  from 
24  to  32  grammes  of  acid  for  a  hernial  tumor  the  size  of  a  fist;  and  the 
friction,  which  ought  to  be  as  equable  as  possible  over  the  whole  surface, 
should  be  continued  for  three  to  five  minutes — supposing  the  animal  to 
be  quiet  and  the  rubbing  not  interrupted.     A  smaller  quantity  of  acid 


728  DISEASES  AND  ABNORMALITIES. 

and  less  friction,  may  be  employed  to  herniae  which  are  not  so  consider- 
able in  volume,  and  are  covered  by  fine  skin.  When  the  animal  has  to 
be  thrown  and  placed  on  its  back,  the  quantity  of  acid  and  amount  of 
friction  must  also  be  diminished.  Dayot  recommends  that  the  application 
be  repeated  once  or  twice  in  the  hour,  according  to  the  thickness  of  the 
skin  ;  but  it  has  been  found  that  one  application  is  generally  sufficient, 
fifteen  days  being  allowed  to  elapse  in  order  to  watch  the  result.  If  at 
the  end  of  this  time  the  skin  is  not  destroyed,  the  application  may  be  re- 
peated. 

The  nitric  acid  produces  a  yellow  eschar,  which,  if  not  dry  on  the  first 
day,  soon  becomes  soft,  unctuous  to  the  touch,  and  easily  destroyed.  With 
the  formation  of  this  eschar,  there  is  much  swelling,  either  immediately 
on  the  application  of  the  acid,  or  soon  after  ;  in  some  cases  there  is  but 
little  if  any  swelling.  The  tumefaction  is  due  to  the  action  of  the  nitric  acid 
on  the  subcutaneous  connective  tissue,  which  is  infiltrated,  and  causes  a 
uniform  pressure  on  the  hernied  mass  ;  this  leads  to  the  latter  being 
pushed  into  the  abdomen  and  kept  there  as  if  by  a  truss.  The  cedema- 
tous  swelling  established  external  to  the  tumor,  is  oblong  and  depressed 
in  the  centre,  in  consequence  of  the  diminished  elasticity  of  the  central 
portion  of  the  escharified  skin  ;  in  a  few  days  it  is  gradually  absorbed 
and  becomes  more  consistent,  while  the  skin  in  the  centre  becomes  dry 
and  hard,  like  parchment.  Instead  of  the  hernia,  there  is  now  only  a 
newly-formed'  mass  of  fibrous  tissue,  which  is  gradually  lessened  in  vol- 
ume, condensed,  and  partly  absorbed,  like  cicatricial  tissue.  At  the  same 
time  the  cauterized  skin  begins  to  be  thrown  off  at  the  margin,  the  pro- 
cess of  separation  extending  to  the  centre,  where  it  takes  a  long  time  to 
be  completed,  because  of  the  remains  of  the  umbilical  cord.  When  com- 
pletely detached,  there  is  a  granulating  healthy-looking  wound  left,  which 
may  have  some  fibrous  masses  in  its  middle.  This  suppurates,  dries,  be- 
comes covered  with  a  crust,  and  is  gradually  furnished  with  epithelium. 
In  retracting,  the  wound  contributes  largely  in  closing  the  hernial  open- 
ing, while  the  indurated  skin  which  continues  for  some  time  to  adhere  to 
the  abdominal  walls,  through  the  medium  of  the  condensed  connective 
tissue,  contributes  its  share.  In  about  a  month  cicatrization  is  finished  ; 
the  cicatrix  remains  destitute  of  hair  and  often  of  pigment. 

According  to  the  testimony  of  Zundel  and  others,  this  mode  of  treat- 
ing umbilical  hernia  is  prompt  and  speedy.  There  is  generally  no  occa- 
sion to  throw  the  animal  down,  and  one  assistant  only  is  necessary  ;  it  is 
rarely  followed  by  accidents.  These  do  occur,  however,  and  the  most 
serious  and  frequent  is  the  escape  of  the  intestines  through  the  eschar, 
about  eight  days  after  the  nitric  acid  has  been  applied.  This  unfortunate 
result  has  been  attributed  to  excessive  cauterization  when  the  skin  is  thin 
and  fine,  though  it  may  also  occur  from  the  animal  rubbing  or  tearing  off 
the  sloughing  cuticle  when  the  pain  or  itching  are  troublesome.  To  ob- 
viate this  accident,  Rev,  Lafosse,  Legoff,  and  others  recommend  the  em- 
ployment of  a  bandage,  and  quietude  after  the  operation.  Reynal  has 
observed  peritonitis  as  a  consequence  of  nitric  acid  cauterization,  and 
Lafosse  mentions  a  case  of  tetanus  due  to  this  treatment. 

When  the  cauterization  has  not  been  sufficient,  a  relapse  is  likely  to 
occur ;  Lafosse  has  observed  one  in  twenty  successful  cases.  This  in- 
sufficiency is  generally  noticed  on  the  following  day,  in  the  absence  or 
trifling  amount  of  swelling  ;  but  the  cauterization  must  not  be  attempted 
again  in  less  than  two  or  three  weeks. 


UMBILICAL  HERNIA.  729 

Hertwig,  as  has  been  mentioned,  recommends  sulphuric  instead  of 
nitric  acid,  and  applies  it  in  lines,  night  and  morning,  for  two  days,  by 
means  of  a  glass  rod.  CEdema  soon  sets  in,  and  it  may  be  increased  by 
rubbing  the  cauterized  surface  with  oil  of  turpentine  and  oil  (one  to 
two).  The  sulphuric  acid,  however,  appears  to  be  less  prompt  than  the 
nitric.  Strong  blistering  ointment  applied  at  intervals  of  three  days  ; 
chromate  of  potass  ointment  (one  to  three)  rubbed  in  once  a  day  for 
five  minutes  at  a  time,  on  two  consecutiv^e  days  ;  solution  of  bichloride 
of  mercury,  and  other  topical  irritants,  have  all  been  more  or  less  suc- 
cessfully employed.  Even  the.  actual  cautery,  in  lines  and  points,  has 
been  resorted  to  j  but  the  beneficial  effect  to  be  derived  from  it  is  uncer- 
tain, and  at  best  it  is  very  painful. 

Bouley  {Recueil  de  Med.  Veterinaire^  July,  1877)  draws  attention  to 
Luton's  method  of  subcutaneous  injections  for  the  cure  of  congenital 
herniae  in  infants,  and  believes  it  will  be  found  more  advantageous  than 
any  other  treatment  yet  attempted 'for  umbilical  hernia  in  animals.  Lu- 
ton's method  consists  in  the  subcutaneous  injection  of  a  few  drops  of 
common  salt  solution  around  the  hernial  tumor,  by  means  of  the  ordinary 
subcutaneous  injection  syringe. 

Under  the  irritating  influence  of  this  injection,  oedema  sets  in,  and  this 
mechanically  repels  the  contained  viscus,  the  margins  of  the  abdominal 
opening  come  into  apposition,  and,  with  the  connective  tissue,  are  inflamed 
and  soon  unite. 

The  needle  of  the  syringe  must  not  pass  beyond  the  subcutaneous  con- 
nective tissue. 

3.  Constriction. — Constriction  of  the  hernial  sac  has  been  largely  re- 
sorted to  for  the  cure  of  umbilical  hernia,  with  the  view  of  destroying  it 
by  mortification,  causing  adhesion  above  the  part  where  this  has  taken 
place,  and  inducing  secondary  cicatrization  when  the  sac  has  sloughed 
away.  The  constriction  is  produced  by  ligature,  dams,  and  suture.  To 
apply  these,  the  animal  must,  in  nearly  all  cases,  be  thrown  ;  but  before 
this  is  attempted,  the  tumor  should  be  well  examined,  in  order  to  ascer- 
tain if  it  is  reducible,  if  there  are  adhesions,  the  extent  of  the  abdominal 
opening,  and  the  limits  within  which  the  constricting  apparatus  should  be 
applied. 

The  best  position  for  reduction  and  constriction  is  the  dorsal.  The 
animal,  if  a  foal,  should  be  cast  on  a  good  bed  of  litter,  and  placed  on 
its  back.  Very  often  the  change  of  position  reduces  the  hernia  ;  if  not, 
gentle  manipulation  and  pressure  will  effect  this,  and  then  the  empty  sac 
is  pulled  away  from  the  body,  and  the  operation  completed. 

The  oldest  procedure  is  ligaturing  the  entire  mass  of  the  hernial  sac 
by  a  piece  of  cord  tied  firmly  round  it,  close  to  the  body.  This  produces 
at  first  a  merely  mechanical  occlusion,  but  subsequently  this  is  physiologi- 
cal— exudation  and  organization  of  the  plasma  thrown  out  by  the  inflam- 
matory process  set  up,  producing  adhesion  of  the  peritoneal  surfaces.  A 
piece  of  whipcord  answers  very  well  for  this  ligature,  but  it  must  be 
drawn  very  tight  around  the  neck  of  the  sac,  in  order  to  produce  its  im- 
mediate and  consecutive  effects. 

To  keep  the  ligature  in  place,  some  practitioners  pass  one  or  two 
wooden  pegs  through  the  sac  where  it  is  encircled  by  the  ligature  ;  these 
prevent  the  twine  being  displaced  by  the  swelling  which  quickly  super- 
venes.    Sometimes  a  ring  is  employed^  which  is  less  in  diameter  than  the 


730  DISEASES  AND  ABNORMALITIES. 

umbilical  opening,  and  through  which  the  hernial  sac  is  passed  before 
the  ligature  is  made. 

Some  authorities  prefer  a  double  ligature,  made  by  passing  a  double 
cord  through  the  base  of  the  sac  by  means  of  a  sacking-needle,  and  tying 
each  separately  or  entirely  round  the  sac.  Sometimes  the  ligatures  are 
multiple  ;  and  Legoff  has  recommended  the  employment  of  several  liga- 
tures passing  through  the  sac  from  apex  to  base,  each  becoming  tighter 
as  the  abdomen  is  neared. 

Ligatures  are  very  simple  and  easily  applied,  but  they  have  their  draw- 
backs, and  these  have  led  to  their  disuse.  Among  their  disadvantages 
are  uncertainty  in  their  action — which  is  sometimes  too  intense,  at  other 
times  insufficient ;  the  sac  often  sloughs  off  before  adhesion  has  taken 


Fig.  211. 
Umbilical  Clam. 

place  to  such  a  degree  as  to  sustain  the  weight  of  the  abdominal  viscera : 
and  it  has  been  pointed  out  that  there  is  risk  of  including  or  wounding 
the  intestine. 

Very  favorable  results  obtained  by  the  elastic  ligature  in  castration,  are 
recently  reported  by  Guerin  {Recueil  de  Med.  Veterinaire,  July  30,  1877)  ; 
this  ligature  might  prove  very  effective  in  umbilical  hernia. 

The  procedure  by  clams  is  often  resorted  to,  particularly  when  the  hernia 
is  serious.  The  ordinary  wooden  clam  (Fig.  211)  may  be  employed,  or  one 
of  iron,  either  hinged  at  one  end  or  tightened  by  screws.  To  render  the 
coaptation  of  the  two  branches  of  the  clam  more  perfect,  and  to  prevent  the 


Fig.  212. 
Armatage's  Iron  Umbilical  Clam. 

instrument  slipping  when  tumefaction  sets  in,  as  well  as  to  produce  more 
prompt  inflammation,  adhesion,  and  gangrene,  various  contrivances  are 
in  use.  Borhauer  has  used  a  clam,  in  the  branches  of  which  are  a  num- 
ber of  holes  placed  opposite  each  other,  and  through  which  wooden  or 
metal  pins  can  be  passed  when  the  instrument  is  fixed  on  the  sac.  Other 
practitioners  use  a  clam  with  toothed  branches,  the  teeth  perforating  the 
walls  of  the  sac.  Armatage  recommends  an  iron  screw  clam,  one  branch 
of  which  has  a  long  deep  groove,  and  into  this  fits  a  narrow  projecting 
ridge  on  the  opposite  branch  (Fig,  212). 

To  apply  the  clam,  he  gives  the  folio\ying  directions  :    "  The  animal  is 


(EDEMA   OF  THE  UMBILICUS. 


731 


secured  and  placed  on  its  back.  The  skin  over  the  rupture  is  drawn 
together  by  the  fingers  in  a  flat  fold,  corresponding  with  a  central  longi- 
tudinal line  through  the  abdomen  {linea  alba),  and  elevated  from  the  parts 
beneath,  in  order  to  cause  the  intestines  or  omentum  to  descend.  The 
clam  is  then  put  over  the  skin,  as  close  to  the  abdomen  as  possible,  and 
the  screws  tightened.  The  pressure  must  not  be  too  severe,  or  the  parts 
will  drop  off  too  soon,  and  possibly  the  intestines  may  escape.  The 
operation,  therefore,  requires  to  be  carefully  watched." 

Sutures  are  frequently  employed,  and  there  are  various  ways  of  using 
them.  One  method  is  the  "twisted  "  suture,  which  is  applied  as  follows : 
The  hernial  sac  is  included  between  two  round  pieces  of  hard  wood  or 
iron,  which  are  drawn  tightly  together  by  whipcord  passed  round  their 
extremities  before  and  behind  ;  double  sutures  are  then  passed  through 
the  sac,  one  of  which  is  tied  to  the  piece  of  wood  on  one  side,  and  the 
other  to  that  on  the  other  side — so  that  the  sac  is  completely  invested 
between  the  wood  and  ligatures,  which  divide  it  into  two  portions. 
Another  procedure  by  suture  is  to  make  a  thick  longitudinal  fold  of  the 
skin  covering  the  hernia,  to  pass  the  suture  needle — armed  with  a  waxed 
thread  or  cord — as  near  to  the  muscles  as  possible,  and  about  three  to 
four  inches  from  the  ring,  from  before  to  behind,  or  one  side  to  the  other  ; 
the  needle  is  again  passed  through  in  the  contrary  direction,  about  half 
an  inch  from  the  first  perforation,  and  the  two  portions  of  suture  firmly 
tied,  so  as  to  draw  the  skin  together  like  the  mouth  of  a  sac.  Sutures 
are  then  passed  through  the  sides  of  the  pedicle  and  tied,  so  as  to  include 
the  whole  of  the  skin  in  the  multiple  loops.  A  cure  by  this  procedure  is 
usually  effected  in  about  fifteen  days.  The  only  objection  to  the  opera- 
tion appears  to  be  the  danger  of  wounding  the  intestine  by  the  needle. 
To  obviate  this,  some  operators,  after  reducing  the  hernia,  pull  the  empty 
sac  well  away  from  the  abdomen,  and  pass  it  through  a  partially  split 
piece  of  lead  which  is  applied  close  to  the  belly  ;  then  the  needle  can  be 
used  without  risk,  as  the  lead — which  is  secured  in  situ — forms  a  shield 
as  well  as  a  truss,  and  prevents  the  descent  of  the  intestine  until  adhesion 
has  taken  place. 

When  the  hernia  is  irreducible  or  strangulation  has  taken  place,  then  it 
will  be  necessary  to  carefully  open  the  sac.  Should  adhesion  have  taken 
place  between  the  latter  and  the  intestine,  or  between  the  skin  and  per- 
itoneum, this  must  be  broken  up  ;  if  the  umbilical  ring  has  to  be  incised 
in  order  to  return  the  viscus,  this  may  be  effected  by  a  probe-pointed 
bistoury.     The  incision  should  be  no  longer  than  is  absolutely  requisite. 

The  after-treatment  of  operation  for  hernia  must  be  conducted  on 
surgical  principles,  and  according  to  the  necessities  of  the  case. 


CHAPTER  V. 

CEdema  of  the  Umbilicus. 

* 
Tumefaction,  or  rather  "  oedema  "  of  the  umbilical  region,  is  not  at  all  rare. 
Often  it  is  simply  due  to  an  effusion  of  serum  in  the  connective  tissue  of 
the  umbilical  cord,  and  sometimes  to  an  infiltration  of  blood  in  this  part 
and  the  surrounding  connective  tissue. 

This  accident  is  usually  produced  by  contusion  and  laceration  during 


732  DISEASES  AND  ABNORMALITIES, 

•birth,  though  at  times  it  may  also  be  caused  by  the  young  creatures,  when 
two  or  more  are  together,  sucking  and  pulling  at  the  remains  of  the 
umbilical  cord.  It  may  also  be  due  to  chronic  inflammation  of  this  part, 
or  the  formation  of  abscess  in  the  umbilical  ring. 

The  accident  is  readily  recognized  ;  the  swelling  is  often  very  consid- 
erable, and  always  cold  to  the  touch.  It  often  persists  a  long  time  in 
bovine  animals  ;  and  Zundel  says  that  it  then  constitutes  a  grave  defect 
in  young  bulls,  which  it  mechanically  prevents  from  copulating.  When 
due  to  sclerosis  of  the  connective  tissue,  it  is  usually  persistent. 

Treatment. 

Cold  applications  and  compresses  have  been  recommended  in  the  way 
of  treatment,  as  well  as  lotions  of  arnica,  camphorated  spirits  of  wine, 
preparations  of  iodine,  mercury,  etc.  These  often  fail,  however,  and  it 
is  generally  better  to  resort  to  scarifications  or  leeches  at  once,  to  be 
succeeded  by  hot  water  fomentations.  When  the  swelling  is  chronic,  and 
due  to  a  blood  clot,  which  is  sometimes  the  case,  Baumeister  recom- 
mends enucleation. 


CHAPTER  VI. 

Inflammation  of  the  Umbilical  Cord. 

Inflammation  of  the  umbilicus,  or  o?tiphalitis  (the  so-called  "  navel-ilV  of 
shepherds),  is  a  serious  accident,  and  often  terminates  fatally.  It  con- 
sists essentially  in  inflammation  of  the  umbilical  vein,  which  sooner  or 
later  involves  the  adjoining  tissues,  and  is  often  followed  by  suppuration 
and  pyaemia,  which  causes  the  death  of  the  young  creature.  It  is  rare 
indeed  that  the  inflammation  remains  of  a  simple  kind  throughout  its 
course.  As  a  rule,  it  is  not  merely  an  omphalo-phlebitis,  but  involves 
the  abdominal  portion  of  the  umbilical  vein.  There  is  a  thrombus,  which 
soon  suppurates ;  a  fistula  appears  at  the  umbilicus,  the  umbilical  vein  is 
inflamed  as  far  as  the  liver,  to  which  the  thrombosis  extends,  and  the 
portal  and  hepatic  veins  may  even  be  affected.  As  a  consequence,  the 
most  serious  accidents  may  arise.  Embolic  infarction  of  the  lungs,  liver, 
or  other  organs  is  likely  to  occur,  with  gangrene,  septikaemia  or  pyaemia. 

Symptoms, 

The  inflammation  commences  soon  after  birth.  The  remains  of  the 
umbilical  cord,  in  the  normal  condition,  quickly  dries  up  and  withers,  as 
it  were,  within  a  few  days  after  the  creature  is  born.  When  inflamed, 
however, -the  part  appears  to  be  moist,  and  projects  from  the  abdomen 
as  an  enlarged,  compact,  and  hard  mass,  from  the  centre  of  which  flows 
a  small  quantity  of  thin,  unhealthy,  purulent-looking  fluid  that  soils  the 
surrounding  skin.  The  peculiar  tap-like  appearance  of  the  umbilical  cord, 
its  density  and  high  tenaperature,  with  the  discharge  therefrom,  will  lead 
the  careful  observer  to  recognize  the  existence  of  omphalitis. 

A  probe  can  bfe  readily  passed  into  the  umbilical  vein,  which  remains 
patent  to  a  considerable  extent.  The  local  symptoms  are  often  over- 
looked at  the  commencement,  and  the  first  general  signs  of  omphalitis 
observed  are  usually  dulness,  arched  back,  indifference  to  the  teat  and 


INFLAMMA  TION  OF  THE  UMBILICAL  CORD.  733 

to  surrounding  objects,  persistent  recumbency,  fever,  and  hurried  pant- 
ing respiration  wlien  general  infection  takes  place,  and  embolism  of  the 
lungs  exists.  As  the  malady  progresses,  great  prostration  is  manifest ; 
there  is  swelling  at  the  umbilicus,  and  intense  pain  on  manipulation  of 
that  region ;  the  eyes  are  dull  and  injected,  the  mouth  very  hot  and  dry  ; 
the  pulse  is  so  small  and  quick  as  to  be  scarcely  perceptible  ;  the  bowels 
may  be  constipated  and  the  faeces  scanty,  or  obstinate  diarrhoea  may  su- 
pervene ;  the  urine  is  greatly  diminished  in  quantity  ;  the  mucous  mem- 
branes often  assume  a  yellowish  tint ;  soft,  fluctuating  swellings,  contain- 
ing a  yellow  gelatinous  fluid,  often  appear  on  various  parts  of  the  body; 
the  creature  refuses  to  suck;  indications  of  colic  or  peritonitis  are  some- 
times manifested,  with  enterrorhagia  ;  and  in  the  majority  of  cases  death 
rapidly  ensues. 

Not  unfrequently  the  phlebitis  is  most  intense  in  the  internal  abdom- 
inal portion  of  the  vein,  and  the  pus,  instead  of  freely  escaping  from  the 
external  opening,  accumulates  in  the  canal  to  such  a  degree  as  to  form 
a  large  swelling  at  the  umbilical  ring,  which  might  be  mistaken  at  the 
first  glance  for  a  hernia.  When  this  swelling  has  been  opened,  about  half 
a  pint  of  pus  has  escaped  in  some  instances. 

When  a  fatal  termination  does  not  quickly  follow  from  septikaemia,  or 
from  embolism  of  some  important  organs,  through  detached  portions  of 
the  thrombus  being  carried  into  them  by  the  circulation,  we  may  have 
chronic  morbid  conditions  of  a  pyaemic  character  set  up,  which  are  char- 
acterized by  metastatic  inflammation  of  the  serous  membranes  in  various 
parts  of  the  body,  and  particularly  of  the  articulations.  Indeed,  it  is  now 
recognized  by  the  highest  continental  veterinarians  that  the  destructive 
arthritis  or  "^joint  disease  "  of  foals,  calves,  and  lambs  is  attributable  to 
omphalo-phlebitis.  Inflammation  of  the  joints — especially  those  of  the 
hocks — has  often  been  accidentally  produced  by  the  inflammation  ex- 
cited through  ligaturing  the  umbilical  cord. 

Metastasis  to  the  iris,  choroid  coat  of  the  eye,  diarrhoea,  tumefaction 
of  the  lymphatic  glands,  abscesses  in  the  muscles  and  other  parts,  and 
other  accidents,  have  been  observed  as  a  result  of  inflammation  of  the 
umbilical  cord. 

Pathological  Anatomy. 

In  animals  which  have  died  or  been  killed  in  consequence  of  this  dis- 
ease, the  walls  of  the  umbilical  vein  throughout  the  course  of  the  vessel, 
are  much  thickened,  and  the  communication  with  the  portal  veili  entirely 
interrupted  by  a  blood  clot.  The  vessel  is  filled  by  a  yellow  pulpy  mass, 
foul-smelling  in  some  cases,  odorless  in  others  ;  while  its  ifitima  is  de- 
tached, and  forms  part  of  the  contents.  In  the  abdominal  cavity  we 
may  find  effusion,  exudation,  and  adhesion  of  various  viscera,  with  peri- 
toneal haemorrhagic  spots.  The  portal  and  other  abdominal  veins  often 
contain  matter  similar  to  that  in  the  umbilical  vein  ;  the  liver  is  enlarged, 
in  some  cases  atrophied,  qlay-colored,  and  almost  bloodless.  The  lym- 
phatics of  the  liver  and  mesentery  are  usually  nodulated,  swollen,  and 
infiltrated.  The  lungs  in  many  instances  exhibit  intense  haemorrhagic 
infarction,  lobular  pneumonia  and  its  consequence,  and  particularly  pur- 
ulent broncho-pneumonia.  In  special  cases,  to  be  alluded  to  hereafter, 
the  joints  are  swollen  and  inflamed,  and  their  capsules  contain  pus. 
When  the  creature  lives  until  it  becomes  cachectic,  fatty  degeneration  of 
the  muscles,  with  ecchymoses  in  various  parts  of  the  body,  are  nearly 
always  noticed. 


734  DISEASES  AND  ABNORMALITIES. 

Causes. 

The  causes  of  omphalitis  are  numerous.  They  may  be  enumerated  as 
follows  :  the  admission  of  air  or  foreign  matters  to  the  interior  of  the 
umbilical  vessels  ;  bruises  or  injury  to  the  umbilicus,  either  during  birth 
or  afterwards  ;  irritation  of  this  part  either  by  the  litter,  manure,  or 
urine  ;  the  habit  which  certain  females  have  of  licking  the  umbilicus  of 
their  progeny,  or  of  young  creatures  to  suck  the  remains  of  the  umbilical 
cord  of  each  other  ;  rupture  of  the  cord  close  to,  or  within  the  abdomen ; 
improper  food  given  to  the  mother ;  exposure  to  cold  and  wet ;  and  in- 
fection. Bollinger  admits  that  in  certain  establishments,  in  consequence 
of  over-crowding,  the  omphalitis  of  young  animals  may  become  erysipe- 
latous, and  be  due  to  an  analogous  infection  to  that  which  produces  the 
oftentimes  fatal  inflammation  of  the  umbilical  cicatrix  in  the  new-born 
children  in  maternity  hospitals.  Rueff  asserts  that  omphalitis  is  more 
frequent  in  some  years  than  others. 

There  can  scarcely  be  any  doubt  that,  as  Franck  remarks,  this  inflam- 
mation is  largely  due  to  contact  of  the  atmosphere  with  the  umbilical 
wound,  and  to  the  ingress  of  germs  which  excite  zymosis  ;  or  to  contact 
with  filth  or  putrid  matters. 

There  can  scarcely  be  a  doubt,  also,  that  the  manner  in  which  the  um- 
bilical cord  is  divided  at  birth  has  an  influence  in  the  production  of  this 
inflammation  ;  indeed,  this  division  or  rupture  of  the  cord  necessarily 
produces  a  wound  which  is  readily  absorbent  under  all  circumstances, 
until  the  remaining  portion  attached  to  the  umbilicus  becomes  dry  and 
shrivelled.  The  exposed  umbilical  vein  and  artery  in  the  foal,  the  double 
vein  in  ruminants,  also  increase  this  readiness  to  receive  infection,  and 
consequent  tendency, to  phlebitis  ;  and  these  vessels  are  occasionally  laid 
quite  bare  when  the  cord  is  divided  close  to  the  umbilical  ring,  and  their 
protecting  sheath  is  removed. 

Franck  gives  an  instance  of  this  accident,  which  was  witnessed  in  the 
breeding  sheds  of  the  Munich  Veterinary  School.  A  Cow  brought  forth 
twin  calves,  one  of  which — A — had  the  umbilical  cord  ruptured  in  the 
usual  way,  while  the  other — B — had  it  torn  asunder  in  a  markedly  abnor- 
mal manner. 

Alongside  this  Cow  stood  another  which  had  recently  calved,  then  was 
attacked  with  puerperal  fever,  and  eventually  succumbed  to  that  disease. 
The  aftef-birth  of  this  animal  was  allowed  to  lie  behind  the  Cow  which 
had  given  birth  to  the  twins  ;  so  that  there  was  no  lack  of  infection-pro- 
ducing material — the  floor,  straw,  implements,  as  well  as  the  hands  of  the 
cowmen,  being  impregnated  with  it. 

The  calf — B — which  had  the  umbilical  cord  abnormally  ruptured,  be- 
came affected  with  omphalitis  ;  while  the  other — A — with  the  wound 
better  protected,  escaped  infection  and  remained  in  good  health. 

This  cause  of  ompklialitis  must  be  frequently  and  extensively  in  opera- 
tion among  the  lambs  of  flocks  of  Ewes,  when  abortions  occur  among 
these,  or  when  putrid  matters  are  discharged  from  the  vulva,  or  even 
when  gangrenous  or  septic  mammitis  is  present  among  them.  It  is  often 
remarked  that  omphalitis  sometimes  appears  among  a  larger  number  of 
lambs  on  a  particular  pasture  ;  and  it  is  extremely  probable  that  careful 
investigation  will  lead  to  the  discovery  that  many  of  these  outbreaks  are 
largely,  if  not  entirely,  due  to  septic  infection  of  this  kind.  Franck  has 
observed  such  occurrences  in  extensive  cowsheds,  when  sometimes  of  ten 


INFLAMMATION  OF  THE  UMBILICAL  CORD.  735 

to  fifteen  calves  born  within  a  few  days  of  each  other  and  kept  together, 
half  the  number  has  become  affected  with  this  inflammation  of  the  navel, 
and  the  remainder  has  escaped. 

.  It  must  be  remembered,  too,  that  the  discharge  from  one  diseased  um- 
bilicus may  afford  sufficient  material  to  infect  a  great  many  newly-born 
animals,  should  circumstances  prove  favorable. 

Not  only  may  contamination  take  place  through  actual  contact  with 
objects  soiled  or  impregnated  by  such  infective  material,  but  the  air  itself, 
or  flies,  may  prove  media  for  its  conveyance  to  the  umbilical  wound. 
There  may  also  be  a  special  infection,  as  a  consequence  of  over-crowding 
in  badly-ventilated  dwellings — something  analogous  to  the  puerperal  in- 
fection observed  in  certain  maternity  and  other  hospitals. 

A  malignant  and  a  benignant  form  of  omphalitis  have  been  described  by 
various  authorities ;  but  the  distinction,  if  it  really  exists,  is  of  no  prac- 
tical importance,  and  it  is  perhaps  advisable,  in  so  far  as  treatment  is  con- 
cerned, to  consider  the  disease  always  as  malignant.  It  would  appear  to 
be  fully  ascertained  that  septic  infection  gives  rise  to  a  far  more  serious 
and  destructive  inflammation  than  that  due  to  entrance  of  the  air,  or  an 
aerial  ferment,  into  the  wound  or  open  vessels  of  the  cord. 

As  has  been  remarked,  this  inflammation  of  the  umbilical  cord  is  more 
frequent  in  calves  and  lambs  than  in  foals  ;  and  the  reason  for  this  is 
probably  due  to  the  fact  that  in  the  former  there  is  a  dudics  Arantii^  which 
is  absent  in  the  latter.  There  may  also  occur  a  kind  of  aspiration  of  air 
into  the  umbilical  vein.  However  this  may  be,  it  must  not  be  forgotten, 
when  considering  the  etiology  of  omphalitis  and  its  frequency  in  differ- 
ent species  of  animals,  that  putrid  or  septic  diseases  are  much  more  com- 
mon in  Cows  and  Ewes  than  Mares,  and  that  the  latter  do  not  so  often 
receive  manual  assistance  during  parturition  ;  so  that  they  are  less  liable 
to  parturient  fever  and  other  septic  disorders  which  might  involve  their 
offspring. 

When  the  remains  of  the  umbilical  cord  are  once  fairly  dried  and 
shrivelled,  omphalitis  is  very  seldom,  if  ever,  v;itnessed. 

Ulrich  {Canstatfs  Jahresbericht,  i860,  p.  41)  reports  that  he  saw  a  wide 
outbreak  of  the  disease  in  a  flock  of  lambs,  many  of  which  died  from 
abscess  in  the  liver.  He  attributed  the  outbreak  to  feeding  the  Ewes  on 
rape-cake.  Changing  the  food  to  oil-cake,  and  administering  Glauber 
salts  to  the  Ewes  checked  the  malady.  Franck  is  inclined  to  think  that 
infection  may  have  had  something  to  do  with  the  outbreak. 

Treatment. 

T\i^ prophylaxis  oiovc\'^\i2X\\\%  or  purulent  phlebitis  of  the  umbilical  cord, 
is  very  important,  and  must  be  based  on  our  knowledge  of  the  etiologv  of 
the  malady.  This  we  have  just  alluded  to.  Cleanliness  is  absolutely  ne- 
cessary, and  the  young  creature  should  be  protected  from  every  possible 
source  of  septic  infection.  The  danger  of  infection  may  be  greatly  obvi- 
ated, if  the  extremity  of  the  umbilical  cord  be  dressed  with  a  concentrated 
solution  of  carbolic  acid,  which  destroys  atmospheric  germs,  keeps  away 
flies,  and  renders  putrid  matters  innocuous,  while  it  quickly  shrivels  up  the 
cord  itself.  This  preventive  treatment  is  strongly  to  be  recommended  for 
lambs,  and  particularly  when  there  have  been  abortions  among  the  Ewes, 
retention  of  dead  lambs  or  the  placental  membranes,  or  any  other  likely 
cause  of  putridity  on  a  sheep-run  or  pasture.     The  same  measure  is  appli- 


736  DISEASES  AND  ABNORMALITIES. 

cable  to  the  calf  and  foal,  but  in  all  care  must  be  observed  not  to  apply 
the  acid  to  the  parts  surrounding  the  umbilicus. 

Curative  treatment  must  be  chiefly  of  a  disinfecting  and  antiseptic  kind. 
At  the  commencement  it  must  be  chiefly  local,  and  the  applications  most 
likely  to  prove  beneficial  are  lotions  of  carbolic  acid,  salicylic  acid  (par- 
ticularly if  fever  runs  high),  salicylate  of  soda,  permanganate  of  potass, 
borate  of  soda,  alum,  or  other  astringent.  If  the  umbilical  vein  is  readily 
accessible,  one  of  these  lotions  may  be  introduced  into  it,  either  by  a  fine 
bone  probe  wrapped  round  with  lint,  or  by  a  syringe.  Franck  states  that  a 
five  per  cent,  solution  of  carbolic  acid  may  be  passed  in  this  way  into  the 
abdominal  portion  of  the  vein  of  small  calves  ;  this  vessel  can  be  pene- 
trated to  a  distance  of  nearly  ten  inches.  He  does  not  approve  of  inject- 
ing the  solution,  because  of  the  danger  of  injuring  the  portal  vein. 

If  the  suppuration  is  superficial,  the  same  lotions  may  be  used,  or  the 
part  may  be  cauterized  with  solid  nitrate  of  silver. 

When  the  inflammation  is  very  intense,  several  authorities  recom- 
mend recourse  to  vesicating  agents  ;  others  employ  ammoniacal  liniment, 
and  Rueff  advocates  tartarized  antimony  ointment. 

.When  there  is  danger  of  general  infection,  or  this  has  already  oc- 
curred, then  the  internal  administration  of  antiseptic  agents  must  be 
resorted  to.  Franck  recommends  salicylate  of  soda  in  doses  of  about  one 
gramme  every  hour.  Carbolic  acid,  sulphite  of  soda,  or  other  agents  of 
this  class  may  also  be  given  with  advantage. 

Constipation  may  be  averted  by  castor-oil  or  a  suitable  diet — skimmed 
milk  alternately  with  new  milk.  Preparations  of  iron  may  also  be  ad- 
ministered j  and  if  the  young  creature  is  still  at  the  teat,  its  dam  should 
be  well  fed. 

Franck  notes  that,  during  omphalitis,  the  most  serious  complication  is 
inflammation  of  the  umbilical  artery,  the  existence  of  which  can  gen- 
erally only  be  detected  on  a  post-mortem  examination  of  an  animal  which 
has  died,' or  has  been  killed  because  of  the  disease.  This  complication 
is  more  frequent  in  the  foal  than  the  calf,  probably  because  the  vessel  is 
torn  at  the  umbilical  ring  in  the  first,  and  in  the  abdomen  in  the  second. 
The  peripheral  portion  is  thickened,  and  contains  a  reddish-colored 
thrombus,  or  is  filled  with  a  puriform  breaking-up  mass,  and  often  the 
vessel  is  surrounded  by,  or  imbedded  in,  an  abscess  ;  a  sharp  line  of  de- 
marcation separates  the  inflamed  from  the  healthy  portion.  General 
infection  or  pyaemia  rapidly  follows  umbilical  arteritis. 


CHAPTER  VII. 
Arthritis. 

Disease  of  the  joints  of  young  animals,  occurring  soon  after  birth,  has 
been  for  a  long  time  recorded  in  districts  or  regions  where  breeding  is 
largely  carried  on  ;  the  animals  affected  belonging  to  the  equine,  bovine, 
and  ovine  species — much  less  frequently  are  dogs  and  pigs  attacked.  In 
France  it  is  usually  known  as  the  "  Arthrite  "  or  "  Paralysie  des  Jeunes 
Animaux,"  in  Germany  as  the  "  Fohlenlahme,"  "  Kalblahme,"  and 
"  Lammerlahme,"  and  in  England — where  it  has  evidently  been  but  little 


ARTHRITIS.  737 

studied,  it  lias  been  popularly  known  as  "  Joint  111,"  and  technically  as 
"  Scrofulous  Disease  of  the  Joints,"  or  "  Specific  "  or  "  Constitutional 
Synovitis." 

The  disease  was  first  described,  we  believe,  by  Brugnone  {Trattato 
delle  Razze  de  Cavalli,  Turin,  1781)  ;  then  it  was  noticed  by  Roupp 
{Recueil  de  Med.  Veterinaire,  1825),  Lecoq  in  1828,  Strauss  in  1831 
{Darrsucht  der  Fohlen,  Vienna,  1831),  Benard  in  1832  {Recueil  de  Med. ^ 
etc.,  1832)  Trager  in  1839  {Fohlenkrankheiten^  Berlin,  1839),  Noll  in 
1840,  Darreau  in  1842  {Recueil  de  Med.,  etc.,  1842),  Anker  in  1848  {Kal- 
berldhme,  Zurich,  1848),  Roloff  in  1865  {Fohlenldhme,  Berlin,  1865),  and 
Bollinger  in  1873  {Zur  Kentniss  der  Fohlenldhme,  Virchow's  Arc/iiv.,  Bd. 
58,  1873),  and  in  1875  {Deutsche  Zeitschrift fiir  Thiermedicin,  1875).  I" 
England,  the  most  valuable  description  of  the  malady  which  has  ap- 
peared, is  to  be  found  in  a  paper  by  Walley  ("  Joint  111  in  Lambs,"  Vet- 
erhiary  journal,  1876,  p.  406).  It  has  been  more  particularly  described 
as  it  occurs  in  the  equine  race  in  Normandy,  by  Lecoq  and  Darreau,  and 
in  Poitou  by  Terai  ;  in  North  Germany  by  Trager,  Bollinger,  Strauss, 
and  Roloff.  In  the  bovine  species,  it  has  been  portrayed  as  it  prevails 
in  Bourbonnais,  by  Benard  and  Gay  ;  in  Switzerland  by  Anker,  and  in 
Bavaria  by  Bollinger.  In  the  ovine  species.  Roll  describes  it  as  existing* 
in  Hungary,  Haubner  in  Saxony,  Kuers  in  Prussia,  and  Chambert  and 
Cauvet  in  the  South  of  France.  Walley  alludes  to  its  principal  features, 
as  it  is  witnessed  in  lambs  in  England. 

In  some  years  it  prevails  very  extensively,  and  appears  to  be  almost 
enzootic  in  some  portions  of  the  above-mentioned  countries. 

By  some  authorities  it  is  supposed  to  be  a  constitutional  disease,  by 
others  as  scrofulous  in  its  nature  ;  while  others,  again,  consider  it  as 
essentially  pyaemic,  and  a  sequel  of  purulent  omphalo-phlebitis. 

Roloff  is  of  opinion  that  the  affection  is  due  to  an  alteration  in  the 
blood — to  a  diminution  in  the  amount  of  mineral  salts  in  that  fluid — a 
veritable  cachexia,'  in  fact,  allied  to  rachitism  or  osteomalacia.  In  this 
view,  the  inflammation  which  attacks  the  joints  and  is  symptomatic  of 
the  disorder,  should  be  attributed,  primarily,  to  a  cachectic  or  scrofulous  ' 
diathesis,  and,  secondarily,  to  the  traction  exercised  by  the  ligaments, 
connective  tissue,  and  periosteum  imperfectly  attached  to  the  soft  and 
unequally  consistent  bones,  when  the  animal  movies. 

Walley  defines  it  as  an  inflammatory  affection  of  the  synovial  mem- 
brane of  the  joints,  of  a  specific  character ;  hence  the  terms  "  Specific 
Synovitis  "  and  "  Specific  Arthritis." 

Causes. 

If  there  is  some  diversity  of  opinion  as  to  the  etiology  of  this  joint 
disease  of  young  animals,  there  is  absolute  unanimity  as  to  its  predis- 
posing cause — the  period  of  youth,  as  it  only  appears  during  lactation. 
This  fact  disposes  of  its  constitutional  or  hereditary  nature,  and  has  in- 
clined some  veterinary  pathologists  to  attribute  its  occurrence  to  an  al- 
teration in  the  composition  of  the  milk  of  the  parent. 

Darreau  believed  that  the  malady  is  more  frequent  among  foals  which 
do  not  receive  the  first  milk,  which  contains  colostrum  ;  but  this  view  is 
not  borne  out  by  other  observers.  Roloff  has  witnessed  its  advent  in 
such  a  manner,  that  he  thought  it  must  be  sometimes  congenital.  Walley 
states  that  the  causes  are  entirely  local,  and  can  be  traced  to  an  impure 
or  anaemic  condition  of  the  milk  of  the  dam,  as  the  result  of  improper 


738  DISEASES  AND  ABNORMALITIES. 

systems  of  management,  or  giving  food  deficient  in  the  necessary  con- 
stituents of  the  blood.  Hence,  he  asserts,  it  is  seen  when  Ewes  have 
been  fed  on  an  abundance  of  turnips,  without  a  sufficient  allowance  of 
hay  or  corn,  particularly  if  the  turnips  are  decaying,  or  have  been  un- 
duly forced  with  artificial  manures. 

It  has  also  been  remarked  that  it  often  occurs  on  heath  lands  which 
are  much  exposed,  and  have  been  top-dressed  with  marl  ;  but  the  ap- 
pearance of  the  malady  only  when  the  young  creatures  are  at  the  teat, 
rather  negatives  the  idea  that  exposure  has  any  thing  to  do  with  it.  It 
has  likewise  been  noted,  that  when  Ewes  are  fed  on  decaying  turnips  or 
mangold  wurtzel,  the  lambs  are  frequently  the  subjects  of  effusions  of 
lymph  between  the  muscles — the  effusion  being  arrested  when  corn  is 
given  to  the  Ewes. 

Walley  insists  upon  an  altered  condition  of  the  milk  as  the  cause  of 
the  disease.  '*  That  it  is  due  to,  and  must  be  associated  with,  an  altered 
condition  of  the  mother's  milk  is  proved  by  the  fact  that  it  only  attacks 
young  animals  while  sucking  the  dam  ;  that  the  Ewes  coincidentally  die 
from  malignant  paturient  fever  (though  it  must  be  borne  in  mind  that  it 
.  is  not  necessary  that  the  Ewe  should  exhibit  any  external  symptoms  of  a 
diseased  condition  of  the  blood);  and  that  it  is  frequently  found  to  disap- 
pear on  farms  which  have  been  heavily  limed  and  drained,  and  also  when 
a  different  system  of  management  has  been  adopted.  Again,  the  general 
post-mortem  appearances  bear  a  strong  resemblance  to  those  of  distemper 
in  the  dog,  especially  of  the  hepatic  form  of  the  disease  ;  and  the  enlarged 
and  softened  state  of  the  liver,  where  external  symptoms  have  not  been 
manifested,  points  to  disease  of  a  typhoid  character,  brought  on  by  the 
imbibition  of  impure  milk."  He  enumerates  the  exciting  causes  as  "ex- 
posure ;  cold,  damp  pastures  (hence  the  more  frequent  localization  of  the 
disease  in  the  joints);  neglect  at  birth,  allowing  the  young  animals  to  be- 
come covered  with  mud  and  dirt,  thus  preventing  the  dam  licking  them  ; 
excess  of  wet  weather,  etc." 

Roloff,  as  just  mentioned,  thinks  the  development  of  the  disease  is  due 
to  the  insufficient  ingestion  of  calcareous  salts  ;  and  as  the  malady  is 
originated  during  intra-uterine  life  or  the  sucking  period,  it  is  evident,  he 
adds,  that  it  is  in  the  regime  to  which  the  dam  is  submitted  during  gesta- 
tion, when  the  osseous  system  of  the  foetus  is  being  developed,  and  when 
suckling,  that  the  cause  of  the  disorder  must  be  especially  sought  for. 
Careful  analyses  have  shown  that  the  ash  of  the  herbage  or  hay  in  the  lo- 
calities where  the  malady  makes  the  largest  number  of  victims,  does  not 
contain  more  than  six  to  eight  per  cent,  of  lime  salts,  while  that  of  good 
quality  should  have  from  eleven  to  thirteen  per  cent.  It  is  also  remarked 
that  this  form  of  arthritis  sometimes  prevails  in  those  places  where  the 
osteoclasty  of  cattle  is  frequent ;  and  this  coincidence,  it  is  affirmed, 
should  indicate  a  common  origin  of  the  two  affections — a  defective  sup- 
ply of  calcareous  salts,  and  particularly  of  the  phosphates  This  defi- 
ciency is  sometimes  noticed  when  the  food  is  relatively  of  a  rich  charac- 
ter ;  though  then  the  amyloid  and  proteic  constituents  are  in  excessive 
proportion. 

Bollinger,  whose  scientific  and  most  valuable  researches  in  compara- 
tive pathology  entitle  his  opinions  to  the  greatest  consideration,  enter- 
tains different  views  as  to  the  origin  of  the  malady ;  and  his  anatomo- 
pathological  investigations  in  this  direction  are  of  the  highest  interest 
and  importance.     His  observations  on  this  disorder  commenced  in  1869, 


ARTHRITIS. 


739 


at  the  Government  Stud  at  Graditz,  Silesia,  where  it  prevailed  enzootic 
ally  and  caused  considerable  loss.  In  that  year  forty-seven  foals  were 
attacked,  and  in  1870,  twelve.  Nineteen  cases  were  not  very  serious ; 
but  of  the  other  forty,  twenty-nine  succumbed — a  mortality  of  72  per 
cent,  of  those  affected.  The  foals  were  generally  seized  with  it  (75  per 
cent,  of  the  cases)  during  the  three  weeks  succeeding  birth.  Of  the 
forty  foals  above  alluded  to,  twenty  were  ill  within  the  first  eight  days, 
ten  in  fifteen  days,  and  the  others  in  the  fourth  or  sixth  week.  The 
period  of  the  malady  was,  of  course,  related  to  the  foaling  season — April, 
May,  and  June.  After  an  attentive  study  of  the  symptoms,  and  making 
postmortem  examinations,  Bollinger  came  to  the  conclusion  that  there  is 
a  complete  analogy  between  the  arthritis  of  foals — particularly  in  the 
"lesions  observed — and  the  results  noticed  as  a  consequence  of  omphalitis 
in  infants.  In  his  opinion,  this  joint  disease,  with  its  complications,  is 
due  to  metastatic  pyaemia,  which  has  its  point  of  departure  in  the  puru- 
lent omphalo-phlebitis  described  in  the  preceding  section  of  this  work. 

In  a  more  recent  publication,  Bollinger  returns  to  this  subject  ;  and 
after  alluding  to  his  former  opinion,  founded  on  literary  studies  and  clin- 
ical observations,  that  the  lameness  or  disease  of  the  joints  which  attacks 
foals  and  calves  during  the  first  weeks  after  birth,  are  due  to  primary  al- 
terations in  the  apparatus  of  the  circulation,  viz. — inflammation  of  the 
umbilicus  and  umbilical  vessels,  he  gives  further  evidence  in  support  of 
this  supposition.  The  autopsies  of  the  calves  which  form  the  subject  of 
his  second  communication,  we  will  notice  hereafter  ;  but  we  may  men- 
tion that  they  afford  indubitable  evidence  of  the  existence  of  puru- 
lent omphalo-phlebitis,  and  its  consequences.  As  in  foals,  so  in  calves, 
he  traces  the  origin  of  joint  disease  to  violent  inflammation  of  the  um- 
bilical veins.  He  notes  that  in  calves  —  which  have  a  ductus  venosus 
Arantii,  and  foals  have  not — the  direct  opening  of  the  vessels  into  the 
posterior  vena  cava,  as  well  as  the  general  implication  of  the  latter, 
causes  a  proportionately  larger  number  of  cases  in  them  than  in  foals.  The 
influences  at  work  in  the  production  omphalitis  we  have  enumerated,  but 
Bollinger  lays  great  stress  on  the  want  of  care,  which  is,  as  a  rule,  be- 
stowed on  the  navel  in  newly-born  domesticated  animals,  and  compares 
this  neglect  with  the  scrupulous  attention -paid  to  that  of  infants,  which 
is  severed  and  bandaged  immediately  after  birth ;  while  the  former  have 
to  lie  with  an  open  wound  in  all  kinds  of  filth,  and  are  thus  exposed  in 
the  readiest  manner  to  inoculation  with  poisonous  or  injurious  matters, 
which  cannot  be  excluded  even  from  stables  built  especially  for  the  purpose, 
and  kept  thoroughly  clean.  If  the  navel  wound  of  an  infant  was  ex- 
posed to  the  filth  which  young  foals  and  calves  have  to  lie  in,  it  would 
be  quite  as  liable  to  blood-poisoning  as  animals,  and  to  the  consequent 
affection  of  the  joints. 

Bollinger  contests  the  influence  of  food  in  the  production  of  the 
disease,  as  the  strong,  no  less  than  the  weak  animals,  are  attacked ;  and 
it  appears  when  every  kind  of  diet  is  given  to  the  parent. 

He  also  denies  that  it  is  produced  by  chills,  and  attributes  its  advent 
chiefly  to  pyaemic  or  septic  infection.  He  compares  the  enzootic  appear- 
ances of  joint  lameness  with  the  endemic  outbreaks  of  pyaemia  and 
septikaemia  (or  puerperal  fever),  and  points  out  that  the  only  real  differ- 
ence between  man  and  beast  lies  in  the  simultaneous  appearance  of 
puerperal  fever  epidemics  with  pyaemia  in  infants.  One  point  is  certain, 
he  adds,  and  that  is  that  there  is  a  physiological  and  anatomical  differ- 


740  DISEASES  AND  ABNORMALITIES. 

ence  between  woman  and  the  domestic  animals.  The  anatomical  struc- 
ture of  the  placenta  and  its  villi,  and  its  relations  with  the  placenta  mater- 
na,  are  of  such  a  nature  in  these  animals,  as  to  prevent  (on  the  normal 
detachment  of  the  placenta)  any  rupture  of  the  blood-vessels,  and  conse- 
quent haemorrhage.  In  other  words,  if  delivery  has  been  successfully  ac- 
complished, no  injury  in  the  shape  of  wounds  or  abrasions  is  inflicted  on 
the  inner  surface  of  the  uterus  ;  and  owing  chiefly  to  this  fact  is  the  in- 
flammatory reaction  and  consecutive  lochial  fever  reduced  to  a  minimum 
among  animals,  and  the  introduction  of  poisonous  matters  (be  they  veg- 
etable organisms  or  other  injurious  substances)  into  the  uterus  is  ren- 
dered much  more  difficult ;  while  we  frequently  find  instances  of  the 
pyaemic  process,  due  to  inflammation  of  the  navel  and  its  vessels,  among 
sucking  animals,  though  with  the  parent — except  in  the  case  of  the  Cow 
— this  process  is  rare. 

Symptoms. 

The  symptoms  of  this  form  of  arthritis  are  variously  enumerated. 
The  principal  is  extreme  difficulty  in  moving  which  is  often  noticed  with- 
out any  other  premonitory  indication.  The  movements  are  painfully  and 
reluctantly  performed,  so  that  the  yoeng  creature  generally  persists  in 
lying.  Around  the  epiphyses  of  the  bones,  and  consequently  near  the 
articulations,  there  is  swelling  not  only  of  the  proper  tissues  of  the  joints, 
but  also  of  the  surrounding  connective  tissue  ;  with  hot,  oedematous,  and 
very  painful  infiltration  of  the  region.  From  the  very  commencement 
the  symptoms  are  most  acute,  and  similar  to  those  of  ordinary  arthritis  ; 
and  they  are  rendered  more  marked  by  the  least  movement,  the  lameness 
being  then  extremely  great,  and  generally  all  the  joints  are  involved. 
T'he  fever  is  extreme,  the  respiration  hurried,  and  the  visible  mucous 
membranes  highly  injected ;  sometimes,  and  especially  with  lambs,  there 
are  ^//^j-/-tetanic  spasmodic  contractions.  The  appetite  is  lost,  but  thirst 
is  intense,  and  the  suffering  creature  will  often  be  observed  dragging 
itself  along  the  ground  to  reach  water  or  the  teat  of  its  dam.  Not  unfre- 
quently  there  is  at  the  same  time  a  debilitating  diarrhoea  or  dysentery, 
and  sometimes  in  lambs  a  purulent  nasal  discharge. 

The  progress  of  the  disease  is  sometimes  very  rapid,  death  occurring 
in  twenty-four  or  forty-eight  hours  after  the  manifestation  of  the  earliest 
symptoms.  This  rapid  course  is,  however,  rare,  and  the  animal  may  live 
for  twenty  or  thirty  days,  or  even  longer.  Recovery  is  also  rare,  and 
death  is  the  usual  termination  ;  it  is  quite  exceptional  that  the  disease 
becomes  chronic.  The  malady  usually  ends  in  suppuration,  which  nearly 
always  becomes  general ;  numerous  abscesses  forming  around  the  joints, 
whose  capsules  contain  pus,  as  well  as  purulent  deposits  in  other  regions 
of  the  body.  Generally  after  the  fourth  day,  when  the  joints  are  greatly 
swollen,  the  hair  falls  off  in  these  parts,  and  a  yellowish  or  citron-colored 
fluid,  then  pus,  begins  to  exude  through  the  skin,  which  sloughs  away  ; 
the  ligaments  are  also  involved  in  this  sloughing  process,  and  at  last  the 
articulations  are  completely  disorganized.  In  some  cases  the  limb  is 
only  retained  by  remains  of  tendons,  the  bones  being  exposed,  the  articu 
lar  surfaces  destroyed,  and  the  odor  almost  insupportable.  As  complica- 
tions, we  may  have  pneumonia,  pleurisy,  pericarditis,  and  the  usual  indi 
"cations  of  pyaemia. 

With  foals,  Bollinger  noted,  as  the  chief  symptoms,  a  violent  fever  with 
very  hurried  respiration  ;  the  animals  did  not  suck  so  much  as  usual,  and 


ARTHRITIS.  741 

if  lively  and  attentive  at  the  commencement  of  the  disease,  they  were 
quickly  prostrated  and  extremely  weak.  They  became  emaciated,  and 
the  coat  was  harsh  and  lustreless  ;  often  there  was  a  nasal  catarrh  and 
discharge,  tumefaction  of  the  submaxillary  lymphatic  glands,  sometimes 
capillary  bronchitis,  and  generally  diarrhoea.  With  the  majority  there  was 
tumefaction  of  certain  joints,  and  particularly  of  the  hocks.  In  addi- 
tion to  the  swelling,  there  were  heat  and  pain,  with  great  lameness.  Not 
unfrequently  there  were  immense  subcutaneous  abscesses.  Stupor  event- 
ually set  in,  and  the  creatures  looked  as  if  half  asleep  ;  coma  was  soon 
manifested  ;  there  was  dysenteric  diarrhoea,  the  dejections  being  quite 
fluid,  greyish-colored,  and  extremely  foetid  ;  while  the  visible  mucous 
membranes  had  often  a  yellowish  tint,  in  consequence  of  the  existence 
.of  icterus. 

In  lambs  the  symptoms  are  similar  to  those  just  enumerated.  Walley 
describes  them  as  follows  : — A  general  febrile  condition  of  the  system, 
as  shown  by  the  injected  state  of  the  mucous  membranes  ;  quick,  irrita- 
ble pulse,  irregularity  of  the  bowels,  hurried  respiration,  and  refusal  to 
suck.  The  animal  persistently  lies,  and  if  made  to  move  does  so  unwil- 
lingly and  very  stiffly,  with  the  back  arched,  and  placing  as  little  weight 
as  possible  on  the  affected  limb  or  limbs,  which  are  usually  flexed,  even 
in  recubation,  to  remove  pressure — this  persistent  flexion  ultimately  lead- 
ing to  contraction  of  the  tendons  and  distorted  limbs.  If  the  disease 
continues,  the  muscles  waste,  causing  the  affected  joint  to  appear  larger 
than  it  really  is.  The  characteristic  swellings  usually  appear,  in  the  hocks, 
knees,  and  stifles,  though  they  are  not  by  any  means  confined  to  these 
particular  joints.  In  character,  they  are  round,  have  a  doughy  feel,  are 
intensely  painful  to  the  touch,  very  hot,  immovable,  and  increase  in  size. 
Thus  they  are  like,  yet  dissimilar  to,  rheumatismal  swellings  :  like  them 
in  being  located  in  the  joints,  and  being  hard,  round,  and  tender ;  unlike 
them  in  being  stationary,  and  attacking  the  internal  structures  of  the 
joints — the  primary  lesions  in  rheumatism  being  confined  to  the  external 
ligamentous  structures  of  these  organs,  and  when  attacking  the  interior 
of  the  joints  formative  processes  are  evidenced  ;  while  in  "  joint  ill "  de- 
generative processes  predominate.  As  the  disease  progresses,  and  life 
is  prolonged,  the  animal  becomes  emaciated,  diarrhoea  sets  in,  the  wool 
falls  off,  and  a  variety  of  changes  are  detected  in  the  joints.  Erysipela- 
tous inflammation  makes  its  appearance  in  various  parts  of  the  skin  of 
the  body,  especially  at  the  external  orifice  of  the  urino-genital  organs,  at 
the  postero-inferior  part  of  the  abdomen,  and  round  the  navel,  in  the 
latter  position  constituting  "  navel  ill."  Local  dropsies  are  frequent 
under  the  jaw  and  other  dependent  positions — as  the  navel,  which  is  said 
to  ho.  pocked.  If  blood  is  abstracted  during  life,  or  collected  after  death, 
and  set  at  rest  for  a  time,  it  deposits  a  peculiar  dark-colored,  grumous 
mass  at  the  bottom  of  the  vessel,  composed,  so  far  as  can  be  seen  by  the 
microscope,  of  altered  blood-cells.  This  deposit  lacks  the  firmness  of 
the  other  parts  of  the  clot,  and  bears  a  close  resemblance  to  half-fermented 
damson  pulp.  Bacteria  are  developed  in  the  blood  shortly  after  death, 
and  long  before  any  putrefactive  odor  can  be  detected.  Absorption  of 
pus  into  the  blood — pyaemia — is  indicated  by  elevation  of  the  tempera- 
ture, foetor  of  the  breath,  diarrhoea,  dark  yellowish-red  color  of  the  mu- 
cous membrane,  gnashing  of  the  teeth,  rigors,  and  hectic  fever — the  lat- 
ter being  present  also  in  ulceration  of  the  joints. 

In  the  latter,  the  swellings  become  softer  and  more  irregular  in  outline, 


742  DISEASES  AND  ABNORMALITIES. 

from  bulging  of  the  more  flaccid  portions  of  the  synovial  membrane  and 
skin  ;  and,  from  portions  of  the  effused  lymph  becoming  liquefied,  fluc- 
tuation is  produced — other  portions  remaining  solid.  The  fluctuating 
swellings  extend  along  the  thecse  or  sheaths  of  the  tendons — two  joints 
often  becoming  in  this  way  connected  with  each  other  ;  finally,  the  skin 
over  the  most  prominent  portions  of  the  joint  becomes  absorbed,  ulcer- 
ates, and  if  not  divided  with  the  lancet  or  by  accidental  violence,  bursts 
— allowing  the  escape  of  the  contained  fluids  and  semi-solid  matters, 
and  being  followed  by  sinuous  ulcers,  caries,  or  abscess  proper,  of  the 
joint.  The  sinuses  may  extend  a  considerable  distance  from  the  joint, 
and  discharge  an  ichorous  unhealthy  fluid,  accompanied  by  foetor  if  bony 
or  ligamentous  structure  is  involved.  In  some  cases  the  exuded  lymph 
simply  becomes  liquefied  and  absorbed,  without  any  external  opening 
being  formed  ;  in  others — /.  e.,  when  the  lymph  is  plastic  and  the  consti- 
tution strong — it  undergoes  healthy  organization,  and  remains  as  a  part 
of  the  joint,  producing,  however  permanent  thickening,  distortion,  and 
stiffness.. 

Prognosis. 

From  what  has  been  stated,  it  will  be  seen  that  the  prognosis  with  re- 
gard to  this  disease  must  always  be  unfavorable,  especially  when  the 
creature  is  very  young.  The  mortality  reaches  as  high  as  forty,  fifty, 
sixty,  and  even  more  per  cent.  Indeed,  Darreau  states  that  eighteen  out 
of  every  twenty  foals  die  ;  and  Lecoq  says  that  the  breeders  in  Noi*mandy 
have  an  axiom,  "  Poulain  boiteux,  poulain  perdu." 

Pathological  A?iatomy, 

According  to  Roloff,  the  predominant  lesions  are  the  characteristic 
alterations  of  rachitism  and  periostitis.  The  cartilage  uniting  the  epiphy- 
ses to  the  body  of  the  bones,  is  soft  from  cellular  proliferation,  and  in- 
jected in  places  by  hsemorrhagic  spots ;  the  periosteum  is  also  thickened, 
injected,  and  here  and  there  detached  from  the  bones  ;  while  towards  the 
diarthrodial  surfaces  the  bone  tissue  is  greatly  involved.  There  are,  in 
fact,  all  the  lesions  of  arthritis,  but  of  a  much  more  serious  character  than 
are  observed  in  adult  animals.  The  synovial  membrane  is  highly  in- 
flamed, and  there  is  great  infiltration  of  the  connective  tissue  around  the 
joints. 

Reynal  has  found  in  the  intra-articular  cavities  of  the  joints,  deep- 
yellow-colored  clots,  streaked  with  red,  and  elastic  and  firm,  which  are 
nothing  more  than  false  membranes  that  have  had  time  to  form  in  the 
short  space  of  two  to  five  days. 

Walley  remarks  that,  in  lambs,  the  post-7nortem  appearances  zxt  general 
and  loca,l.  The  general,  in  the  earlier  stages,  are  effusion  of  lymph  be- 
tween the  intercostal  muscles,  and  beneath  the  pleura  and  into  the  lungs 
and  other  organs ;  with  hyperaemia  or  cngorge'ment  of  the  small  blood- 
vessels of  the  mucous  membrane  of  the  stomach  (fourth  compartment) 
and  intestines. 

If  the  disease  has  existed  for  any  length  of  time,  erysipelatous  exuda- 
tions will  be  found  under  and  within  the  structure  of  the  skin  of  depend- 
ent parts,  or  effusion  of  serum  (dropsy)  into  the  connective  tissue,  and 
into  the  various  cavities  of  the  body.  The  large  blood-vessels — even  those 
of  the  brain — are  filled  with  dark  grumous  damson-colored  blood  ;  the 
structure  of  the  brain  is  dark  :  the  liver  is  often  enlarged,  friable,  and 


•  ARTHRITIS.  743 

full  of  minute  abscesses,  which  give  it  a  mottled  appearance  that  is 
frequently  mistaken  for  scrofula  ;  all  the  organs  and  tissues  are  tinged 
with  the  coloring  matter  of  the  bile  ;  the  small  vessels  of  the  omentum 
are  charged  with  blood,  and  the  mucous  lining  of  the  fourth  stomach  is 
congested  and  black  wherever  the  milk  has  lain  in  contact  with  it.  In 
many  cases,  the  urachus  is  black — a  bluish-black  hue  extending  some 
distance  along  the  mucous  membrane  of  the  bladder.  The  umbilical 
vein  is  also  black,  and  filled  with  a  cheesy  material — degenerated  lymph, 
or  coagulum  of  blood. 

The  local  appearances — i.e.,  in  the  jc^nts — are,  in  the  first  stages,  in- 
flammation of  the  synovial  membrane,  which,  in  a  short  time,  extends  to 
the  ends  of  the  bones  and  ligamentous  structures — the  whole  having  an 
intensely  scarlet  hue,  which  in  a  few  days  diminishes.  Coagulable  lymph 
becomes  effused  into  the  cavities  of  the  joints,  forming  perfect  casts  of 
their  interior,  and  filling  up  the  interspaces  between  the  bones.  In  time, 
the  exuded  lymph  commences  to  soften  and  break  down.  From  the  con- 
traction of  the  mass,  the  fluid  portion  is  pressed  out,  and  intermixes  with 
the  degenerated  lymph.  Fluid  is  also  thrown  out  from  the  irritated 
vessels  of  the  joint,  and  aids  in  the  softening  of  the  lymph.  After  a  time, 
suppuration  is  thoroughly  established,  and  pus  cells  are  distinguished  by 
the  aid  of  the  microscope.  The  sheaths  of  the  tendons  running  over  the 
fronts  of  the  joints  become  excessively  inflamed,  and  the  blood-vessels  of 
the  ligamentous  structures  are  filled  with  scarlet  blood.  The  cartilage 
covering  the  articular  ends  of  the  bones  becomes  ulcerated  and  blackened, 
as  also  the  cancellated  structure  of  the  bones  ;  extravasations  of  blood, 
from  ulceration  through  the  coats  of  the  vessel,  take  place,  the  coagula 
either  undergoing  degeneration  or  healthy  organization.  In  the  latter 
case,  distinct  granulations  are  formed,  which,  on  recovery  of  the  animal, 
fill  up  the  cavities  formed  by  the  lymph.  The  flakes  of  lymph  which  are 
found  floating  in  the  fluid  contents  of  the  joints  or  adherent  to  their  sides, 
are  often  mistaken  for  scrofulous  deposits.  If  animals  have  lived  suffi- 
ciently long,  multiple  pyaemic  abscesses  are  found  in  the  various  organs 
and  structures  of  the  body.  Blood  from  diseitsed  lambs  introduced  into 
the  veins  of  a  dog,  gives  rise  to  the  formation  of  multiple  hepatic  ab- 
scesses. 

From  this  description  of  the  pathological  anatomy  of  the  malady,  there 
can  scarcely  be  any  doubt  as  to  its  pyaemic  or  septic  origin,  and  this  is 
further  demonstrated  by  the  following  account  of  its  morbid  anatomy  by 
Bollinger  {Deutsche  Zeitschrift fur  Thiennediciti^  1875)  : — 

A  male  calf  born  at  the  Agricultural  School  of  Strickhof,  near  Zurich,  showed  symp- 
toms, soon  after  birth,  of  inflammation  of  the  umbilicus.  As  the  joints  began  to  swell, 
and  there  appeared  to  be  no  hope  of  saving  the  animal  from  the  effects  of  the  dreadful 
joint  disease — "  gelenkseuche  " — it  was  destroyed  eight  days  afterwards.  The  body 
was  dissected  an  hour  after  death,  but  the  examination  was  imperfectly  made.  The 
umbilical  ring  was  discovered  to  be  still  open  ;  it  formed  a  circular  aperture  about  two 
centimetres  in  diameter,  the  sides  of  which  were  covered  w^ith  ulcers  and  a  greenish- 
yellow  pus.  The  umbilical  veins  and  the  joints  had  been  thrown  away,  and  therefore 
the  investigation  could  not  be  continued.  Projecting  about  the  upper  margin  of  both 
lungs  were  several  cuneiform  tumors  of  a  daric-red  color,  and  of  a  solid  consistency.  In 
the  pericardium  was  a  quantity  of  pale  serum,  in  which  floated  loose  stringy  fibres.  In 
the  cavity  of  the  heart  were  a  few  detached  fibres  and  blood  clots.  Beneath  the  endo- 
cardium were  various-sized  patches  of  ecchymoses  and  blood  extravasations.  Nothing 
abnormal  was  observed  in  the  liver  and  kidneys,  except  bloodlessness. 

Another  calf  was  produced  at  the  same  establishment  on  February  6th.  Its  birth 
had  been  laborious,  and  the  umbilical  cord  was  divided  in  the  ordinary  natural  manner. 


744  DISEASES  AND  ABNORMALITIES. 

The  animal  did  not  appear  to  be  as  lively  as  it  ought.  About  eight  days  after  birth  a 
swelling  showed  itself  in  the  neigborhood  of  the  navel ;  this,  however,  disappeared  after 
the  application  of  poultices.  Fourteen  days  after  birth  the  calf  could  not  stand,  and 
painful  swellings  appeared  on  the  inner  aspect  of  the  knee  joints.  Until  this  time,  the 
creature  had  a  good  appetite,  and  had  taken  a  plentiful  supply  of  milk  regularly  every 
day.  On  February  27th  the  appetite  entirely  failed,  and  on  the  28th  the  calf  was 
killed,  in  order  that  the  carcase  might  realize  something.  The  most  important  organs 
were  sent  to  Bollinger,  and  their  examination  yielded  the  following  results  : 

There  via.?,  purulent  omphalo-thrombo-p/ilebitis,  with  thrombosis  of  the  portal  vein  ;  fibro- 
purulent  gonarthritis  of  the  stifle  joints,  afid  purulent  peri-arthritis  ;  ptirulent  tracheo- 
bronchitis, embolic  infarction  of  the  lungs,  conuneiicing  endocarditis  of  the  mitral  valves,  and 
getieralized  icterus.  The  parts  surrounding  the  stifle  joints  were  of  a  pale-yellow  color, 
infiltrated  with  sero-purulent  fluid,  and  moderately  thickened.  In  the  cavity  of  the 
joints  there  was  a  tolerable  quantity  of  dark-tinted  serum,  and  on  the  synovial  membrane 
more  especially  was  a  mass  of  yellowish-green,  firm  fibro-purulent  matter,  about  two 
centimetres  thick,  which  projected  into  the  synovial  cavity.  The  cartilages  of  the  joints 
were  covered  with  similar  matter,  and  in  some  places  they  were  quite  rough.  The 
entire  capsule  of  the  joint  was  inflamed,  softened,  and  purulent.  The  trachea  and 
bronchial  tubes  contained  a  quantity  of  muco-purulent  fluid,  which,  in  the  latter,  formed 
itself  into  one  mass.  The  mucous  membrane  was  paFe  :  the  almost  bloodless  lungs  had 
ecchymosed  spots  beneath  the  pleura,  and  in  one  place  were  two  wedge-shaped  masses 
the  size  of  a  pea,  which,  on  being  cut  open,  were  found  to  contain  pus  in  the  centre. 
The  heart  and  pericardium  were  normal,  with  the  exception  of  the  mitral  valve,  which 
showed  alteration  in  being  of  a  dark-red  color,  thickened,  and  exhibiting  haemorrhagic 
infiltration  in  places;  by  means  of  the  microscope,  a  notable  cellular  opening  could  be 
perceived  in  the  connective  tissue  close  to  the  haemorrhage.  The  spleen  was  of  normal 
size,  but  pale  and  bloodless;  the  liver  was  enlarged,  full  of  blood,  icteric  in  tint;  in 
parts  were  small  subperitoneal  haemorrhagic  deposits.  The  umbilical  vein  was  dis- 
tended throughout  its  entire  length,  its  walls  were  considerably  thickened,  and  the  inner 
surface  was  of  a  dirty-grey  color,  rough,  uneven,  and  studded  with  greyish-white  puri- 
form  deposits.  This  alteration  in  the  umbilical  vein  extended  as  far  as  its  junction  with 
the  posterior  vena  cava,  which,  owing  to  the  closure  of  the  ductus  venosus,  is  not  in 
direct  communication  with  the  umbilical  vein.  Where  the  umbilical  vein  enters  the 
portal  vein  was  a  purulent  cloaca,  beyond  which  was  a  large  thrombotic  puriform  mass 
that  obliterated  the  cavity  of  the  latter  vessel  as  far  as  its  bifurcation.  As  fatty  degen- 
eration of  the  heart  was  suspected  from  its  appearance,  the  tissue  of  that  organ  was 
examined  microscopically,  but  it  was  found  to  be  normal.  The  voluntary  muscles  in 
the  vicinity  of  the  diseased  joints,  and  which  appeared  very  pale  to  the  naked  eye,  were 
only  clouded  with  granular  matter.  The  puriform  contents  of  the  umbilical  vein  con- 
sisted of  fatty  granular  detritus,  in  which  it  was  diflicult  to  detect  pus  corpuscles  ; 
bacteria  could  not  be  found  in  any  number.  The  liver  offered  indications  of  a  violent 
icterus,  and  exhibited  all  the  alterations  of  acute  parenchymatous  hepatitis,  with  marked 
granular  degeneration  of  the  hepatic  cells. 

In  the  three  autopsies  of  foals  made  by  Bollinger  at  Graditz  (  Virchozu's  Archiv.,  1873), 
he  found  double  broncho-pneumonia  of  the  anterior  lobes  of  the  lungs,  pulmonary 
abscesses,  purulent  arthritis,  intra-muscular  abscesses,  caries  of  the  bones,  and  fatty 
degeneration  of  the  muscles  of  animal  life,  particularly  in  the  neighborhood  of  the 
affected  joints ;  fatty  degeneration  of  the  heart  tissue,  liver,  and  kidneys.  In  the  in- 
testinal canal  were  lesions  of  catarrhal  enteritis,  accompanied  by  hyperplasia  of  the 
mesenteric  glands.  Neither  in  the  animals  when  alive,  nor  at  their  autopsy,  were  there 
any  of  the  signs  of  rachitism  mentioned  by  Roloff.  The  umbilical  cord  was  unfor- 
tunately not  examined. 

On  another  occasion,  the  same  excellent  veterinary  pathologist  examined  the  bodies  of 
two  foals — one  three  weeks,  the  other  five  weeks  old — which  had  succumbed  to  this 
malady.  In  these  there  was  inflammation  and  thrombosis  of  the  umbilical  vessels,  con- 
tinuation of  the  thrombosis  of  the  umbilical  vein  (in  process  of  suppuration)  into  the 
portal  vein,  which  was  also  affected  with  thrombosis,  as  well  as  its  hepatic  ramifica- 
tions. In  one  of  these  cases  there  was  likewise  thrombosis  of  the  pulmonary  artery, 
double  pleurisy  with  pericarditis,  purulent  arthritis  affecting  several  joints,  vast  intra- 
muscular or  subcutaneous  abscesses,  and  cutaneous  erysipelas.  In  the  other  case,  there 
were  pulmonary  abscesses,  circumscribe  pleurisy,  purulent  irido-choroiditis,  and, 
finally,  in  addition  to  general  anaemia,  there  was  great  tumefaction  of  the  bronchial  and 
mesenteric  glands. 

The  result  of  these  autopsies,  together  with  the  symptoms  observed 
during  life,  led  Bollinger  to  the  conclusion  that  the  development  of  the 


ARTHRITIS. 


745 


pathological  process  is  solely  as  follows  :  inflammation  of  the  umbilical 
vessels,  notably  the  vein,  its  decomposed  and  softened  thrombus  which 
communicates  with  the  vena  portae,  and  forms  the  point  of  departure  or 
the  source  of  a  metastatic  pyaemia,  whence  embolism  of  the  lungs  is  some- 
times directly  originated  ;  or  at  other  times,  in  consequence  of  the  alter- 
ation in  the  blood,  which  is  septic,  and  of  the  general  character  of  the 
inflammations,  there  are  metastatic  inflammations  of  the  serous  and 
synovial  membranes  (pleurisy,  pericarditis,  "arthritis)  of  the  lungs,  iris  and 
choroid  coat  of  the  eye,  abscesses  in  the  muscles  and  connective  tissue 
— in  a  word,  the  entire  series  of  clinical  and  anatomical  alterations  which 
constitute  the  complicated  arthritis  of  foals.* 

*  The  great  importance  of  this  subject  in  a  sanitary  point  of  view,  induces  me  to  notice  it  so  fully  as  I 
luve  done.  The  septic  or  pyaemic  nature  of  the  malady  has  not,  to  my  knowledge,  been  pointed  out,  or 
at  least  insisted  upon,  in  England.  And  yet  it  is  a  matter  of  vital  importance  that  this  be  recognized, 
wli2n  we  consider  that  very  often  the  flesh  of  calves  and  lambs  which  have  been  affected  with  joint  disease, 
ii  utilized  as  food  when  the  creatures  have  been  purposely  slaughtered,  which  is  generally  the  case  before 
tha  malady  has  reached  its  worst  stage.  Doubtless  such  flesh,  when  well  cooked  or  cleaned,  is  very  much 
relished,  and  may  often  be  eaten  without  any  ill  effect ;  but,  on  the  o.her  hand,  as  Bollinger  has  pointed 
out,  many  cases  of  illness  in  human  beings  are  due  to  its  consumption.  Poisoning  from  eating  veal  can 
often  bi  traced  with  great  certainty  to  the  pyjeaiic  or  septikaemic  infection  of  the  calf  ;  and  that  authority 
quotes  an  instanca  in  support  of  this  assertion.  The  occurrence  is  communicated  by  Zann^er  (Arckiv/iir 
ThierJieilkiinde,  Band  xxiv.,  S.  204,  Zurich,  1871)  to  Zehnder's  official  report,  and  which,  notwithstanding 
its  urgent  importance,  has  not  been  taken  notice  of  by  the  medical  journals. 

During  ths  epidemic  of  cholera  in  Zurich  in  1867,  in  August,  twenty-seven  members  of  six  families  living 
at  Fluntern  (a  suburb  of  Zurich),  were  attacked  with  diarrhoea,  accompanied  by  varied  cerebral  disturb- 
ance. Ail  tho32  who  ware  ta'.cen  ill  had  eaten  the  fl3sh  of  a  five  days'  old  calf,  which  was  the  progeny  of 
a  diseased  Cow,  and  which  had  yellow  water  (^rt'fcj  ivrLsser)'m.  the  knee-joints.  The  Cow  w.is  suffering 
from  a  large  dark  swelling  on  the  uddar,  and  which  extended  along  the  belly  to  beneath  the  breast. 

The  milk  from  this  Cow  produced,  in  a  number  of  people  who  consumed  it,  vomiting  and  diarrhoea.  The 
calf  at  birth  was  smafT  and  weak,  and  had  swellings  o;i  its  joints  and  limbs.  As  soon  as  it  was  killed,  its 
carcase  wis  sold  and  the  flesh  e^ten.  No  examination  of  the  body  was  made.  Chemical  analysis  was 
made  of  its  re:nains  for  the  detection  of  inorganic  substances,  as  well  as  a  microscopical  examination  for 
trichinae,  but  wit'i  negative  results.  The  outbreak,  which  was  followed  by  fatal  consequences,  was  ascribed 
to  the  cholera  ;  thou:;h  it  ensued  within  from  twenty-four  to  forty-aight  hours  after  eating  the  flesh.  The 
diffarent  mambers  of  some  families — in  one  instance  nine  individuals — were  seized  within  a  few  hours  of 
each  othar,  and  tha  violence  of  the  attack  varied  according  to  the  quantity  of  the  diseased  veal  they  had 
eatan.  Tha  chief  symjjtoms  ware:  vomiting  a  thin  greenish  matter,  watery  stools  of  the  same  color,  great 
and  CDntinued  prostration,  often  preceded  by  shivering  fits;  stupor,  combined  with  delirium;  involuntary 
evacuations ;  and,  in  the  milder  cases,  headache  and  giddiness  were  observed.  Convalescence  was  most 
tedijus.  The  vomiting  lasted,  as  a  rule,  for  several  days,  and  when  it  ceased  it  left  the  patients  very  weak 
and  prostrate.  In  some  cases,  cedematous  swellings  made  their  appearance,  and  of  those  who  recovered, 
twalva  individuals  ware  helpless  for  frjm  two  to  four  weeks.  In  one  instance,  in  which  death  took  place 
on  the  eleventh  day,  and  in  which  the  patient— a  man  fifty-two  years  of  age,  and  who  had  eaten  a  compar- 
atively larga  quantity  of  the  partly  raw,  partly  cooked  liver — there  were  found  petechix  over  the  entire 
surfica  of  the  body,  in  the  epicardium,  kidneys,  stomach,  intestines,  and  brain,  as  well  as  great  oedema 
of  the  luags— all  of  which  corresponded  with  the  appearances  presented  during  life,  and  which  led  to  the 
conclusion  that  the  alterations  were  due  to  intense  blood-poisoning  through  putrid  organic  matter— the 
appearances  closely  simultating  those  often  observed  in  poisoning  by  sausages  {ivurstgi/t,  "  Botulismus"), 
through  some  change  in  the  flesh  of  which  they  are  composed,  but  the  chemical  nature  of  which  is  not  yet 
ascertained. 

It  may  ba  noted,  however,  that  decomposition  had  not  begun  in  the  flesh  of  this  calf  ;  as  vaal  is  usually 
sold  on  the  day  on  which  the  animal  is  killed,  or  on  the  following  day,  and  at  once  eaten  ;  and  that  the 
craature  was  affected  with  septikaemia  or  pyaemia  at  birth.  As,  for  various  reasons,  the  existence  of 
anthrax  cannot  ba  accepted  in  this  case,  the  illness  of  the  calf  may  reasonably  be  compared  to  what  in 
children  is  called  "  congenital  pyjemia  or  septikaemia."  Bollinger  concludes  his  notice  of  the  outbreak, 
by  adding  the  following  remarks.— "  Although  I  do  not  wish  to  go  into  any  further  discussion  on  the 
sanitary  aspect  of  our  food  supply,  I  may  be  allowed  to  give  my  opinion  that  the  celebrated  epidemy  at 
Adelfingen  (Greisinger,  Handbuch  der  Speciellen  Pathologie  und  Titer apie,  Art.  Ileotyphus),  the  nature 
of  which,  according  to  tha  latest  discoveries — and  particularly  those  of  Biermer — was  not  typhoid,  but  was 
to  be  attributed  to  a  similar  poisoning  of  the  flesh  eaten  by  the  people,  to  that  occurring  in  this  calf.  In 
this  epidemy  five  hundred  people  ware  seized  with  illness  from  eating  diseased  meat.  Although  the  nature 
of  the  saptikae  nic  and  pyjemic  poison  is  not  well  defined,  we  are,  I  think,  justified,  after  the  numerous 
experiments  made,  in  considering  it  identical  with  certain  substances,  be  they  of  a  chemical  or  vegetable 
nature,  or  in  fact  both  chemical  and  vegetable.  In  other  words,  this  poison  belongs  to  that  class  of  poisons 
whicli  can  multiply  both  in  and  out  of  the  human  body.  In  conclusion,  the  general  remark  may  be  ven- 
tured upon  that,  with  regard  to  the  etiolosy  of  the  diarrhoea,  and  the  multiple  hsetnorrhagic  and  petechial 
aoDe-arances  which  marked  the  progress  of  the  disease  in  the  people  attacked  at  Zurich,  the  dates  given  in 
Zeh-idar's  report  on  the  meat  poisoning  are  of  the  P'reatest  importance.  If  such  cases  occur  sporadically — 
as,  for  instance,  in  large  towns — it  will  always  be  difficult  to  discover  their  etiology.  Anyhow,  it  is  cer- 
tainly tha  fact  that,  in  the  latest  treatises  on  the  subject,  the  occurrence  of  meat  poisoning — with  the  excep- 
tion of  poisoning  from  eating  unsound  sausages — is  completely  proved.  To  assert  that,  as  a  rule,  such 
poisoning  does  not  occur,  seems  to  me  to  be  scarcely  right,  and  especially  when  one  knows  the  numberless 
tricks  of  the  meat-market  in  preparing  the  flesh  for  sale.  On  the  other  hand,  it  is  an  indisr  utable  fact  that, 
notwithstanding  the  vast  importance  of  our  food  supnly,  for  the  so-called  official  and  leeal  meat  inspection 
there  is  no  proper  basis  to  work  upon.  The  cause  of  this  deficiency,  the  repair  of  which  must  be  of  the 
greatest  moment  to  huma#  hygiene,  can  be  traced  to  the  complete  neglect  of  the  pathological  anatomy  and 


746  DISEASES  AND  ABNORMALITIES. 

Treatment. 

Curative  treatment  of  this  form  of  joint  disease  being,  under  the  most 
favorable  circumstances,  very  unsatisfactory  unless  it  is  adopted  at  the 
very  commencement,  the  greatest  importance  must  be  attached  to  pre- 
ventive measures,  and  especially  if  the  malady  is  enzootic.  On  the  Con- 
tinent, those  veterinarians  who  adopt  Roloff's  view  lay  great  stress  on  the 
necessity  for  preserving  the  young  animals,  and  particularly  the  female 
parents,  from  the  effects  of  improper  feeding.  These  are  to  be  well  fed 
during  pregnancy,  and  aliment  rich  in  earthy  salts  is  to  be  given.  In 
addition,  bone-dust  may  be  mixed  with  their  prepared  food,  or  with  bran, 
meal,  or  oil-cake. 

When  it  is  continually  prevalent  in  districts,  it  is  recommended  to  im- 
prove the  pasture  lands,  and  to  restore  to  them,  by  means  of  top-dress- 
ings, the  mineral  elements  abstracted  by  the  growth  of  forage,  or  the 
herbage  consumed  by  the  animals  grazing  upon  them.  Attention  i-^> 
drawn  to  the  fact,  that  in  a  hundred  days  a  medium-sized  Cow  will 
remove  from  the  soil  about  a  kilogramme  of  phosphoric  acid,  which  is 
present  in  the  milk  yielded  during  that  period. 

If  we  have  reason  to  believe  that  the  malady  is  of  septic  origin,  as  Bol- 
linger and  others  are,  from  clinical  and  anatomical  investigation,  assured 
of,  then  the  preventive  measures  recommended  for  omphalitis  must  be 
adopted.  In  all  cases  where  the  affection  is  enzootic,  or  even  sporadic, 
every  means  should  be  resorted  to,  in  order  to  discover  tlffe  predisposing 
and  exciting  causes,  as  on  the  successful  removal  or  suppression  of  these 
must  loss  be  mainly  averted.  And  with  modern  means  of  investigation 
and  clinical  and  physiological  knowledge,  there  should  be  no  difficulty  in 
arriving  at  correct  conclusions  in  this  direction. 

Curative  treatment,  as  has  just  been  said,  is  generally  unsatisfactory, 
and  this  not  only  from  the  comparatively  small  value  of  the  animals 
affected,  and  the  difficulty  in  applying  remedies  to  them,  but  also  from 
the  very  serious  nature  of  the  disease,  and  the  character  of  the  tissues 
involved.  Even  when  the  life  of  the  creature  affected  with  arthritis  is 
preserved,  only  too  frequently  its  health  and  condition  are  irretrievably 
impaired. 

Zundel  remarks  that  counter-irritants  to  the  joints  augment  the  pain 
and  increase  the  debility,  and  emollients  have  only  a  doubtful  effect.  In 
the  hands  of  Strauss,  refrigerants  were  productive  of  good  results,  the 
inflamed  joints  being  enveloped  afterwards  in  linen  bandages.  Anodyne 
lotions  and  embrocations  have  also  been  recommended,-  in  order  to  allay 
the  pain  and  irritative  fever  ;  as  well  as  the  application  of  tincture  of 

histology  of  the  domestic  animals.    The  study  of  these  subjects  can  alone  place  the  onerous  and  responsible 
duty  of  the  meat  inspector  on  a  surer  footing. 

In  connection  with  this  subject,  it  may  be  interesting  and  important  to  remark  that  a  very  melancholy 
case  of  wholesale  poisoning  from  the  consumption  of  diseased  meat,  was  reported  from  Wurzen,  a  small 
town  in  Saxony,  in  the  summer  of  1877.  A  local  farmer,  finding  one  of  his  recently-calved  Cows  to  be  suf- 
fering from  puerperal  fever  (not  puerperal  apoplexy),  with  accompanying  abscess  and  ulcers,  and  beyond 
all  hope  of  recovery,  employed  the  services  of  two  neighboring  butchers  to  slaughter  the  beast  and  dress 
the  carcase  ;  after  which  the  trio  managed  to  dispose  of  the  meat,  partly  in  the  form  of  sausages,  and 
partly  as  joints.  Among  those  who  partook  of  it,  at  least  206  cases  of  illness  occurred,  and  in  seven  in- 
stances such  illness  terminated  fatally.  The  symptoms  observed  during  life  were  analogous  to  those  of 
Asiatic  cholera,  and  in  the  fatal  cases  decomposition  of  the  bodies  rapidly  set  in.  In  six  of  these  cases, 
post-mortem  examinations  were  made,  and  in  all  were  found  most  extensive  inflammation  of  the  mucous 
membrane  of  the  stomach  and  intestines,  with  peculiar  extravasations  of  blood  in  the  mucous  membrane, 
and  marked  swelling  of  the  glands  of  the  small  intestine.  The  other  sufferers  recovered,  though  convales- 
cence was  slow,  and  in  many  instances  attended  with  serious  relapses.  Inquiries  instituted  by  the  author- 
ities clearly  showed  the  origin  of  the  outbreak  ;  and  the  heartless  culprits,  whose  miserable  cupidity  had 
led  to  such  sad  results,  were  committed  to  prison  to  await  their  trial.  • 


ARTHRITIS.  747 

iodine,  before  the  suppuration  period.  When  suppuration  is  established, 
the  abscess  should  be  opened  at  the  proper  time. 

Tonics  have  been  given  with  advantage,  as  well  as  cod-liver-oil,  castor- 
oil,  and  even  ordinary  oils  and  fats.  These  not  only  aid  in  the  assimila- 
tion of  earthy  salts  and  nitrogenous  matters,  but  to  some  extent  act  as  a 
laxative — a  service  of  some  importance.  Small  doses  of  sulphate  of 
magnesia  or  soda,  or  aloes,  may  also  be  given  with  the  last-named  object, 
or  even  to  produce  continuous  purgation  for  some  time. 

With  regard  to  the  treatment  of  the  disease  in  lambs,  Walley  advises 
that  those  affected  be  removed  from  the  dam,  and  receive  milk  from 
healthy  animals.  The  milk  maybe  mixed  with  beaten-up  eggs,  and  good 
nitrogenized  gruels  may  also  be  allowed.  "  Place  in  dry,  warm  houses, 
and  give  gentle  aperients — as  castor-oil — or  better,  a  small  dose  of  mer- 
cury with  chalk  ;  follow  up  by  febrifuges  and  diuretics,  as  nitrate  of  pot- 
ash and  camphor,  with  nitric  ether,  or  carbonate  of  ammonia  ;  if  much 
pain  is  evinced,  give  small  doses  of  opiates — Dover's  powder  being  the 
best  agent  of  this  class  ;  or  inject  a  small  quantity  of  the  solution  of 
morphia  underneath  the  skin  of  the  joints.  In  the  course  of  a  few  days^ 
tonic  treatment  should  be  adopted,  as  the  administration  of  iron,  alter- 
nated with  iodide  of  potassium  ;  or  mineral  acids  with  cinchona,  or  other 
vegetable  tonics  j  and  allow  a  little  wine,  good  old  ale,  or  porter."  The 
same  authority  recommends,  as  local  treatment,  the  application  of  a 
strong  blister — as  the  compound  tincture  of  iodine  ointment — all  round 
the  joint,  at  the  commencement  of  the  disease  ;  and  when  the  subsequent 
inflammation  has  subsided,  to  keep  the  joints  at  rest  and  in  their  proper 
position  by  the  use  of  light  splints  and  bandages,  leaving  the  joint 
exposed  for  further  observation.  As  soon  as  any  tendency  towards 
"pointing"  in  suppuration  is  perceived,  the  joint  is  to  be  opened  freely, 
the  inflammatory  products  removed,  and  the  interior  washed  out  with  a 
solution  of  carbolic  acid  in  glycerine  and  warm  water — one  part  of  the 
first,  two  of  the  second,  and  forty  or  fifty  of  the  last.  Afterwards,  pads 
of  soft  lint  or  linen  and  tow,  saturated  in  carbolized  oil  (one  to  eight  or 
ten)  should  be  applied,  leaving  an  aperture  inferiorly  for  the  escape  of 
discharge  ;  the  dressings  are  to  be  renewed  every  day.  Mild  caustics  or 
astringent  lotions  are  to  be  applied  if  granulations  project  above  the  skin. 
If  the  ends  of  the  bones  are  carious,  they  must  be  scraped,  and  nitric  or 
muriatic  acid  applied  ;  should  sinuses  have  formed,  they  must  be  obliter- 
ated by  the  use  of  setons,  or  laying  them  open  with  the  knife,  and  treat- 
ing them  afterwards  as  ordinary  wounds.  "  In  treating  the  results  of 
this  disease,  it  must  be  borne  in  mind  that  in  young  animals  the  repara- 
tive processes  go  on  very  rapidly ;  and  that  what  appears  to  be  a  very 
formidable  wound,  is  soon  converted  into  a  comparatively  simple  one. 
Animals,  too,  may,  with  a  little  trouble,  be  fattened  and  their  flesh  utilized  ; 
few  can  be  preserved  for  breeding  purposes." 

As  salicylic  acid  is  unrivalled  for  its  antipyretic  properties,  and  partic- 
ularly in  inflammation  of  the  fibro-serous  membranes,  its  internal  admin- 
istration should  be  tried  in  the  arthritis  of  young  animals.  The  soda  salt 
(salicylate  of  soda)  is  the  best  form,  perhaps.  The  internal  administra- 
tion of  other  antiseptic  remedies — as  preparations  of  carbolic  acid, 
and  boracic  acid,  sulphite  of  soda,  etc.,  might  also  be  tried  in  those  cases 
in  which  the  joint  disease  is  suspected  to  be  due  to  septikaemia  as  the  result 
of  omphalitis. 


748  DISEASES  AND  ABNORMALITIES. 

CHAPTER  VIII. 

Indigestion. 

Indigestion  sometimes  attacks  young  animals  soon  after  birth,  and  is 
perhaps  most  frequently  observed  in  calves,  seldomer  in  lambs ;  in  foals, 
and  the  young  of  carnivora,  it  is  rarely  met  with. 

Causes. 

The  principal  cause  would  appear  to  be  too  rich  milk,  or  even  milk 
difficult  of  digestion  from  its  poorness,  or  its  containing  some  extraneous 
ingredient  to  which  the  young  creature  is  not  accustomed.  The  quantity 
of  milk  may  also  prove  as  potent  a  cause  as  its  quality.  Therefore  it 
often  happens,  that  too  copious  sucking  after  abstinence  will  give  rise  to 
an  attack,  and  among  calves  reared  by  hand,  those  which  receive  artificial 
food  of  improper  quality  or  in  undue  quantity,  are  frequently  the  subjects 
of  indigestion.  An  alteration  in  the  milk  of  the  Cow,  produced  by 
fatigue,  or  bad  food  or  water,  will  also  lead  to  the  same  accident ;  while 
altered  secretions  in  the  stomach  of  the  calf — as  too  much  acidity — will 
undoubtedly  cause  coagulation  of  the  milk,  and,  as  a  consequence,  indi- 
gestion. 

Indigestion  is  often  witnessed  in  high-bred  calves  which  are  unnaturally 
forced,  in  order  to  produce  greater  and  premature  development. 

Symptoms. 

The  young  animal  looks  dull  and  dejected,  and  evinces  uneasiness  or 
suffering ;  the  movements  are  torpid  ;  the  coat  is  dry  and  staring  ;  it 
yawns  now  and  again,  and  there  are  sharp  gaseous  eructations  which 
cause  the  animal  to  elevate  its  head.  Soon  it  refuses  to  suck  or  to  par- 
take of  food,  and  the  nausea  is  more  marked  ;  there  may  be  vomiting  of 
coagulated  milk  ;  the  breath  has  an  acid  odor,  and  the  tongue  is  coated 
with  a -white  or  greyish  matter  ;  the  abdomen  is  swollen  and  tympanitic  ; 
and  pressure  made  towards  the  upper  part  of  the  right  side,  as  well  as 
along  the  cartilages  of  the  ribs,  causes  pain  ;  flatus  is  expelled  when 
diarrhoea — the  faeces  being  yellow  and  foetid — sets  in,  which  is  frequent — 
though  constipation  is  not  rare ;  and  at  this  period  symptoms  of  colic 
are  often  noted,  and  the  respiration  is  at  times  hurried.  The  diarrhoea 
is  a  means  of  cure  ;  though  should  it  persist  too  long,  inflammation  of 
the  stomach  and  intestines  may  ensue.  Then  there  is  emaciation,  the 
abdomen  is  retracted  and  flanks  tucked  up  ;  fever  is  present ;  great  pain 
is  manifested,  and  the  dejections  are  small  in  quantity,  and  consists  of  a 
yellow  glairy  mucus,  mixed  with  lymph  or  false  membranes. 

Indigestion  runs  its  course  rapidly  in  the  calf — in  the  majority  of  cases 
only  occupying  two,  three,  or  four  days.  It  may  be  considered  a  serious 
condition,  as  death  often  occurs.  As  it  is  frequently  induced  by  causes- 
which  remain  in  operation  for  some  time,  even  when  recovery  takes  place 
relapses  are  to  be  apprehended  ;  and  at  last  the  stomach  and  intestines 
become  inflamed,  and  enteritis  brings  about  a  fatal  termination.  At  the 
best,  it  causes  loss  of  condition,  and  often  retards  growth. 

Treatment. 

Preventive  treatment  is  to  be  based  on  the  predisposing  or  exciting 
causes  just  enumerated.     Over-repletion  with  milk  should  be  guarded 


DIARRHCEA.  749 

against,  and  if  the  animal  is  being  reared  artificially,  great  care  must  be 
paid  to  the  diet.  If  at  the  teat,  the  food  and  water  of  the  mother  should 
be  attended  to  ;  and  if  the  milk  is  too  rich,  this  may  be  remedied  by  giv- 
ing less  stimulating  food.  With  Mares  which  are  worked  during  the 
suckling  period,  the  milk  is  often  retained  for  a  long  time  in  the  udder, 
and  becomes  altered  ;  on  returning  to  the  foal,  the  latter  is  ravenously 
hungry,  and  over-gorges  itself  with  this  unhealthy  fluid.  The  preventive 
measures  are  obvious  in  such  a  case.  Indigestion  may  be  due  to  an 
insufficiency  of  oily  matters  in  the  milk  of  the  mother ;  here,  the  diet  of 
the  latter  must  be  altered. 

The  curative  measures  in  mild  cases  are  simple.  Some  French  and 
Italian  veterinarians  recommend  the  administration  of  barley-water  or 
very  weak  beef-tea,  and  if  there  is  not  speedy  amendment,  they  prescribe 
a  spoonful  of  rennet,  which,  they  assert,  readily  effects  a  cure. 

When  the  indigestion  is  due  to  acidity,  alkaline  agents — as  carbonate 
of  potass  or  soda,  lime-water,  calcined  magnesia,  etc. — and  afterwards 
castor-oil — are  generally  effective.  A  mild  purgative — such  as  castor-oil, 
manna,  cream  of  tartar,  olive-oil,  or  a  dose  of  glycerine  in  albuminized 
water — is  very  useful,  even  when  diarrhoea  has  set  in.  Manna  has  proved 
an  excellent  remedy  for  lambs,  and  even  calves.  When  constipation  is 
present,  enemata  of  soap  and  water  may  prove  serviceable.  Vegetable 
bitters — as  tincture  of  gentian — and  mild  stimulants,  are  often  beneficial ; 
and  much  success  has  attended  the  administration  of  a  spoooful  of  very 
finely-powdered  vegetable  charcoal,  given  twice  a  day,  mixed  with  water 
in  which  an  Q.gg  has  been  beaten  up. 

When  there  is  pain  and  uneasiness,  chlorodyne  will  be  found  an  ex- 
cellent medicine,  particularly  if  diarrhoea  has  persisted  for  some  time. 
Of  course,  a  change  of  regime  is  generally  necessary.  In  chronic  indi- 
gestion of  calves,  Philippi  omits  all  medical  treatment,  which  he  asserts 
is  usually  found  to  be  inefficacious  in  these  cases,  and  puts  them  to  be 
suckled  by  Cows  which  have  newly  calved,  dieting  them  carefully  at  the 
same  time. 


CHAPTER  IX. 

Diarrhoea. 

The  peculiar  diarrhoea  which  attacks  young  animals  while  at  the  teat, 
has  for  very  many  years  attracted  particular  attention  because  of  its 
specific  nature,  its  almost  incurable  character,  and  the  great  mortality 
which  attends  it.  Known  by  various  names  in  different  animal-rearing 
countries  (as  "White  Scour"  in  England — the  "Weisse  Ruhr"  of  the 
Germans,  and  the  "  Diarrhee  des  Jeunes  Animaux  "  of  the  French),  it  is 
generally  acknowledged  that  calves  are  far  more  frequently  attacked  than 
other  animals  ;  though  it  is  also  an  extremely  fatal  disease  among  foals. 
Brugnone  {La  Mascalcia,  Turin,  1774)  long  ago  asserted,  that  it  is  one 
of  the  maladies  which  cause  most  destruction  among  the  foals  in  breed- 
ing establishments  ;  and  to  our  own  knowledge,  it  is  a  most  serious 
scourge  among  the  young  thorough-bred  stock  in  England.  It  is  also 
a  fatal  malady  among  young  lambs  \  and  it  is  observed  in  piggeries  and 
kennels  as  a  very  destructive  disorder.     It  appears  to  be  much  more 


750 


DISEASES  AND  ABNORMALITIES. 


frequent  among  animals  reared-  in  dwellings  than  those  at  pasture,  and 
seems  to  be  a  malady  due  to  the  artificial  way  in  which  they  are  kept. 

It  presents  itself  in  somewhat  diverse  forms  ;  but  in  the  majority  of 
cases  it  arises  from  disturbance  in  the  secretory  functions  of  the  intestinal 
mucous  membrane,  without  any  very  marked  anatomical  alterations — 
being  merely  an  intestinal  catarrh.  It  is  rare  indeed,  and  only  consecu- 
tively, that  there  is  inflammation — unless  the  young  creature  is  somewhat 
old,  when  we  may  have  the  ordinary  lesions  of  gastro-enteritis,  as  it 
occurs  in  infants.  The  idiopathic  mucous  diarrhoea  of  young  animals 
has  a  special  character,  seldom  observed  in  the  diarrhoea  of  adult  creatures, 
and  is  therefore  to  be  studied  apart  from  those  inflammatory  conditions 
of  the  intestinal  tract  which  affect  young  and  old  alike. 

The  malady,  though  very  common  and  fatal,  does  not  appear  to  have 
been  much  studied  ;  but  from  what  has  already  been  learnt  with  regard 
to  it,  it  appears  to  be  one  of  the  most  dangerous  and  infectious  disorders 
to  which  new-born  animals  are  liable.  The  diarrhoea  often  manifests 
itself  as  an  epizooty,  and  runs  its  course  rapidly,  death  taking  place 
within  one  to  three  days.  It  sometimes  haunts  breeding  stables  and 
cowsheds  for  years.  It  is  extremely  difficult  of  cure,  and  among  calves 
is  seen  more  frequently  in  some  localities  than  others — low-lying  districts 
being,  perhaps,  more  often  and  severely  visited  than  elevated  situations. 
It  is  sqtid  to  be  particularly  prevalent  in  districts  where  the  spe.nt  grains 
of  distilleries  and  breweries  are  generally  used  for  feeding  purposes. 
When  a  number  of  new-born  animals  are  crowded  together,  if  one  is 
attacked  by  diarrhoea,  all  are  likely  to  suffer. 

Syfnpfoms. 

The  disease  generally  appears  suddenly  in  a  shed  :  an  apparently 
healthy  calf  being  seized  all  at  once,  and  without  any  notable  alteration 
in  the  food  or  hygienic  management.  The  diarrhoea  manifests  itself 
most  frequently  during  the  first  eight  days  after  birth,  though  in  calves  it 
may  not  show  itself  until  the  tenth  or  fifteenth  day.  In  many  cases  it  is 
present  almost  immediately — within  twenty-four  hours — after  the  creature 
is  born  :  and  death  ensues  in  from  twenty-four  to  forty-eight  hours — from 
the  second  to  the  fourth  day  after  birth.  In  a  number  of  instances, 
Franck  has  known  the  diarrhoea  to  appear  immediately  the  calf  was  born, 
and  before  it  had  time  to  suck  ;  indeed,  it  never  sucked,  as  it  was  dead 
before  it  could  do  so.  As  a  rule,  according  to  the  same  authority,  the 
calf  has  two  or  three  good  meals  before  the  acute  diarrhoea  sets  in. 

The  faeces  are  very  fluid  and  mucus  in  character,  they  have  a  sour  or 
foetid  odor,  are  yellow-tinted  and  then  whitish,  or  of  a  greyish-green  hue, 
but  most  frequently  light-colored.  The  evacuations  are  more  or  less 
numerous  in  a  brief  period — from  five  to  fifteen  or  twenty  in  twenty-four 
hours,  and  the  excreta  are  projected  with  some  force.  The  first  indica- 
tion of  the  presence  of  diarrhoea  is  usually  the  soiled  condition  of  the  tail, 
and  the  animal  ceasing  to  suck.  The  creature  seems  suddenly  to  lose  its 
strength,  remains  nearly  always  lying,  and  when  it  gets  up  it  staggers 
about ;  it  is  indifferent  to  surrounding  objects ;  the  eyes  sink  deeply  in 
their  orbits ;  saliva  flows  from  the  mouth,  no  attempt  being  made  to 
swallow  it,  and  it  wets  the  throat  and  breast.  Emaciation  is  astonishing- 
ly rapid,  and  the  hair  is  dry  and  erect.  Nevertheless,  the  belly  is  not 
painful  to  pressure,  neither  is  meteorismus  present ;  no  gas  is  mingled 
with  the  alvine  evacuations,  borborygmi  are  not  heard,  nor  are  symptoms 


DTARRHCEA.  751 

of  colic  manifest.  Tliere  may  be  slight  tenesmus,  and  the  anus  is  dilated 
as  if  it  were  paralyzed  ;  while  the  air  passing  into  the  rectum  produces  a 
peculiar  sound.  Towards  the  end,  the  creature  remains  immovable,  as  if 
paralyzed,  and  dies  without  a  struggle. 

Zundel  and  others  state,  that  if  the  disease  continues  for  any  length  of 
time,  the  diarrhoea  is  accompanied  by  congestion  and  ulceration  of  the 
intestinal  mucous  membrane,  through  the  acridity  of  the  secretions,  as  well 
as  inflammation  and  excoriation  of  the  skin  around  the  anal  opening. 
Then  there  is  fever  with  its  attendant  symptoms,  and  the  abdomen  is  very 
sensitive  to  pressure  and  becomes  more  and  more  retracted  ;  while  the 
evacuations  are  increased  in  frequency,  are  more  foetid,  and  finally  become 
serous  and  sanguinolent. 

Brugnone  has  observed  as  a  complication  in  the  diarrhoea  of  foals,  a 
kind  of  ophthalmia  more  particularly  involving  the  anterior  chamber  of 
the  eye,  accompanied  by  tumefaction  of  the  cornea  and  lachrymation.* 
A  similar  complication  has  been  noticed  in  calves  ;  and  in  the  diarrhoea 
of  poultry  this  ophthalmia  is  often  noticed. 

Zundel  alludes  to  constipation  alternating  with  the  diarrhoea  ;  and  also 
to  the  occurrence  of  convulsions,  similar  to  those  present  in  infantile 
diarrhoea.  Rainard  mentions  consecutive  pneumonia,  with  suppression 
of  the  diarrhoea,  as  a  termination  of  the  disorder. 

Pathological  Anatomy. 

Rainard  was  of  opinion  that  the  diarrhoea  of  young  animals  is  due  to 
an  irritation  of  the  colon  and  rectum.  There  is  a  kind  of  atony,  and  a 
special  catarrhal  condition  of  this  portion  of  the  intestinal  tract,  with 
frequently  pseudo-ulcerations  due  to  an  alteration  in  the  follicles,  but 
without  any  trace  of  inflammation.  He  never  found  any  lesions  in  the 
small  intestines  or  stomach.  The  lymphatic  glands  corresponding  to  the 
diseased  intestines  are  voluminous,  reddened,  and  infiltrated  with  a  red- 
dish fluid.  Zundel  thinks  these  alterations  are  caused  by  microscopic 
entozoa,  and  he  is  of  opinion  that  the  malady  is  especially  due  to  the 
influence  of  microphytes,  which  are  developed  in  excess  in  the  posterior 
portions  of  the  intestinal  canal,  which  the  bile  does  not  reach.  This 
excessive  development  is  simply  owing  to  the  superabundance  of  fluid  in 
the  tube  ;  and  the  growth  of  these  minute  organisms,  again,  still  further 
increases  the  secretion  of  intestinal  mucus.  Billard  and  Valleix,  a  long 
time  ago,  announced  that  the  diseased  condition  known  as  "  thrush " 
{aphtha)  of  children  is  produced  by  a  cryptogamous  parasite,  and  that 
this,  extending  along  the  mucous  membrane  of  the  intestines,  has  been 
found  in  infantile  diarrhoea.  Hallier  and  Zurn  have  proved  the  presence 
of  micrococci  in  the  diarrhoea  of  animals. 

Franck  is  the  most  recent  authority  on  this  malady,  and  his  observa- 
tions are  of  great  importance,  not  only  from  the  care  with  which  he  has 
studied  it,  but  also  from  the  scientific  manner  in  which  he  has  investi- 
gated its  pathological  anatomy.  He  examined  a  number  of  bodies  of 
calves  which  had  recently  died  of  the  disease,  and  always  found  the  same 
characteristic  alterations,  of  which  the  following  are  given  as  typical  : 

*  The  following  are  the  symptoms  observed  in  the  foal  by  Brugnone.  "  The  diarrhoea  commences  two  or 
three  days  after  birth  ;  a  yellow,  acrid,  sometimes  purulent-looking  fluid,  is  evacuated  ;  the  foal  becomes 
rapidly  emaciated  and  is  nearly  always  lying  ;  it  is  weak  and  staggers  about,  sucks  little  or  none  at  all,  and 
finally  falls  into  a  state  of  complete  marasmus-  During  the  first  period  it  is  not  rare  to  observe  a  general 
ophthalmia  occur;  the  humors  of  the  eye  are  turbid,  the  eyes  are  painful,  tears  flow  continually,  the  eye- 
ball becomes  bnried  in  its  socket  and  atrophied,  and  vision  appears  to  be  lost." 


752 


DISEASES  AND  ABNORMALITIES. 


A  bull  calf  of  the  Algauer  breed,  which  died  on  the  third  day  after 
birth,  the  second  day  of  the  disease.  Weight  37*4  kilogrammes.  The 
remaining  portion  of  the  umbilical  cord  is  perfectly  dry.  The  hind  parts 
are  somewhat  soiled  by  fasces,  the  eyes  are  deep  in  their  sockets  ;  there 
is  no  meteorismus.  Eight  incisors  are  cut.  There  is  a  remarkable 
and  general  bloodlessness  observed,  and  this  is  more  particularly  noted 
in  the  digestive  organs,  which  look  very  white.  (This  anaemia  was 
present  in  all  the  cases  to  the  highest  degree  :  so  much  so,  indeed,  that 
the  tanner  who  bought  the  skins  thought  they  were  from  calves  which 
had  been  slaughtered  in  the  ordinary  way,  /.  ^.,  bled  to  death — "white 
veal.")  The  umbilical  artery  is,  at  the  torn  extremity,  contracted,  dark- 
red  in  color,  and  retracted  towards  the  pelvic  opening  ;  it  is  distended 
by  a  dark-red  blood-clot,  which  extends  as  far  as  the  aorta.  The  umbilical 
vein  is  not  inflamed,  but  contains  a  Quantity  of  dark,  small  blood-clots(these 
were  not  always  present)  ;  it  had  been  torn  through  towards  the  outer  half 
of  the  navel-ring,  so  that  both  divisions  were  visible.  The  urachus  is  rup- 
tured at  the  inner  portion  of  the  umbilical  opening.  Around  the  latter  are 
a  number  of  generally  small  ecchymoses.  The  abdominal  cavity  is  filled 
with  a  dark  fluid,  which  extends  through  the  second  and  third  compart- 
ments of  the  stomach,  as  far  as  the  fourth  compartment.  This  fluid  is 
also  found  in  the  mouth  and  pharynx,  as  well  as  in  the  trachea  ;  though 
none  is  observed  in  the  lungs.  In  the  true  stomach  is  discovered  a  greater 
quantity  (about  one  and  a  half-litre)  of  curdled  milk,  in  which  were  dirty- 
white  masses  of  casein  ;  this  fluid  has  an  acid  reaction — making  litmus 
paper  double-red  :  its  normal  condition.  The  mucous  membrane  of  this 
portion  of  the  stomach  is  cedematous,  of  a  dirty  yellowish-red  color,  with 
traces  of  post-mortem  solution.  In  the  third  compartment  are  a  number 
of  isolated  ecchymoses  about  the  size  of  a  pin's  head.  The  intestines  are 
quite  empty,  and  their  lining  membrane  is  covered  by  a  thin  layer  of  puru- 
lent-looking matter,  which  has  a  feeble  alkaline  reaction.  Peyer's  glands 
are  slightly  swollen,  somewhat  injected,  but  otherwise  normal.  The 
caecum  is  remarkably  void  of  solid  or  fluid  contents,  and  is  full  of  gas. 
The  liver  is  very  small,  pale,cIay-colored,  and  bloodless  ;  the  little  gall-blad- 
der is  completely  empty ;  the  spleen  is  normal.  The  lungs  are  speckled 
red  ;  at  some  points  the  patches  are  reddish-brown  ;  the  organs  are  perme- 
able to  air.  The  cavities  in  both  sides  of  the  heart  are  full  of  dark  coagu- 
lated blood,  and  beneath  the  epicardium  are  a  number  of  small  ecchymoses. 
Otherwise  the  heart  and  its  valves  are  very  healthy.  The  dura  mater  of 
the  brain  is  strongly  attached  to  the  cranium.  The  sinuses  are  dark- 
colored,  and  full  of  coagulated  blood.  The  brain  is  remarkably  anaemic ; 
its  lateral  ventricles  are  distended  by  a  clear  serous  fluid  ;  the  rete  mira- 
bile  at  its  base,  and  the  neighboring  membranes,  are  also  distended  by  co- 
agulated blood. 

Microscopic  examination  of  the  blood  and  the  blood-clots  in  the  heart, 
umbilical  vein  and  artery,  proved  that  these  were  perfectly  normal.  The 
red  and  white  corpuscles  in  them  were  unaltered,  and  there  were  no 
special  organisms  ;  the  color  of  the  blood  was  not  diminished.  All  those 
appearances  which  are  particularly  noted  in  putrid  diseases — as  in  puer- 
peral fever,  and  particularly  in  septikasmia,  were  absent.  The  liver-cells 
were  certainly  partly  filled  with  fat  granules,  but  there  was  otherwise  no 
indication  of  fatty  degeneration. 

A  very  special  feature  of  the  disease  was  always  found  in  the  micro- 
scopical examination  of  the  contents  of  the  true  stomach  and  small  intes- 


DIARRHCEA.  753 

tine.  In  these  were  discovered  great  quantities  of  epithelium,  and  crowds 
of  minule  organisms.  This  purulent-looking  matter  appeared  to  be  a 
kind  of  bacteria  pulp  {Bakterienbret).  Besides  innumerable  micrococci, 
there  were  also  immense  numbers  of  vibratile  staff-shaped  bodies  {scfnving- 
mde  Stdbcheti).  In  the  present  state  of  uncertainty  of  the  question  with 
regard  to  minute  vegetable  organisms,  Franck  declines  to  give  an  opinion 
as  to  the  species  to  which  the  last-'described  bodies  belongs. 

Causes, 

Zundel  is  of  opinion  that  the  most  ordinary  cause  consists  in  a  modifi- 
cation in  the  food  of  the  young  creatures,  and  most  frequently  in  an 
alteration  in  the  mother's  milk,  under  the  influence  of  some  inscrutable 
agency.  Brugnone  admitted  the  existence  in  the  mother  of  constitutional 
maladies — as  mange,  grease,  and  other  skin  affections — which  might 
produce  the  disease  in  question  in  their  progeny  :  just  as  Bouchut  asserts 
that  the  herpetisme  dartreux  of  woman  may  similarly  affect  the  child.  Dela- 
fond  thinks  that  the  more  frequent  causes  are  too  rich  food  given  to  the 
mother,  the  use  of  highly  nitrogenous  aliment,  too  poor  regime,  innutri- 
tions food — and  particularly  that  w'hich  is  in  bad  condition.  In  the  milk 
of  Cows  fed  in  this  manner,  is  a  superabundance  of  white  granular  cor- 
puscles, which  are  particularly  numerous  in  the  colostrum,  while  the  other 
constituents  of  the  milk  are  relatively  deficient. 

These  colostrum  corpuscles  are  supposed  to  be  agglomerated,  generally 
granular,  leucocytes — the  granules  being  probably  nothing  else  than  the 
spores  of  some  mycoderm.  These  leucocytes  are  greatly  increased  in  the 
milk  when  the  Cow  is  excited  or  disturbed  in  any  way,  according  to  Zun- 
del ;  and  he  fancies  this  may  lead  to  the  production  of  diarrhoea  in  the 
offspring.  But  he  also  insists  strongly  on  the  influence  of  unfavorable 
hygienic  conditions,  when  the  animals  are  fed  without  care,  and  lodged 
in  unhealthy  dwellings. 

The  supposed  causes  of  this  form  of  diarrhoea  Franck  enumerated  as 
follows  :  bad,  deficient,  or  improper  food  ;  an  undue  proportion  of  lime 
salts  in  the  food  ;  milk  too  rich  in  fatty  constituents,  housing  at  night, 
chills,  defective  stabling,  stable  miasma  (Roloff),  or  a  volatile  contagium 
(Obich).  That  the  nature  of  the  fodder  or  the  milk,  or  even  chills,  will 
not  induce  the  disease,  Franck  is  certain  ;  and  he  points  to  the  fact  that 
ample  stable  room  and  good  food  is  no  safeguard  against  it.  And  he  also 
alludes  to  what  is  another  fact,  that  some  time  after  birth,  young  animals 
are  only  exceptionally  attacked,  though  the  food  and  stables  may  be  the 
same.  Even  when  the  food  or  the  milk  is  changed,  there  is  no  differ- 
ence. 

The  malady  is  most  intense  during  permanent  stabling ;  and  with  the 
advent  of  grazing,  when  the  cattle  are  driven  to  pasture  it  begins  to  dis- 
appear, and  is  no  more  heard  of  until  the  pregnant  Cows  are  again  stabled 
and  begin  to  calve.  All  this  would  indicate,  according  to  Franck,  that 
there  is  an  agent  at  work  in  the  production  of  the  disease,  to  which  the  des- 
ignation of  "  stable-miasma,"  for  want  of  a  better,  may  properly  be  given. 
This  view  as  to  the  existence  of  an  infecting  agent,  would  seem  to  be  borne 
out  by  the  circumstance,  that  whenever  one  young  creature  in  a  large 
breeding-shed  is  affected,  other  cases  soon  follow.  Obich  (  Wochenschrift 
fur  Thierheilkunde,  1865),  who  was  the  first  to  direct  attention  to  the  in- 
fectious nature  of  the  malady,  gives  several  strong  illustrations,  which  not. 
only  support  this  opinion,  but  would  also  tend  to  prove  that  the  infecting 

48 


754 


DISEASES  AND  ABNORMALITIES. 


agent  can  be  spontaneously  developed.  Franck  could  not  produce  the 
disease  spontaneously,  however;  for  though  he  administered  in  milk,  and 
to  sheep,  goats,  and  rabbits  a  quantity  of  the  intestinal  matter  which 
swarmed  with  bacteria,  no  positive  result  was  noted. 

This,  however,  can  scarcely  be  deemed  a  satisfactory  experiment  ;  and 
it  would  be  better  to  try  the  effects  of  the  morbid  products  on  sucking 
calves  or  other  creatures  of  the  teat.  If  nothing  is  at  present  known  as 
to  the  manner  in  which  the  contagium  acts,  or  its  origin,  as  little  are  we 
acquainted  with  its  mode  of  transmission  or  its  vital  tenacity.  We  can 
only  assert  that  such  contagium  must  exist,  from  the  manner  in  which  the 
disease  spreads,  and  from  the  other  evidence  already  adduced. 

It  is  interesting  to  note  in  this  respect,  that  a  case  is  recorded  in  which, 
in  an  infected  shed,  of  twin  calves  one  was  attacked  with  "  white  scour  " 
and  died,  while  the  other  remained  sound.  And  when  pregnant  Cows 
are  transferred  from  an  infected  to  a  healthy  stable  and  soon  after  calve 
there,  yet  their  progeny  may  still  be  attacked.  But  if  the  transfer  has 
taken  place  so  long  as  six  weeks  or  two  months  before  parturition,  then 
there  is  indeed  but  little  risk  of  the  young  creatures  being  seized  with 
the  diarrhoea. 

Roloff  {Mittheilwtgen  aus  der  Thierarztlichen  Praxis,  1875,  P-  1 19),  from  his  experience 
of  the  disease,  concluded  that  it  was  due  to  a  "  stable  miasma."  "  The  malady  will 
suddenly  appear  in  a  cowshed,  and  vanish  again  after  a  time,  without  any  alteration 
having  been  made  in  the  feeding  or  management  of  the  Cow.  I  was  consulted  in  a  case 
of  this  kind,  where,  in  a  large  cowshed,  during  eight  weeks  every  calf  produced  therein 
had  perished.  The  calves  were  generally,  about  the  second  day  after  birth,  uneasy, 
bellowed,  appeared  to  be  suffering  from  abdominal  pain,  had  no  appetite,  rapidly  lost 
condition,  passed  watery  stools,  and  died  within  twenty-four  hours.  All  remedies  tried 
— among  them,  large  doses  of  ojaium — were  useless.  Some  of  the  new-born  calves 
were  fed  on  skimmed  milk,  others  on  boiled  milk  diluted  with  water,  while  others 
received  no  milk  at  all,  but  were  fed  on  oatmeal  gruel  with  which  preparations  of  iron 
were  mixed— but  all  to  no  purpose,  as  they  died  all  the  same.  The  feeding  of  the 
Cows  was  in  every  way  good,  and  had  not  varied  from  that  of  other  times,  when  this 
disease  did  not  appear.  Roloff  therefore  concluded  that  the  mortality  was  due  to  a 
miasma  in  the  shed  ;  consequently  all  the  Cows  which  had  not  yet  calved  were  removed 
to  another  dry  and  airy  shed.  In  this  they  brought  forth  at  various  times,  and  the 
calves  remained  healthy." 

In  a  second  instance,  the  malady  broke  out  suddenly  in  a  cowshed  at  the  commence- 
ment of  1874.  The  calves  were  apparently  healthy  when  born,  but  in  about  two  days 
they  became  unwell  and  soon  died  in  the  usual  way.  As  an  experiment,  some  new-born 
calves  were  not  allowed  to  get  milk  from  their  parent,  but  were  fed  on  milk  from  Cows 
in  other  sheds  where  the  disease  did  not  exist.  On  the  second  day,  however,  the  calves 
sickened  all  the  same,  and  succumbed.  The  feeding  of  the  Cows  was  modified,  but 
without  benefit. 

In  a  third  instance,  Roloff  mentions  that,  for  a  long  time,  all  the  calves  in  a  large  cow- 
shed had  perished  in  a  similar  manner,  and  though  many  of  them  had  not  received  any 
of  their  mother's  milk — some  of  them  no  food  at  all — yet  it  made  no  difference.  This 
instance  was  particularly  conclusive  that  the  milk  of  the  parent  was  certainly  not  the 
cause  of  the  disorder.  The  Cows  near  their  time  for  calving  were  moved  from  this 
shed  into  another  some  distance  away,  and  the  change  was  attended  with  the  happiest 
results. 

With  regard  to  the  disease  in  lambs,  we  find  Benedikt  [Sdchsen  Jahresbericht,  1871,  p. 
140)  describing  it  under  the  head  of  "  typhus  diarrhoea  in  Sheep"  [Typhbse  Ruhr  bei 
Schafen),  He  writes  :  "  At  the  commencement  of  lambing-time,  the  lambs  are  observed, 
soon  after  birth,  to  be  dull  and  dejected  ;  they  do  not  care  to  suck  ;  there  is  great 
debility ;  the  eye  is  dull  and  sunken ;  there  are  involuntary  evacuations  of  a  foetid, 
brownish-yellow  color,  which  is  ejected  some  distance  ;  and  in  three  or  four  hours  death 
ensues.  In  all  the  cases  the  lambs,  when  born,  appeared  to  be  quite  healthy ;  but  in 
two  or  three  hours  after  they  began  to  exhibit  these  .symptoms,  and  during  the  first, 
seldom  the  second  day,  they  perished.  On  examination  of  the  carcase,  bright-red 
spots  are  observed  in  the  true  stomach  and  intestines,  which  contain  matter  having  an 


DIARRHCEA.  755 

unpleasant  odor.  The  Ewes  remain  healthy.  With  regard  to  the  cause,  this  was  prob- 
ably in  the  fodder,  which  consisted  of  damp  oats,  and  also  in  the  dwellings,  which 
were  hot  and  steamy.  The  Ewes  in  lamb  were  therefore  fed  with  maize  and  good  fod- 
der, sulphuric  acid  was  put  in  the  water  they  drank,  and  every  week  they  received  two 
draughts  of  a  solution  of  sulphate  of  iron  with  vegetable  bitters,  the  dwelling  was 
changed,  and  the  disease  ceased. 

Prognosis. 
The  prognosis  of  this  disease  is  generally  unfavorable.  Nearly  all  the 
young  animals  seized  with  it  perish  ;  and  when  a  few  recover,  it  is  either 
through  energetic  and  appropriate  treatment,  being  attacked  in  a  less 
severe  manner,  or  from  being  endowed  with  greater  vital  tenacity.  And 
even  those  which  recover  are  usually  so  reduced  in  strength  and  condi- 
tion, and  convalescence  is  so  protracted  and  unsatisfactory,  that  there  is 
little  if  any  profit  in  rearing  them.  As  a  rule,  all  those  born  about  the 
same  period  succumb  ;  but  after  the  malady  has  prevailed  for  one  or  two 
years  in  a  shed,  it  assumes  a  milder  form,  and  more  recoveries  are 
recorded.  When  the  disease  appears  in  small  cowsheds,  where  there  are 
fewer  calves  and  comparatively  more  space,  it  is  much  less  to  be  dreaded. 
Sometimes  it  disappears  from  a  cowshed  for  some  months.  Old  calves 
are  not  so  readily  affected,  and  recover  more  readily.  Weaned  calves 
which  are  fed  on  fodder,  appear  to  enjoy  immunity  from  attack. 

Treatment. 

As  with  every  other  animal  m3.]7idiy,  preventive  treatment  is  the  most 
important,  with  regard  to  this  diarrhoea  of  young  animals.  Attention  to 
hygiene  is  very  necessary  at  all  times,  and  more  so  when  the  disease  has 
shown  itself  in  a  stable  or  shed.  It  is  much  the  safer  plan,  however,  to 
remove  all  pregnant  animals  from  the  dwelling  in  which  it  has  appeared, 
and  the  longer  the  interval  which  elapses  between  their  removal  and 
parturition,  so  the  more  likelihood  there  is  of  their  progeny  escaping.  If 
moved  three  to  four,  or  four  to  six  weeks  before  parturition,  their  safety 
may  be  fairly  assured.  The  stable  or  shed  in  which  the  malady  has 
occurred  should  be  well  disinfected,  and  if  possible  left  unoccupied  during 
the  grazing  season.  The  floor  particularly  demands  attention,  as  it  is 
not  at  all  improbable  that  the  infection  is  retained  there ;  if  possible,  the 
floor  should  be  renewed.  Strong  carbolic  acid  or  chloride  of  lime-wash 
must  be  freely  employed,  and  especially  where  the  excreta  from  the  sick 
animals  have  fallen.  Thorough  disinfection  of  the  building  with  sulphuric 
acid  or  chlorine  gas  is  advisable. 

With  regard  to  curative  measures,  but  little,  unfortunately,  can  be  said. 
The  history  of  the  outbreak  may  suggest  the  nature  of  predisposing 
causes,  and  furnish  indications  for  their  removal. 

In  the  Milch  Zeitung  for  1877,  is  a  good  paper  on  the  malady  in  calves, 
by  Kessel-Zeutsch,  who  says,  with  regard  to  treatment : 

"  When  only  isolated  cases  occur  among  the  sucking  calves  in  a  herd,  they  are  usually 
of  a  mild  and  tractable  form,  and  due  to  cold  or  temporary  unsuitability  of  the  mother's 
milk,  or  to  a  natural  predisposition  to  weakness  of  digestion.  The  external  symptoms 
generally  observed  are  the  frequent  passage  of  slimy  motions,  marked  tenesmus,  and  a 
disinclination  to  suck.  Consequently  the  calves  soon  become  weak,  and  the  primary  con- 
sideration is,  therefore,  to  support  their  strength  while  treating  the  attack.  To  this  end 
it  is  absolutely  necessary  that  any  calf  having  diarrhoea  to  an  extent  requiring  medicinal 
treatment  should  immediately  be  placed  with  the  mother,  so  as  to  benefit  by  the  animal 
heat  of  the  Cow,  and  by  its  own  instinctive  inclination  to  suck.  Diarrhoea  caused  by 
over-sucking  is  rarely  met  with  except  when  the  calves  have  been  separated  from  the 
mother  shortly  after  birth,  in  which  case  they  naturally  feed  too  greedily  when  allowed 
access  to  the  teat,  and  so  overburden  their  still  immature  digestive  apparatus. 


756  DISEASES  AND  ABNORMALITIES. 

"  The  color  of  the  motion  is  always  an  index  to  the  cause  of  the  diarrhoea,  and,  with 
this  point  established,  its  treatment  by  appropriate  means  can  be  rationally  conducted. 
When  the  motion  is  yellowish-white,  the  diarrhoea  is  chiefly  dependent  on  simple  weak- 
ness of  digestion,  and  in  such  cases  a  couple  of  raw  eggs,  with  their  shells,  or  the  whites 
of  two  eggs  with  some  chalk,  may  probably  be  of  service  ;  or  should  this  treatment 
not  suffice  for  the  cure,  it  may  be  followed  by  the  administration  of  an  infusion  of  oak 
bark,  or  peppermint  root  in  starch.  On  the  other  hand,  when  the  motion  is  of  deep 
golden  yellow  color,  slimy  and  tough,  and  the  orifice  of  the  anus  irritated,  the  liver  is 
at  fault,  and  laxative  and  strengthening  medicines  are  called  for.  These  are  best  given 
in  the  form  of  rhubarb  and  Epsom  salts,  three  or  four  times  a  day,  in  half  a  pint  of 
linseed  tea.  Again,  if  the  motion  be  slightly  colored,  and  have  no  appreciable  smell, 
but  is  still  accompanied  by  pain  in  the  passage,  the  diarrhoea  is  dependent  on  the 
inflammatory  condition  of  the  intestines,  and  is  best  treated  by  decoctions  of  linseed, 
or  by  infusions  of  marsh-mallow  or  of  camomile  flowers,  either  given  internally,  or  admin- 
istered as  clysters.  A  decoction  of  bruised  bitter  almonds  (125  grammes  in  a  pint  of 
new  milk)  has  also  proved  useful  in  such  cases.  In  Switzerland,  and  in  the  Tyrol, 
diarrhcea  dependent  on  inflammation  is  generally  treated  by  camomile  infusions,  and 
that  caused  by  weakness  of  digestion  by  coffee.  In  France  the  former  class  of  cases  is 
treated  by  mallow  flowers,  and  the  latter  by  broth  made  from  mutton  bones,  or  by 
rennet.  In  Holland  and  Oldenburgh  the  means  chiefly  relied  upon  are  infusions  of 
hops. 

"  All  the  above  methods  are  good  if  applied  early,  and  if  the  cases  are  sporadic  only ; 
but  when  the  calves  generally  are  attacked  soon  after  birth,  presenting  such  symptoms 
as  diminished  appetite,  debility,  constant  passage  of  yellowish-white  modons,  and  fits  of 
cramp,  they  are  generally  of  little  avail.  In  such  cases  the  calves  are  but  secondarily 
affected,  and  the  proximate  cause  of  mischief  must  be  looked  for  in  the  mother  Cows, 
whose  condition  of  blood  will  generally  be  found  at  fault.  Till  this  fact  is  recognized, 
all  treatment  of  the  calves  is  but  lost.  Where  diarrhoea  is  generally  prevalent  among 
the  calves,  the  Cow's  coat  will  usually  be  found  in  an  unhealthy  condition — the  hair 
rough  and  dull,  its  roots  colorless,  and  its  skin  covered  with  a  crust  or  scale.  The  milk 
of  such  Cows,  tested  with  litmus  paper,  invariably  exhibits  an  acid  reaction.  To  cor- 
rect this  faulty  condition  of  blood,  it  has  been  my  practice  to  give  them  a  lick-bit  of 
bitter  aromatics  three  or  four  times  a  week.  The  preparation  employed  is  a  mixture  of 
equal  parts  of  calamus  root,  juniper  berries,  and  gentian  in  powder,  to  which  a  spoonful 
of  salt  is  added  A  handful  of  rye  meal  is  sprinkled  over  it,  and  the  powder  placed  in 
a  dry  state  at  the  bottom  of  the  crib,  food  being  withheld  for  an  hour  or  so  after  the 
dose  has  been  taken.  At  the  same  time,  to  promote  an  increased  action  of  the  skin, 
the  ordinary  curry-combing  and  brushing  is  supplemented  by  a  vigorous  rubbing-down 
of  the  whole  body,  more  especially  of  the  flanks,  belly  and  back,  with  wisps  of  straw. 
In  a  few  weeks  such  treatment  proves  successful,  a  healthy  appearance  of  skin  and 
hair  gradually  returning,  while  the  milk  regains  its  normal  wholesome  condition,  and  can 
be  taken  by  the  calves  without  danger  of  a  return  of  diarrhoea.  Of  course,  careful 
attention  is  also  given  to  the  diet,  all  injurious  substances  being  scrupulously  avoided. 
Such  calves  as  fell  victimsto  the  disease  were  examined  after  death,  and  in  no  case  were 
any  organic  changes  detected,  but  the  stomach  and  neck  of  the  bladder  were  invariably 
found  swollen,  the  intestines  inflamed,  and  the  milk  contained  in  them  curdled.  The 
rationale  of  treatment  is  to  promote  the  secretion  of  bile,  to  neutralize  the  acidity  of  the 
mother's  milk,  and  to  support  the  strength.  Powerful  medicines  are  too  drastic  in 
their  effects,  and  even  if  successful  in  checking  the  diarrhoea,  bring  on  convulsions  which 
often  prove  fatal.  I  have  found  the  administration  of  small  powders  of  opium  and  car- 
bonate of  magnesia,  given  once,  twice,  or  thrice  a  day,  according  to  the  severity  of  the 
attack,  extremely  useful. 

"  To  all  bleeding  and  issues,  often  so  strongly  recommended,  I  am  decidedly  opposed, 
since  they  cannot  possibly  exercise  any  influence  on  organic  disease,  and  simply  serve 
to  weaken  the  patients  still  further.  As  a  preventive  against  diarrhoea,  it  is  often 
recommended  to  place  lumps  of  chalk  in  the  rack  for  the  calves  to  help  themselves 
from.  To  this  practice  also  I  am  strongly  opposed.  Though  commonly  eaten  readily 
enough  by  young  animals,  chalk  is  far  too  irritating  and  constipating  in  its  effects  to  be 
good  for  them.  The  occasional  use  of  bicarbonate  of  soda  is  in  all  respects  far  pref- 
erable. 

"  In  many  districts  it  is  the  practice  to  draw  off  by  hand  the  first  portion  of  milk 
found  in  the  udder  after  calving,  before  allowing  the  calf  access  to  the  teat.  Nature  has, 
however,  specially  provided  this  peculiarly  constituted  milk  for  the  benefit  of  the  new- 
born calf,  and  many  later  ailments  of  digestion  would  undoubtedly  be  avoided  if  it  were 
allowed  this  gentle  natural  purge.  Any  one  who  can  overcome  this  prejudice  against 
its  use,  and  let  Nature  have  her  way,  will  be  saved  endless  worry  and  trouble  in  the 
constant  physicing  of  young  live  stock." 


DTARRHCEA.  757 

Hertwig  recommends  the  following  as  a  specific  remedy : 

Pulv.  rad.  rhei         -         -         -         -     4-0  grammes. 
"     magnes.  carb.         -         -         -     i*  " 

opii  pur  .         -         .         _     o*3  " 

This  is  to  be  given  in  100  to  120  grammes  of  camomile  tea  or  in  fifty 
grammes  of  whiskey — the  dose  to  be  repeated  in  twelve  hours  if  neces- 
sary. 

Obich  gives  a  recipe  which  he  speaks  confidently  of.  It  is  the  follow- 
ing : 

Decoct,  rad.  althag  concis.     -         -    250         grammes. 
Tinct,  opii  simpl.  -         .         _         7-^0  " 

Two  table-spoonfuls  to  be  given  every  two  hours,  according  to  the  size 
of  the  calf  or  the  urgency  of  the  symptoms. 

Sulphate  of  iron,  nitrate  of  silver,  phosphoric  acid,  hydrochloric  acid, 
sulphate  of  zinc,  opium  and  rhubarb,  chalk,  strong  coffee  decoction,  etc., 
have  all  been  recommended,  tried,  and  failed,  Beltz,  Auloge,  Rueff,  and 
others  recommend  castor-oil  or  glycerine,  or  even  magnesia,  to  which  a 
little  rhubarb  or  gentian  has  been  added. 

Armatage  gives  the  following  as  an  astringent  mixture  for  calves, 
lambs,  and  pigs : 

Powdered  opium         -         -         -         -         -     2  grs. 
Tincture  of  cardimoms        -         -         -         -     2  drs. 

Sulphuric  ether 20  to  30  drops. 

Linseed-tea  or  starch  gruel  -         -         -     4  "     6  oz. 

Half  an  additional  quantity  is  the  dose  for  a  calf ;  half  the  above  is 
that  for  lambs  and  pigs.  He  mentions  that  alum  whey  is  in  common 
use.  This  is  made  by  mixing  together  half  an  ounce  of  powdered  alum 
and  two  quarts  of  milk,  and  boiling  them  for  about  ten  minutes.  The 
mixture,  after  being  strained  and'  cooled,  is  ready  for  use,  and  is  given 
twice  a  day  to  calves,  and  proportionately  to  other  animals.  This  com- 
pound is  also  useful  as  an  injection,  together  with  mixtures  of  starch  or 
wheaten  flour,  and  tincture  of  opium  in  water. 

Zundel  speaks  of  enemeta  of  starch  or  dextrine,  or  water  slightly 
carbolized  ;  and  he  particularly  recommends  those  composed  of  a  dilute 
solution  of  permanganate  of  potass  (i  to  2  to  100).  Franck  suggests 
the  employment  of  tepid  enemas  of  the  neutral  salicylate  of  soda  (about 
ten  grammes /^r^/z>»2),  in  doses  of  one  or  two  grammes.  The  same 
medicament  might  be  tried  in  draughts.  Chlorodyne  might  likewise  be 
most  usefully  resorted  to. 

Careful  attention,  as  has  been  stated,  must  be  given  to  the  feeding. 
Either  from  a  cow,  or  in  a  bucket,  the  calf  should  have,  three  times 
daily,  a  small  quantity  of  fresh  milk — if  possible  from  a  recently  calved 
Cow.  In  severe  cases,  it  is  recommended  that  the  milk  be  supplied  from 
the  same  Cow  -,  and  where  these  precautions  are  not  very  ejffectual,  each 
meal  of  milk  is  to  be  diluted  with  about  a  fourth  of  lime-water,  which  is 
said  to  prevent  the  formation  of  curd  in  the  stomach.  In  more  serious 
cases,  milk  should  be  withheld,  and  instead  of  it  may  be  substituted  well- 
boiled  gruel  made  with  wheaten  flour,  Liebig's  farinaceous  food,  or  even 
eggs  and  beef-tea  may  be  administered. 


758  DISEASES  AND  ABNORMALITIES. 

The  patient  should  be  kept  warm  and  comfortable,  warm  baths  have 
sometimes  proved  useful,  as  have  also  poultices  of  camomile  flowers  to 
the  abdomen,  when  symptoms  of  pain  are  manifested. 


CHAPTER  X. 

Retention  of  Meconium. — Constipation. 

The  contents  of  the  intestines — the  meconium — are  generally  expelled 
immediately  after  birth,  when  the  umbilical  circulation  is  first  interrupted. 
When  the  meconium  is  retained  much  longer  it  is  abnormal ;  and  this 
occurs  more  frequently  with  the  foal,  perhaps,  than  other  creatures.  The 
prolonged  retention  of  the  meconium  gives  rise  to  constipation,  and  this 
is  often  a  serious  condition.  The  animals  in  which  it  occurs  are  gener- 
ally weakly,  and  not  well  developed. 

Cattses. 

Constipation  is  usually  observed  in  foals  which  have  been  dropped  in 
February  or  March,  and  whose  dams  have  been  fed  exclusively  on  dry 
fodder  during  the  winter.  This  result  is  still  more  likely  to  follow  if 
the  dams  have  been  worked  until  near  foaling-time.  Their  milk  is  then 
deficient  in  those  purgative  qualities  which  are  so  necessary  for  the  new- 
born animal.  It  is  the  same  with  Cows  which  have  been  stall-fed  all 
the  winter  with  dry  food  ;  and  the  calves  are  almost  certain  to  suffer 
from  retention  of  the  meconium  if  deprived  of  the  first  milk  of  the  Cow, 
no  matter  whether  the  latter  may  have  been  properly  fed. 

^  Symptoms. 

One  or  two  days  after  birth,  the  foal  appears  to  be  uneasy,  refuses  to 
suck,  has  tenesmus,  makes  efforts  to  defecate,  shows  symptoms  of  colic, 
rolls  on  the  ground,  and  often  looks  towards  the  abdomen  ;  the  back  is 
arched,  micturition  is  suspended,  pulse  and  respiration  frequent,  the  eyes 
injected,  and  the  teeth  ground  against  each  other.  Enteritis  sets  in,  and 
death  takes  place  in  struggles  and  convulsions. 

The  symptoms  are  similar  in  the  calf :  the  abdomen  is  very  much  re- 
tracted ;  the  respiration  hurried  ;  back  raised  when  the  creature  is  stand- 
ing, though  it  generally  persists  in  lying ;  it  moans  continually ;  refuses 
to  suck  ;  and  is  very  restless. 

Treatment. 

The  preventive  treatment  consists  in  attending  to  the  feeding  and  con- 
dition of  the  pregnant  animal  some  time  before  parturition.  The  young 
creature  should  be  fed  on  the  first  milk  its  parent  gives. 

The  curative  treatment  must  be  directed  towards  removing  the  meco- 
nium from  the  intestines.  This  may  be  effected  by  giving  a  soap  or  oil 
enema,  or  previously  removing  as  much  as  is  accessible  to  a  well-oiled 
finger. 

That  which  is  beyond  reach  of  the  finger,  Franck  recommends  to  be 
brought  away  by  means  of  a  flexible,  but  not  too  weak,  noose  of  wire. 
The  Cow  should  have  an  abundance  of  fluid  to  drink,  and  this  may  be 
rendered  slightly  laxative  by  the  addition  of  cream  of  tartar  or  sulphate 
of  soda. 


IMPERFORA  TION  OF  THE  ANUS, 


759 


If  the  constipation  persists,  purgatives  may  be  administered.  These 
may  be  castor-oil,  manna,  sulphate  of  soda,  aloes,  etc.  Frequent  enemas 
will  aid  the"  action  of  the  purgatives. 

Sometimes  constipation  is  due  to  giving  too  rich  food,  and,  in  artificial 
rearing,  to  an  excessive  allowance  of  meal  or  flour.  The  treatment  is  the 
same. 


CHAPTER  XI. 

Skin  Dryness  of  the  New-born  Animal. 

Obich  {Wochenschrift  fur  Thierheilkimde,  1869,  p.  10/)  is,  to  my  knowl- 
edge, the  only  writer  who  has  alluded  to  this  peculiar  condition  of  the  foal 
at  birth.  He  says  :  "  In  the  case  of  some  primiparous  Mares,  a  fatal  ac- 
cident often  happens  to  their  progeny.  When  parturition  takes  place 
without  any  one  being  present,  the  young  creature,  on  being  expelled 
from  the  mother,  continues  lying  away  from  her  until  its  skin  is  dry.  The 
consequence  is  that  the  Mare  does  not  care  for  it,  does  not  lick  or  attend 
to  it,  and  opposes  all  attempts  to  compel  her  to  suckle  it.  For  some  days 
constraint  is  necessary,  and  much  trouble  and  danger  may  be  incurred 
before  she  .is  accustomed  to  it.  This  may  be  averted  if  the  new-born 
creature  is  rubbed  over  with  the  'after-birth'  (placental  membranes). 
The  instinct  of  the  Mare  impels  her  then  to  lick  and  fondle  heroffspringj 
and  to  take  to  it  kindly  and  in  a  natural  manner." 


CHAPTER  XII. 
Imperforation  of  the  Anus. 

Imperforation  of  the  anus  is  not  a  very  rare  occurrence  in  new-born  an- 
imals, and  this  vicious  conformation  has  been  observed  in  foals,  calves, 
pigs,  and  lambs.  The  latter  appear  to  furnish  the  largest  number  of 
cases.  This  condition  is,  of  course,  very  serious  unless  surgical  aid  is 
quickly  afforded,  and  even  then  the  young  creature  cannot  always  be  saved. 

The  meconium  cannot  be  evacuated,  nor  yet  the  residue  of  the  milk  the 
animal  may  have  ingested  after  birth  ;  whence  results  an  accumulation  of 
irritating  matters  in  the  intestines,  which  give  rise  to  inflammation,  and 
this  quickly  causes  death. 

This  occlusion  or  imperforation  may  exist  in  various  degrees.  There 
maybe  merely  a  membrane  covering  and  occluding  the  anal  opening; 
the  borders  of  the  anus  may  be  adherent  to  a  greater  or  less  extent ;  the 
rectum  may  be  more  or  less  absent  or  incomplete ;  or  it  may  open  into 
the  genito-urinary  passages  instead  of  at  the  anus. 

Symptoms. 

When  no  faeces  can  be  expelled,  usually  towards  the  second  or  third 
day  after  birth,  uneasiness  and  symptoms  of  acute  colic  are  manifested  ; 
the  animal  does  not  suck,  the  abdomen  becomes  distended,  expulsive  ef- 
forts and  pawing  are  observed,  yet  nothing  is  passed.  The  animal  shows 
signs  of  great  pain  and  misery,  and  if  help  is  not  afforded  it  dies  in  agony. 


76o  DISEASES  AND  ABNORMALITIES. 

Ill  young  female  animals  in  which  the  rectum  is  absent,  it  often  hap- 
pens that  the  intestine  opens  into  the  vagina,  and  the  fasces  are  expelled 
by  that  canal.  Rainard  has  witnessed  this  malformation  in  several  fillies, 
and  his  attention  was  also  drawn  to  four  young  pigs — males  and  females 
— in  which  the  anus  was  absent.  They  were  the  litter  of  one  Sow.  It  is 
therefore  well  to  ascertain,  in  the  case  of  female  animals  destitute  of  an 
anus,  whether  the  meconium  or  faeces  pass  by  the  vulva. 

Treatment. 

The  symptoms  lead  the  veterinary  surgeon  to  examine  the  defecating 
organs,  and  to  discover  the  character  of  the  obstruction.  If  there  is  only 
a  simple  membrane  occluding  the  anus,  this  projects  like  a  large  vesicle 
through  the  pressure  made  upon  it  by  the  faeces.  This  membrane,  which 
is  really  the  skin,  has  usually  a  deep  red  tint,  and  is  soft  and  thin,  offer- 
ing but  little  resistance.  The  prominence  it  forms  is  altogether  soft  and 
pits  on  pressure.  In  such  a  case  all  that  has  to  be  done  is  to  incise  the 
membrane — in  a  crucial  manner,  if  deemed  best.  Along,  narrow,  pointed 
bistoury  is  the  most  suitable.  After  well  ascertaining  the  entrance  to 
the  rectum,  the  skin  is  punctured,  care  being  taken  not  to  allow  the  knife 
to  pass  too  deep  ;  a  director  may  be  employed  to  complete  the  incision, 
and  to  guard  the  intestine  from  injury.  No  sooner  is  this  incision  made, 
than  the  meconium  escapes ;  then  the  crucial  division  may  be  made  with 
a  pair  of  sharp  scissors.  The  index  finger  should  be  introduced  as  far  as 
possible  into  the  intestine,  to  make  certain  that  all  is  right  there. 

In  order  to  prevent  the  opening  closing  by  cicatrization,  a  suppository 
or  tent  may  be  introduced  into  the  rectum,  and  withdrawn  every  now  and 
again  in  order  to  allow  the  fasces  to  be  expelled — injections  assisting  in 
the  latter  ;  or  the  angles  of  the  divided  skin  may  be  snipped  off  by  scis- 
sors, so  as  to  hinder  their  union.  The  lips  of  the  wound  are  subsequently 
lubrified  by  a  little  oil  or  grease,  and,  provided  inflammation  does  not 
set  in,  recovery  is  certain. 

When  the  prominence  is  not  present,  and  yet  there  is  complete  occlu- 
sion, with  all  the  symptoms  above-mentioned,  the  operation  is  more  dif- 
ficult. The  perineal  raphe  is  sought  for,  as  on  its  track  the  anus  should 
be  found.  This  is  carefully  felt,  when  the  prominence  formed  by  the  end 
of  the  intestine  will  be  discovered.  Then  a  short  incision  is  made  through 
the  skin  only  on  the  middle  line ;  the  subcutaneous  tissues  are  dissected 
away  until  the  bulging  of  the  intestine  is  reached  ;  this  is  drawn  outwards 
between  the  lips  of  the  wound  by  forceps  or  a  ligature,  and  an  opening 
made  into  it,  and  the  contents  removed.  The  margins  of  the  opening 
are  then  secured  to  the  borders  of  the  external  wound  by  some  fine  su- 
tures, and  attention  is  paid  to  the  parts  during  the  healing  process,  in 
order  to  prevent  the  artificial  anus  becoming  too  contracted. 

When  the  rectum  is  absent  to  a  more  or  less  considerable  extent  (in 
some  cases  it  is  reduced  to  a  mere  fibrous  cord),  then  but  little  benefit 
can  be  conferred.  In  a  few  instances  nature  has  effected  a  partial  rem- 
edy, by  establishing  an  artificial  opening  by  ulceration  through  organs 
and  textures,  and  the  faeces  have  escaped  by  the  fistula. 

Rainard  mentions  this  natural  colotomy  as  occurring  in  two  young 
horses.  An  artificial  opening  may  be  made  either  in  the  perineal  or  ab- 
dominal region  \  but  it  is  rare  indeed  that  the  animal  is  worth  the  trouble 
and  risk. 


IMPERFORATION  OF  THE  ANUS.  761 

In  those  female  animals  in  which  the  rectum  communicates  with  the 
vagina,  Rainard  makes  the  following  remarks  with  regard  to  operation. 
As  the  part  of  the  vagina  which  has  the  opening  into  the  rectum  is  never 
very  deep,  a  half  S-curved  sound  is  introduced  by  one  of  its  ends  into  the 
normal  track,  and  pushed  into  the  rectum  until  it  reaches  the  cul-de-sac  in  it. 
With  a  bistoury,  an  incision  is  then  made  where  the  anus  should  be  ;  the 
skin  and  subcutaneous  connective  tissue  being  divided,  the  index-finger 
is  passed  into  the  wound  in  search  of  the  curved  sound  in  the  rectum. 
When  met  with,  an  assistant  takes  the  sound,  while  the  blade  of  the  bis- 
toury is  made  to  glide  over  the  nail  of  the  index-finger,  and  the  intestine 
opened  by  it.  The  same  finger  is  plunged  into  this  new  opening,  and 
serves  to  guide  the  bistoury  in  dilating  the  incision  as  much  as  may  be 
deemed  necessary.  After  the  skin  and  connective  tissue  is  incised,  a 
trocar  of  sufficient  size  may  be  employed  to  puncture  the  intestine. 

Landel  [yournal  Vetirinaire  ^elge,  vol.  i.,  p.  95)  met  with  a  case  of  this  kind  in  a 
Cow,  aged  one  and  a  half  year.  On  examining  the  creature,  he  found  that  the  anus  was 
occluded,  and  that  the  vagina  contained  fluid  faeces  which  had  passed  into  it  by  a  nar- 
row opening  leading  to  a  canal  communicating  with  the  rectum.  Landel  decided  to 
make  an  artificial  anus.  He  made  an  incision  in  the  perinaeum  about  two  and  a  half 
inches  in  length,  through  which  the  faeces  escaped.  On  the  following  days  enemas  were 
administered ;  the  margin  of  the  wound  tumefied  slightly ;  the  recto-vaginal  fistula  be- 
came obliterated,  and  the  young  animal  made  a  perfect  recovery. 

From  among  many  recorded  instances  of  anal  atresia,  we  select  the 
following  as  illustrativ^e  : 

1.  Rossignol  (Rainard,  Op.  ciL,  vol.  ii.,  p.  492)  states  that  a  calf,  soon  after  birth,  did 
not  offer  any  trace  of  an  anus.  Hoping  that  the  ail-de-sac  formed  by  the  rectum  was 
not  too  distant  from  the  perineum,  and  that  he  might  feel  it  when  the  calf  attempted  to 
defecate,  he  gave  it  a  dose  of  almond  and  castor-oil.  In  a  few  hours  violent  colicky 
pains  seized  the  creature,  and  nothing  could  allay  them ;  no  bulging  appeared  at  the 
perinaeum,  and  death  soon  ensued.  At  the  autopsy,  made  next  day,  the  rectum  was 
found  to  be  completely  absent ;  the  colon  terminated  in  a  large  dilatation  the  size  of  a 
hen's  egg,  in  the  neighborhood  of  the  left  kidney,  and  from  it  was  a  transparent  liga- 
mentous prolongation  which  was  attached  to  the  commencement  of  the  sacrum.  The 
colon  was  congested  and  full  of  foetid  gas  and  meconium. 

2.  Ammon  {yahresbericht  der  Miinchener  Zeutral  Thierarzneischtde,  1846-47,  p.  22) 
mentions  that  a  new-born  calf  sucked  for  a  day,  when  symptoms  of  constipation-colic 
were  manifested.  The  enemas  administered  did  not  appear  to  penetrate  as  far  as  usual, 
and  they  and  other  treatment  afforded  no  relief.  In  another  day  vomiting  ensued,  and 
in  thirty-six  hours  from  the  appearance  of  the  colic  death  ensued.  The  digestive  organs 
were  found  healthy  as  far  as  the  colon,  which  terminated  in  a  cul-de-sac;  the  urinary 
bladder  was  absent,  and  the  ureters  terminated  in  what  should  have  been  the  rectum. 

3.  Dinter  (Sachsischer  yahresbericht,  1873,  P  ^7)  operated  on  a  new-born  sow  which 
had  atresia  of  the  anus,  but  yet  no  faeces  were  passed.  The  creature  died  in  eight 
weeks  (?)  after  birth,  without  any  defecation.  '  The  caecum  and  large  intestine  were 
found  to  be  enormously  dilated. 

4.  Hartmann  [CEsterreichischer  Vierteljahresschrift  f.  Wiss.  Veterinarkunde,  1874)  re- 
ports that  some  hours  after  birth,  a  foal  was  observed  to  have  no  anal  aperture.  Hart- 
mann was  shortly  after  called  in,  and  it  was  decided  that  an  artificial  opening  should  be 
established.  An  incision  was  made  through  the  skin  along  the  median  line  of  the  per- 
ineum, and  the  connective  tissue  separated,  but  the  finger  could  not  discover  the  ex- 
tremity of  the  rectum.  Enemas  were  tried,  but  without  success  In  the  pelvis,  at  a  . 
distance  of  about  four  inches  from  the  incision,  the  finger  came  upon  a  sac  with  a  con- 
vex extremity,  and  containing  a  faecal  mass. 

The  first  longitudinal  incision  was  enlarged  by  a  second  transverse  one,  and  then  the 
finger  could  explore  three-fourths  of  the  extremity  of  the  sac.  From  it  the  meconium 
was  passed  in  small  quantity,  but  it  was  eventually  completely  evacuated  by  the  acf 
ministration  of  enemas.  Into  the  aperture,  a  bougie  covered  with  lead  ointment  was 
introduced. 

On  the  fourth  day  the  opening  was  nearly  closed,  and  though  various  measures  were 


702  DISEASES  AND  ABNORMALITIES. 

essayed  to  re-widen  it,  it  was  necessary  at  length  to  have  recourse  to  multiple  incisions 
in  the  skin.  But  notwithstanding  these  incisipns,  in  spite  of  all  attempts  at  dilatation, 
and  although  enemas  were  frequently  given,  no  favorable  change  could  be  effected,  and 
the  foal  succumbed  on  the  sixth  day. 

The  autopsy  demonstrated  the  existence  of  peritonitis,  as  well  as  a  notable  distention 
of  the  intestines.  The  rectum  was  about  four  inches  shorter  than  is  natural,  and  the 
surrounding  connective  tissue  was  ulcerated. 

5.  Siebenrogg  {Repertorium  filr  Thierheilkunde,  1875,  P-  5-)  gives  a  case  which  de- 
rives its  importance  from  the  subject  of  it  being  a  nine-months-old  Sow.  Defecation 
took  place  by  the  vagina,  between  which  and  the  rectum  there  was  a  free  communica- 
tion. So  long  as  the  faeces  were  soft,  the  recto-vaginal  opening  sufficed  for  their  ejec- 
tion ;  but  when  the  animal  began  to  be  fattened  with  potatoes,  etc.,  this  did  not  permit 
defecation,  and  the  contents  of  the  intestine  were  arrested.  The  Sow  was  in  the  latter 
condition  when  seen  by  Siebenrogg,  and  the  case  was  so  urgent  that  he  decided  on 
making  an  artificial  anal  orifice.  After  removing  the  skin  at  this  point  and  exposing 
the  extremity  of  the  rectum,  the  latter  was  incised  to  a  sufficient  extent  to  allow  of  its 
being  emptied  ;  this  afforded  the  animal  immediate  relief.  The  faeces  afterwards  con- 
tinued to  pass  through  this  surgical  opening,  as  well  as  that  between  the  rectum  and 
vagina. 

In  six  months  the  Sow  was  slaughtered,  and  on  examination  it  was  found  that  the 
borders  of  the  wound  were  cicatrized,  and  the  opening  into  the  rectum  about  two  inches 
deep  and  large  enough  to  admit  the  little  finger. 


CHAPTER  XIII. 
Imperforation  of  the  Vulva  and  Vagina. 

Imperforation,  atresia,  or  occlusion  of  the  Vulva  does  not  appear  to  be  very 
rare  in  new-born  animals,  they  being  not  unfrequently  found  after  birth 
without  any  apparent  opening  into  this  passage,  the  hibia  of  which  are 
adherent.  The  adhesion  may  be  general  or  partial.  In  the  former  case 
the  urine  cannot  escape,  and  is  therefore  retained  ;  or  it  may  be  expelled 
through  the  urachus,  by  the  umbilical  opening.  When  the  retention  is 
complete,  the  bladder  soon  becomes  distended  and  ruptures.  From  this 
death  soon  ensues. 

Complete  occlusion  is  always  a  serious  condition,  as  there  is  no  precise 
indication  as  to  where  the  urethra  opens,  or  even  if  it  exists  at  all ;  so 
that  it  is  scarcely  possible  to  make  an  artificial  opening  for  the  passage 
of  the  urine  with  perfect  and  permanent  success.  When  the  labia  are 
merely  adherent,  then  there  is  no  difficulty,  and  not  much  danger,  in  the 
case.  The  adhesion  being  destroyed  and  the  labia  freed,  the  urine  is  no 
longer  retained  and  the  malformation  is  remedied  :  the  only  precaution 
necessary  is  to  prevent  their  again  becoming  united — this  is  easily  ef- 
fected by  dressing  the  raw  margi-ns  with  oil  or  grease,  and,  if  need  be, 
keeping  them  apart  until  healed. 

When  occlusion  is  only  partial,  the  interference  of  the  operator  may 
or  may  not  be  deemed  necessary,  according  to  circumstances  ;  but  it  will 
be  generally  most  judicious  to  enlarge  the  opening  to  its  natural  dimen- 
sions before  the  animal  becomes  full-grown. 

Imperforate  Vagina  is  much  less  frequent  than  imperforate  vulva. 
Nevertheless,  it  is  sometimes  met  with  in  new-born  creatures.  The  dan- 
ger is  the  same  as  in  the  other  malformation,  as  the  external  opening  of 
the  urethra  is  situated  below  the  pubic  symphysis,  immediately  anterior 
to  the  entrance  to  the  vagina.  Consequently,  the  urine  may  be  retained, 
and  the  animal  will  soon  perish  from  rupture  of  the  bladder,  peritonitis, 
etc. 


IMPERFORATION  OF  THE  PREPUCE.  763 

All  that  can  be  done  in  such  a  state  of  affairs,  is  to  compensate  for 
the  absence  of  the  natural  canal  by  making  an  artificial  opening,  and  to 
prevent  it  from  closing  by  introducing  a  dilator,  and  keeping  it  there 
(removing  it,  of  course,  from "  time  to  time)  until  there  is  no  danger  of 
closure. 

When  the  obliteration  is  only  partial  the  case  is  not  so  serious,  and 
provided  the  urine  escapes  at  all  freely,  surgical  interference  may  not  be 
necessary — at  least  until  breeding-time  arrives. 


CHAPTER  XIV. 

Imperforation  of  the  Prepuce. 

IMPERFORATION  of  the  prepuce  of  new-born  creatures  is  apparently  a 
very  unusual  occurrence,  as  it  is  scarcely  mentioned  in  veterinary  litera- 
ture. Brugnone  notices  it  as  occurring  in  foals,  and  he  recommends 
that  an  artificial  opening  be  made  in  the  prepuce  where  the  natural  aper- 
ture should  be  ;  the  lips  of  the  wound  to  be  kept  apart  by  any  suitable 
contrivance,  which  may  be  secured  z>z  situ  by  attaching  tapes  to  it,  and 
passing  these  round  the  body,  securing  them  over  the  loins.  When  this 
artificial  opening  is  not  made,  the  same  grave  results  follow  as  in  com- 
plete occlusion  of  the  vulva. 

This  operation  is  successful  only  when  the  urethral  canal  is  patent 
throughout  its  length  ;  when  it  is  occluded  also,  the  operation  will  no 
longer  be  attended  with  benefit,  and  the  operator  must  then  endeavor  to 
discover  where  the  obstruction  is,  and  either  overcome  it,  or  make  an 
opening  somewhere  for  the  escape  of  the  urine. 

In  some  instances,  when  the  orifice  of  the  urethra  is  occluded,  the 
urine  escapes  by  a  congenital  opening  in  some  part  of  the  canal.  When 
this  opening  exists  at  its  upper  surface,  the  defect  receives  the  name  of 
epispadias.,  and  when  at  its  lower  hypospadias.  Such  a  malformation  has 
been  seen  m  the  dog,  lamb,  and  goat,  and  it  is  not  of  much  importance, 
so  far  as  the  flow  of  urine  is  concerned.  If  the  opening  is  near  the  end 
of  the  urethra,  the  urine  runs  into  the  prepuce,  and  passes  thence  ;  but 
if  it  is  more  behind,  between  the  scrotum  and  ischiatic  curvature,  it  then 
flows  over  the  skin,  abrades  it,  and  the  dust  and  dirt  accumulate  ;  this, 
together  with  the  repulsive' odor  of  the  decomposed  urine,  renders  the 
case  very  unpleasant  to  the  eye  and  nose. 

Treatment  is  only  too  often  unsuccessful  and  always  troublesome.  It 
is  least  so  when  the  opening  is  near  the  termination  of  the  urethra,  as 
then  the  defect  is  more  accessible  and  easier  remedied. 

There  are  other  two  regions  which  may  suffer  from  congenital  occlu- 
sion, but  to  the  description  of  which  we  have  not  deemed  it  necessary  to 
allot  separate  chapters  :  we  refer  to  the  visual  and  auditory. 

Occlusion  of  the  eyelids  has  been  witnessed  in  foals,  calves,  and  other 
young  animals.  Of  course  we  do  not  allude  to  the  natural  occlusion  of 
the  eyelids  of  puppies,  kittens,  and  young  rabbits,  which  prevents  their 
seeing  for  some  days  after  birth. 

This  accidental  occlusion  of  the  eyelids  presents  itself  in  two  forms. 
In  one,  the   margins  of  the  upper  and  lower   eyelids  are   only  adherent ; 


764  DISEASES  AND  ABNORMALITIES. 

and  in  the  other,  the  eyelids  are,  in  addition,  adherent  to  the  eye  itself 
throughout  their  entire  surface. 

The  first  variety  is  alone  curable,  and  in  order  to  disunite  the  eyelids, 
the  operator  proceeds  as  follows  :  Securing  the  head  of  the  creature  in 
the  hands  of  an  assistant,  the  upper  eyelid  is  elevated  by  another  assist- 
ant by  means  of  a  pair  of  forceps.  The  operator  himself  seizes  the  lower 
lid  by  the  same  means,  and  pulls  it  as  far  as  possible  from  the  eyeball 
beneath  ;  then  taking  a  pointed  bistoury  or  sharp  scissors  in  his  right 
hand,  a  small  puncture  or  notch  is  made  between  the  margins  of  the 
lids,  in  such  a  manner  as  to  injure  neither,  if  possible,  and  much  less  to 
wound  the  eye.  A  grooved  director  is  passed  into  the  puncture  in  the 
direction  of  one  of  the  canthi  of  the  eye,  and  the  bistoury  or  scissors  run 
along  it,  separates  the  two  lids;  the  director  is  then  turned  towards  the 
other  canthus,  and  the  same  procedure  is  followed.  If  the  scissors  are 
used,  the  director  is  not  necessary.  All  that  is  required  after  the  opera- 
tion, is  to  apply  a  little  lard  to  the  borders  of  the  lids,  should  there  be 
any  tendency  to  re-adhesion. 

Occlusion  of  the  auditory  canal  is  much  less  rare  than  that  of  the  eye- 
lids, and  when  it  exists  deafness  is  the  consequence,  as  well  as  dumb- 
ness. It  is  the  latter  condition  which  most  frequently  attracts  attention, 
and  leads  to  the  discovery  that  the  real  and  serious  defect  is  deafness. 
Then  a  small  prominent  tumor  is  detected  in  the  place  of  the  ear,  or 
where  the  external  auditory  canal  should  be.  This  tumor  is  rather  soft, 
and  can  be  readily  seized  by  forceps,  when  it  may  be  punctured  with  a 
bistoury  or  a  lancet,  and  a  crucial  incision  made  through  it,  or  it  may 
be  resected  by  forceps  and  scalpel  or  scissors. 

When  the  membrane  forming  the  covering  of  the  tumor  is  removed,  a 
quantity  of  grey  cerumen  is  found  obstructing  the  canal  ;  this  can  be 
removed  by  pressure,  injections  of  tepid  water,  or  a  small  scoop.  To 
hinder  the  closure  of  the  canal,  a  little  morsel  of  lint  or  fine  tow  is  placed 
in  the  ear,  and  retained  there  by  a  bandage  round  the  head.  With  the 
dog,  which  is  most  frequently  affected  in  this  way,  the  bandage  requires  to 
be  more  carefully  fixed  than  with  other  animals,  as  it  uses  its  paws,  and 
does  not  rest  until  it  is  removed. 

If  both  ears  are  affected,  one  only  should  be  operated  upon  at  a  time  ; 
and,  as  a  rule,  it  is  better  to  wait  until  the  slight  inflammation  which  fol- 
lows the  operation  subsides,  before  the  other  ear  undergoes  the  same 
treatment. 

So  far  as  hearing  is  concerned,  the  result  is  often  negative  ;  indeed, 
Rainard  confesses  that  of  the  large  number  of  dogs  he  operated  upon,  not 
one  recovered  its  hearing. 


CHAPTER  XV. 

Cyanosis. 

At  page  99,  in  describing  the  foetal  circulation  and  the  modifications 
which  occur  in  it  at  birth,  we  mentioned  that  the  lungs  then  become  the 
organs  of  respiration,  and  rapidly  increase  in  capacity,  while  the  thorax 
enlarges  in  a  commensurate  degree  ;  the  pulmonary  artery  also  dilates  to 
admit  the   increased  flow  of  blood,  and  the  ductus  arteriosus  is  oblit- 


CYANOSIS.  765 

eratecl  to  prevent  the  mingling  of  arterial  and  venous  blood.  It  was  also 
stated  that  the  ductus  venosus  likewise  aids  in  the  isolation  of  the  two 
kinds  of  blood  by  becoming  atrophied,  as  does  also  the  occlusion  of  the 
foramen  ovale,  though  the  latter  opening  not  infrequently  remains  intact 
in  young  animals.  Remarking  upon  the  patency  of  the  foramen  ovale, 
it  was  said  that,  as  a  rule,  this  accident  did  not  greatly  affect  the  circula- 
tion ;  for  when  the  heart  contracts,  the  auricles  are  isolated  by  the  nar- 
rowing of  the  orifice  and  the  elevation  of  the  valve. 

Cases  occur,  nevertheless,  in  which,  either  from  the  persistence  of  the 
foramen  ovale,  with  perhaps  defective  auricular  contraction,  or  an  abnor- 
mal disposition  of  the  large  blood-vessels  at  their  origin,  the  arterial  and 
venous  blood  is  mixed,  and  we  have  the  condition  known  as  cyanosis  or 
the  "  blue  disease."  Then  there  is  a  deep-blue  or  violet  coloration  of  the 
visible  mucous  membranes,  more  or  less  debility  and  difficulty  in  respira- 
tion, especially  during  exertion,  coldness  of  the  limbs  and  surface  of  the 
body,  and  a  great  predisposition  to  haemorrhage. 

Cyanosis  may  occur  in  otherwise  well-developed  individuals,  and  be 
due  to  a  congenital  adhesion  between  the  lungs  and  pleura  or  pericar- 
dium ;  it  is  also  a  symptom  of  asphyxia,  and  is  sometimes  witnessed  in 
colic  in  the  horse,  complicated  with  meteorismus  ;  it  likewise  accompanies 
certain  forms  of  poisoning. 

When  due  to  the  first-named  causes,  this  condition  is  manifested  during, 
or  immediately  after,  birth  ;  it  is  only  in  rare  instances  that  it  is  developed 
at  a  later  period.  It  is  needless  to  mention  that  such  a  conformation  is 
beyond  remedy,  though  animals  so  affected  will  often  live  for  a  long  time; 
Zundel  has  seen  a  horse  seven  years  old  which  was  in  this  condition. 

Vernant  {Reciceil  de  Med.  Veterinaire,  1877,  p.  592)  was  called  to  see  a  calf  which  had 
been  born  the  previous  evening,  and  with  such  ease  that  it  was  found  behind  the  Cow, 
no  one  being  present  at  its  birth.  It  was  viable,  in  very  good  condition,  fat,  and  so  well 
developed  that  it  looked  as  if  fifteen  days  old.  But  it  could  not  stand,  and  lay  constantly 
in  the  sternal  position,  refusing  to  suck.  '  The  symptoms  it  presented  were  markedly  those 
of  asphyxia :  the  tongue  was  half  protruded  from  the  mouth,  the  eyes  prominent,  the 
respiration  plaintive  and  hurried,  and  the  flanks  very  agitated.  When  raised  it  could 
not  stand  ;  its  limbs  were  constantly  and  convulsively  moved,  and  were  unable  to  sus- 
tain the  weight  of  the  body. 

The  animal  was  bled  at  the  tail,  but  this  afforded  no  relief,  and  in  forty-eight  hours 
after  birth  it  died.  The  lungs  were  then  found  to  be  collapsed,  and  looked  very  con- 
gested. The  anterior  extremities  of  the  lobules  floated  well  in  water,  but  the  mass  of 
the  lungs  was  rather  heavy. 

The  foramen  ovale  was  incompletely  closed,  so  that  the  two  auricles  could  communi- 
cate with  each  other  ;  the  opening  was  as  large  as  a  five-franc  piece,  and  the  auricular 
septum  was  extremely  thin. 

Another  congenital  malformation  to  which  we  have  not  devoted  a 
special  chapter,  is  ".tongue-tie "  in  young  animals,  and  particularly 
calves. 

Tyvaert  {Annales  de  Med.  Veterinaire,  June,  1877)  has  observed  this 
condition  on  six  occasions  in  calves.  It  is  similar  to  tongue-tie  in  chil- 
dren and  certain  birds,  and  is  characterized  by  the  fraenum  linguae  being 
too  narrow  from  above  to  below,  and  too  much  prolonged  forward — some- 
times extending  to  the  root  of  the  incisor  teeth.  This  anomaly  greatly 
hinders  the  prehension  of  food  and  swallowing  of  fluids  ;  the  calf,  if 
drinking  out  of  a  bucket,  vainly  plunges  its  face  into  the  fluid  as  far  as 
the  eyes.  The  teat  is  seized  with  difficulty,  and  the  tongue  is  so  limited 
in  its  movements  that  it  cannot  be  protruded  to  lick  the  nostrils,  as  is  the 


766  DISEASES  AND  ABNORMALITIES. 

custom  with  bovine  and  some  other  creatures.  The  defect  is  often  un- 
perceived,  and  the  young  creature  loses  condition,  becomes  weak,  and 
eventually  succumbs. 

The  treatment  is  very  simple.  It  consists  merely  in  dividing  the 
fraenum  to  such  an  extent  that  the  tongue  may  recover  its  liberty  of  move- 
ment. Immediately  after  the  operation,  the  creature  protrudes  its  tongue 
to  lick  the  blood  which  escapes,  and  it  can  drink  with  ease.  The  wound 
heals  in  a  few  days  without  any  precautions. 


The  End. 


INDEX 


Abdominal  evisceration,  548. 
Abdominal  foetation,  161. 
Abdominal  taxis,  310. 
Abnormal  quantity  of  placental  fluid, 

377- 
Abnormal  retention  of  the  foetus,  191. 
Abortion,  197. 

"         artificial,  277. 

"         epizootic,  209. 

"        sporadic,  199. 
Accessory  cotyledons,  82. 
Accidents  of  pregnancy,  182. 
Accidents    incidental    to   parturition, 

567. 
After-pains,  250. 
Agalactia,  714. 
Aid  after  labor,  245. 
Albuminuria,  i8r. 
Alimentary  canal  of  foetus,  loi. 

"  "      annexes  of,  102. 

Allantoic  fluid,  78. 
Allantois,.  77,  78. 

"         differences  in,  78. 
Amaurosis,  181. 
Amnion,  74. 

"       differences  in,  76. 
Amputation  of  the  limbs,  543. 

''  "         fore  limbs,  544. 

"  "         hind  limbs,  546. 

"  "  uterus,  604. 

Anasarca,  386. 
Anatomy,  obstetrical,  531. 
Anidian  monsters,  169. 
Annexes  of  the  foetus,  70. 
Anomalies  in  gestation,  156. 

"  foetal  membranes,  375. 

"  placenta,  358. 

"  umbilical  cord,  378. 

Ante-partum  prolapsus  of  the  vagina, 
182. 

"  rupture  of  the  uterus,  184. 

Anterior  position,  229. 
Anterior  presentation,  227. 


Anus,  atresia  of,  759. 
Apoplexy,  parturient,  656,  669. 
Arthritis,  736. 

"        causes  of,  737. 

"        pathological  anatomy  of,  742. 

"        prognosis  of,  742. 

"        symptoms  of,  740. 

"        treatment  of,  746. 
Articulations  of  pelvis,  12. 

"        differences  in,  14. 

"        ischio-pubic  symphysis,  13. 

"        sacro-coccygeal,  14. 

"        sacro-iliac,  12. 

"        sacro-lumbar,  12. 
Artificial  abortion,  277. 
Artificial  passage  for  foetus,  279, 
Asphyxia  of  the  new-born  animal,  246, 

719. 
Ascites,  386. 
Atresia  of  anus,  759. 

"  OS  uteri,  356. 

Attention  to  the  offspring,  246. 

B. 

Bandages,  or  trusses,  598,  726. 
Bladder,  inversion  of,  615. 


CESAREAN  section,  325. 
Cancerous,    carcinomatous    or   sarco- 
matous tumors,  331. 
Capacity  of  pelvis,  20. 
Cephalotomy,  539. 
Cervix  uteri,  digital  irritation  of,  277. 

"  induration  of,  349. 

"  rigidity  of,  341. 

"  structure  of,  38,  39. 

Changes  in  the  ovum,  64. 
Chorial  cotyledons,  83. 
Chorion,  71. 

"         differences  in,  73,  74. 
Chorion,  scirrhous,  359. 
Cleft  palate,  95. 
Collapse,  parturient,"  656. 


768 


INDEX. 


Colostrum,  253. 

Complete  deformity  of  the  pelvis,  271. 
Complications  cfc  ruptured  vagina,  629. 
Complications  caused  by  deviation  of 

the  hind  limbs  of  the  foetus,  476. 
Condylomatous,     papillomatous,     and 

lipomatous  tumors,  331. 
Constipation,  177,  758. 
Constriction  of  vagina  and  vulva,  365. 
Contorsio  uteri,  291,  325. 
Contention  or  retention  of  the  uterus, 

593- 
Contractions  of  the  foetus,  391. 
Cords  and  bands,  501. 
Corpus  luteum,  51,  52. 
Cotyledonous  milk,  83. 
Cotyledons,  83,  121. 
Cough,  181. 
Cramp,  176. 
Craniotomy,  540. 
Crotchets  or  hooks,  510. 
Cup-and-ball  pessary,  594. 
Cyanosis,  764. 

D. 
Death  of  foetus,  241,  394. 
Decapitation,  541. 
Decidua  serotina,  84,  85. 
Decidua  vera,  258. 
Development  of  embryo,  66,  67,  68. 

"  of  ovaries,  49. 

Deviation  of  the  uterus,  288. 
Diagnosis  of  multiple  pregnancy,  150. 
Diarrhoea,  749. 
Differences  in  pelvis,  10,  25, 
Diffused  placenta,  85. 
Digital  irritation  of  cervix  uteri,  277. 
Diminution  in  the  size   of  the  foetus, 

279. 
Diseases  of  the  foetus,  379. 
Diseases   and    abnormalities    of    the 

young  animal,  719. 
Diseases  of  pregnant  animals,  175, 
Diseases  peculiar  to  pregnancy,  176. 
Distorted  monstrosities,  416. 
Division  or  detruncation  of  the  foetus, 

547- 
Dorso-lumbar  position  of  the  foetus, 

230. 
Dorso-lumbar  presentation,  227,  228. 
Ductus  arteriosus,  99. 
Ductus  venosus,  99. 
Duration  of  pregnancy,  138. 
Dystokia,  iii.  260. 

"         general  considerations^  260. 
Dystokia  foetal,  368,  260. 
"        maternal,  260,  270. 
"        due  to  anterior  limbs  incom- 
pletely extended    in   the 
pelvis,  441. 


Dystokia,  head  deviation  upward  and 
backward,  464. 

"  "  downward,  451. 

"  displacement  or  changed  re- 
lations of  the  uterus,  279. 

"  dorso-lumbar  uresentation, 
489. 

"  extreme  abduction  of  head 
and  limbs,  466, 

*'        fetlock  presentation,  477. 

"        fore  limbs,  441. 

"  fore  limbs  completely  re- 
tained, 447. 

"  fore  limbs  crossed  over  the 
neck,  441. 

"  fore  limbs  flexed  at  the 
knees,  443. 

"        head,  450. 

"  head  and  fore  limbs  in  the 
posterior  presentation,487. 

"         hind  limbs  in  the  pelvis,  467. 

"         hock  presentation,  478. 

"        lateral  deviation,  455. 

"         lumbo-ilial  positions,  476. 

"         lumbo-pubic  position,  474. 

"  lumbo-pubic  and  lumbo-ilial 
positions,  474. 

"  misdirection  of  hind  limbs  in 
the  anterior  presentation, 
466. 

"  morbid  alterations  in  the 
genital  oi'gans,  327. 

"  right  or  left  vertebro-ilial 
position  of  the  foetus,  446. 

"         pelvic  constriction,  270. 

"         posterior  presentation,  473. 

"  sterno-abdominal  presenta- 
tion, 494. 

"  thigh  and  croup  presenta- 
tion, 482. 

"         transverse  presentation,  488. 

"        vertebro-pubic  position,  446. 

"        vertebro-sacral  position,  443. 


Eclampsia,  parturient,  681. 
Embryo,  development  of,  66,  67,  68. 
Embryotomy,  532. 

"  instruments  for,  533. 

preliminary         arrange- 
ments for,  539. 
Emphysema,  390. 

Employment  of  force  in  dystokia,  523. 
Endo-metritis,  643. 

Enlargement  of  the  genital  canal,  279 
Epilepsia  uterina,  687. 
Epispadias,  763. 
Epizootic  abortion,  209. 
Eutokia,  iii.  5. 


INDEX. 


769 


Evisceration,  548. 

"  abdominal,  548. 

"  thoracic,  548. 

Evolution  in  dystokia^  438. 
Excess  in  volume  of  the  foetus,  369. 
Exostoses  on  pelvis,  273. 
External  generative  organs,  27. 
Expulsion  of  the  foetus,  221. 

"  membranes,  225. 

Extra-uterine  pregnancy,  160,  i6r. 

F. 
Fallopian  tubes,  45,  105. 

"  *'      differences  in,  46,  47, 

Fecundation,  61. 
Female  generative  organs,  27. 
Fibroid  tumors,  331. 
Fistulae  of  teat,  718. 

"        vesi CO- vaginal,  635. 
Foetal  cotyledons,  83. 
"       dystokia,  368. 
"      envelopes,  puncture  of,  277. 
"  "  retention  of,  567. 

"      membranes,  anomahes,  and  dis- 
ease in,  375. 
Foetus,  abnormal,  retention  of,  191. 
"      annexes  of,  70. 
"       artificial  passage,  279. 
"       death  of,  24  [. 
"       development  of,  89. 
"  "     circulatory  system,  96. 

"  "     digestive  apparatus,  loi. 

"  "     geui  to-urinary      organs, 

102. 
*'  "     locomotory      apparatus, 

94- 
"  "     nervous  system,  90. 

"  "     organs  of  sense,  91. 

"  "     respiratory      apparatus, 

92. 
"  "     skin     and     appendages, 

92. 
*'       diminution  in  size  of,  278. 
*'       diseases  of,  379. 
'■'•       forcible  extraction  of,  277. 
"      mechanical  means  for  extrac- 
tion of,  501. 
"      periods  of  development  of,  107, 

loS. 
"       physiological    phenomena    in, 

rio. 
"  "  absorption,  112. 

*'  "  circulation,  1 14. 

"  "  nervous  functions.  III. 

*'  "  nutrition,  1 13. 

*'  "  secretion,  116. 

*'       positions  of,  228. 
"  "  in  uterus,  128. 

"       presentations  of,  226. 
*'       weight  and  dimensions  of,  1 1 7. 
Forceps,  515. 


Forcible  extraction  of  the  foetus,  277. 
Fractures  of  pelvis,  273, 
Free-martins,  149. 
Frequency  of  monstrosities,  416. 
Functional   modifications    in   parturi- 
tion, 250. 
Funis,  86. 


Galactophorus    sinus,  obliteration 

of,  717. 
Gastro-hysterotomy,  325,  554. 
Gelatine  of  Wharton,  86. 
Gemelliparous  gestation,  143. 
Generative  organs,  27. 
"  external,  27. 

"  female,  27. 

"  internal,  35. 

Gestation,  107. 

"  anomalies  in,  156. 

"  duration  of,  138. 

"  influence  of,  175. 

"  multiparous,  143,  144,  145. 

"  pathology  of,  1 56. 

"         pluriparous,  143. 
Glandulae  utriculares,  40. 
Graafian  vesicles,  47. 

"  "         maturation  of,  60. 

Gubernaculum  testis,  104. 

H. 

HiEMORRHAGE  from  uterus,  626. 
"  post-partum,  577. 

"  umbilical,  720. 

Head-collar  or  head-cord,  505. 
Hernia  of  bladder  into  vagina,  337. 

"  intestines,  621,  627. 

"  umbilical,  722. 

"  uterus,  183. 

Horizontal  diameter  of  pelvis,  26. 
Hippomanes,  78. 
Hydatid  kysts,  173. 
Hydrocephalus,  379. 
Hydramnios,  178. 
Hydrometra,  173. 
Hydrops  amnii,  178. 
Hydrops  uteri,  173. 
Hydrothorax,  386. 
Hygiene  of  pregnant  animals,  153. 
Hymen,  364. 

"        persistent,  364. 
Hypospadias,  763. 
Hysterocele,  183,  2S0. 
Hysterotomy,  vaginal,  313. 

I. 

Imperforation  of  anus,  759. 

"  prepuce,  763. 

"  vagina  and  vulva, 

762. 
Indigestion  of  young  animals,  748. 


770 


INDEX. 


Induration  of  the  cervix  uteri,  349. 
Infectious  abortion,  209. 
Inflammation  of  the  mammae,  696. 

"  umbilical  cord,  732. 

Influence  of  food  on  the  foetus,  372. 

"  gestation  on  ordinary  dis- 

eases, 175. 
Injuries  to  the  teats,  715. 
Internal  organs  of  generation,  35. 
Intestines,  hernia- of,  621,  627. 
Intestitial  fcetation,  161. 
Inversion  of  the  bladder,  615. 

"  "      uterus,  581. 

"  "      vagina,  611. 

K. 

Kysts,  serous,  336. 
L. 

Labor  pains,  216. 
Laceration  of  uterus,  619. 
"  vagina,  625. 

Lactation,  252. 
Laminitis,  parturient,  689. 
Laws  of  teratology,  41 1. 
Left  vertebro-ilial  position,  229. 
Leucorrhcea,  642. 
Liquor  amnii,  75. 
Lithopoedian,  193.   • 
Lochia,  251,  258. 
Lordosis,  272. 
Lumbo-sacral  position,  230. 

M. 


"         congestion  in,  693. 
"         differences  in,  33,  35, 
"         inflammation  of,  696. 
Mammitis,  693,  696. 

"  parenchymatous,  698. 

"  phlegmonous,  697. 

Mania  puerperalis,  687. 
Manual   and   mechanical  force   com- 
pared. 530. 
Mastitis,  693,  695. 
Maternal  cotyledons,  82. 
Maternal  dystokia,  260,  270. 

"  "  causes  of,  358. 

Maturation  of  Graafian  vesicles,  60. 
Means  for  developing  necessary  force, 

527. 
Mechanical  means  for  the  extraction 

of  the  foetus,  501. 
Mechanism  of  parturition  226,  232. 
Meconium,  retention  of,  758. 
Menstrual  discharge,  57. 
Menstruation,  56. 
Metritis,  643. 
Metro-peritonitis,  643. 
Metrorrhagia,  190. 


Metrotomy,  604. 
Milk,  253. 
Milk  fever,  252. 
Moles,  169. 
Monstrosities,  395. 

"  classification  of,  396. 

"  distorted,  416. 

"  double,  399,  424. 

"  double-headed,  418. 

"  frequency  of,  416. 

"  origin  of,  411. 

"  simple,  396. 

"  treble,  399,  424. 

Acephalian  monstrosities,  407. 
Acephalus,  396. 
Amorphus,  396. 
Androgynus,  399. 
Anencephalian  monstrosities,  407. 
Anidian  or  zoomylian  monstrosities, 

407. 
Aschistodactylus,  398 
Atretocephalus,  398. 
Atretocormus,  398. 
Autositic,  402. 
Campy lorrhacchis,  398. 
Campylorrhinus,  398. 
Celosomian  monstrosities,  404,  420. 
Cryptodidymus,  401. 
Cyclocephalian  monstrosities,  407. 
Cyclopean  monstrosities,  417. 
Cyclops  or  monophthalmus,  398. 
Dicephalus,  400. 
Dicranus,  400. 
Diphallus,  398. 
Diprospus,  399. 
Dipygus,  400. 

Emprosthomelophorus,  400. 
Ensomphalian  monstrosities,  409. 
Epigastrodymus,  401. 
Exencephalian  monstrosities,  406. 
Gastrodidymus,  401. 
Gastro-thoracodidymus,  39. 
Hermaphrodites,  398. 
Heterocephalus,  399. 
Heterodidymus,  400. 
Ischiodidymus,  401. 
Megalocephalus,  398. 
Megalomelus,  398. 
Monocephalian  monstrosities,  409. 
Monocranus,  399. 
Monomphalian  monstrosities,  408. 
Monosomian  monstrosities,  409. 
Nanocephalus,  397. 
Nanocormus,  397. 
Nanomelus,  397. 
Nanosomus,  397. 
Octopus,  401. 

Omphalo-chronodidymus,  401. 
Opisthomelophorus,  400. 
Perocephalus,  397. 


INDEX. 


m 


Monstrosities — continued, 
Perocormus,  397. 
Peromelus,  397. 
Perosomus,  397. 
Pleuromelphorus,  400. 
Pseudencephalian  monstrosity,  407, 

418. 
Pseudo-hermaphroditus,  399. 
Pygadidymus,  401. 
Schelodidymus,  401. 
Schistocephalian  monstrosities,  407. 
Schistocephalus,  397. 
Schistocormus,  397. 
Schistomelus,  398. 
Schistosomus,  398. 
Symelian  monstrosities,  404. 
Syncepnalian  monstrosities,  409. 
Sysomian  monstrosities,  409. 
Tetrachirus,  401. 
Tetrasculus,  401. 
Trigeminal  monstrosities,  399. 
Thoracodidymus,  401. 

Morbid   adhesion  between  the  fcEtus 

and  the  uterus,  359. 
Multiparity,  dystokia  from,  427. 
Multiparous  gestation,  143. 
Multiple  pregnancy,  diagnosis  of,  150. 
"  position  of  foetuses,  151. 

N. 
Necessary  aid  in  normal  patrurition, 

238. 
Normal  parturition,  214. 

"  necessary  aid  in,  238. 

O. 
Obliteration  of  the  galactophorus 

sinus,  717. 
Obliteration  of  os  uteri,  356. 
Obstacles    independent    of    presenta- 
tions and  positions,  369. 
Obstetrical  anatomy,  5. 

"  operations,  500. 

-'  physiology,  53. 

Occlusion  of  auditory  canal,  764. 
"  eyelids,  763. 

"  uterus,  361. 

CEdema  in  pregnancy,  177. 
"         of  umbilicus,  731. 
CEstrum,  56,  57,  58,  60. 
Offspring,  attention  to,  246. 

"  general  care  of,  247. 

Omphalo-mesenteric  vessels,  87. 
Organic  modifications  in  uterus,  257. 
Origin  of  monstrosities,  411. 
Os  uteri,  39. 

obliteration  of,  356. 
Os  tincae,  356. 
Ovarian  foetation,  161. 


Ovaries,  47. 

"        development  of,  49. 

"         differences  in,  49,  50,  51,  52. 
Oviducts,  45. 
Ovula  Nabothi,  40. 
Ovulum,  48. 
Ovum,  changes  in,  52,  64,  67. 


Paralysis,  post-partum,  679. 
Paraplegia,  180. 
Parturient  apoplexy,  656,  669. 
"  collapse,  671,  656. 

"  eclampsia,  681. 

"  fever,  643. 

"  laminitis,  689, 

Parturition,  214. 

"        accidents  incidental  to,  567. 
"         causes  of,  215. 
"         expelling  powers  in,  216. 
"         mechanism  of,  232. 
"         necessary  aid  in,  238. 
"         normal,  physiology  of,  214. 
"         pathology  of,  640. 
"         sequelae  of,  250. 
*'         symptoms    and   course   of, 
214,  219. 
Pathological  congestion  of  the  mam- 
mae, 693. 
Pathology  of  gestation,  156. 

"  parturition,  640. 

Pelvic  cavity,  tumors  in,  276, 
"      cellulitis,  627. 
"      openings,  17. 
"      symphysis,  relaxation  of,  637, 
Pelvimetry,  21. 
Pelvis,  5. 

"      articulations  of,  12. 
"      bones  of,  6. 
"      capacity  of,  20. 
*'      cavity  of,  15. 
"      complete  deformity  of,  271. 
"      diameters  of,  26. 
"      differences  in,  10,  25. 
"      exostoses  on,  273. 
"     fractures  of,  273. 
*'      openings  in,  17. 
Perinaeum,  31. 

"  rupture  of,  632. 

Peritonitis,  621,  627. 
Persistence  of  the  urachus,  721. 
Persistent  hymen,  364. 
Physiology  of  parturition,  214. 
Pica,  177. 
Placenta,  80. 

"         anomalies  in,  358. 
"         differences  in,  81. 
"         functions  of,  85. 
"         praevia,  82. 


772 


INDEX. 


Placentas,  8i. 
Placental  fluid,  75. 

"         abnormal  quantity  of,  377. 
Placentulce,  81. 
Pluriparous  gestation,  143. 
Polycotyledonous  placenta,  Z^. 
Polysarcia,  391. 
Porte-cord,  458. 
Positions  of  foetus,  228. 

"  "        in   multiple    preg- 

nancy, 151. 

"  "        in  the  uterus,  1 28. 

Posterior  presentation,  227,  230. 
Post-partum  haemorrhage,  ^Tj. 

"  paralysis,  679. 

Pregnancy,  119. 

"  accidents  of,  182. 

"  course  of,  167. 

"  diagnosis  of,  168. 

"  diseases  peculiar  to,  176. 

"  duration  of,  138. 

"  "  in  bitch,  142. 

"  "  cat,  143. 

"  "  cow,  141. 

"  "  mare,  139. 

"  "  sow,  142, 

"  "  sheep  and 

goat,  141. 

"  extra-uterine,  160. 

"  signs  of,  129. 

"  symptoms  of,  167. 

"  termination  of,  167. 

"  treatment  of,  168. 

Pregnant  animals,  diseases, of,  175. 

"  "         hygiene  of,  153. 

Prepuce,  imperforation  of,  763. 
Presentations  of  the  foetus,  226. 
Prolapsus  of  vagina,  ante-partum,  182. 

"  vesicae,  615. 

Prolonged  gestation,  369. 
Protracted  labor,  240. 
Pseudo-pregnancy,  169. 
Puberty,  55,  56. 
Puncture  of  cranium,  539. 

"  foetal  envelopes,  277. 

R. 
Reduced  number  of  foetuses,  369. 
Relaxation  of  pelvic  symphysis,  637. 
Reproduction,  53,  54,  SS- 
Repulsion,  438. 
Retention,  abnormal,  of  the  foetus,  191. 

"  foetal  envelopes,  567. 

"  meconium,  758. 

Retropulsion,  433. 
Right  vertebro-ilial  position,  229. 
Rigidity  of  the  cervix  uteri,  341. 
Rotation,  436. 
Rupture  of  abdominal  muscles,  639. 

"  bladder,.  637. 


Rupture  of  diaphragm,  638. 

"  intestines,  638. 

"  perinaeum,  632. 

"  sacro-sciatic  ligament,  639. 

"  uterus,  ante-partum,  184. 
"  "        post-partum,  622. 

"  water-bag,  243. 

S. 
Sacro-sciatic  ligament,  14. 

"  "  "■  rupture    of, 

639- 
Scirrhous  chorion,  359. 
Sequelae  of  parturition,  250. 
Serous  kysts,  336. 
Signs  of  pregnancy,  129. 

"  "  material,   131. 

"  "  rational,  129. 

"  "  sensible,  134. 

Skin  dryness,  759. 
Sporadic  abortion,  198,  199. 
Spurious  or  pseudo-pregnancy,  169. 
Sterility,  62,  63. 
Sterno-abdominal    presentation,    228, 

231. 
Stricture  or  occlusion  of  uterus,  361. 
Super-foetation,  156. 
Sutures,  596. 

Symphyses,  pelvic,  relaxation  of,  637. 
Symphysis,  ischio-pubic,  13. 
Symphysiotomy,  566. 

T. 

Taxis,  abdominal,  311. 

"       vaginal,  314. 
Teats,  anatomy  of,  31,  33,  35. 
"       fistulae  in,  718. 
"       fissures  in,  715. 
"       injuries  to,  715. 
Teratology,  laws  of,  411. 
Thoracic  evisceration,  548. 
Thrombus  or  hasmatoma,  336. 

"  of  vagina  and  vulva,  636. 

Tongue-tie,  765. 

Torsion  of  the  uterus,  291,  325,  327. 
"        degree  of,  303,  306. 
"        diagnosis  of,  303. 
"        direction  of,  303. 
"        history  of,  291. 
"        in  other  animals,  327. 
'*        pathological  anatomy  of,  307. 
"        presence  of,  302. 
"        symptoms  of,  300. 
"        treatment  of,  311. 
Traction  on  foetus,  243. 
"       degree  of,  524. 
"       direction  of,  523. 
Traumatic  lesions  of  genital  and  neigh- 
boring organs,  619. 
Tumors,  393. 


INDEX. 


773 


Tumors,  cancerous,  331. 

"         condylomatous,  331. 

"         fibroid,  331. 

"         in  genital  organs,  340. 

"         "   pelvic  cavity,  327. 

"         "   vicinity  of  genital  organs, 
340.' 
Tubal  foetation,  161. 
Tumultuous  labor,  240. 

U. 

Umbilical  cord,  86. 

"  "      anomalies  in,  378. 

"  "      differences  in,  87. 

"  "      dimensions  of,  88. 

"  "      haemorrhage      from, 

720. 
"  "      inflammation  of,  732. 

Umbilical  hernia,  722. 
Umbilical  vein,  87,  98. 
Umbilical  vesicle,  79. 

"  "        differences  in,  80. 

Umbilicus,  oedema  of,  731. 
Urachus,  79,  87. 

"        persistence  of,  721. 
Uterine  kysts,  171. 
Uterine  milk,  83. 
Utero-vaginal  tumors,  327. 
Uterus,  38. 

"         amputation  of,  604. 
"         deviations  of,  288. 
"         differences  in,  41,  42,  43. 
"         direction  of,  125. 
"         form  of,  123. 
"         hernia  of,  183,  280. 
"        influence  on  neighboring  or- 
gans, 126. 
"         inversion  of,  581. 
"        laceration  and  rupture  of,  619, 

622. 
"         modifications  in,  119. 
"         occlusion  of,  361. 
"        reposition  of,  589. 


Uterus,  rupture  of,  184. 

"  sensibility  of,  122. 

"  situation  of,  125. 

"  structure  of,  120. 

"  torsion  of,  291,  319. 

"  volume  of,  1 19. 


Vagina,  35. 

"        complications  in  rupture  of, 
629. 

"         differences  in,  37. 

"         imperf oration  of,  762. 

*'         inversion  of,  61 1. 

"         laceration  of,  625. 

"         rupture  of,  625. 

"         thrombus  of,  636. 
Vaginal  constriction  or  atresia,  365. 

"       cystocele,  337. 

"       hysterotomy,  313,  549. 

"        irrigations,  277. 

"       taxis,  314. 
Vaginitis,  640. 
Venereal  oestrum,  56. 
Ventral  foetation,  161. 
Version,  437. 

Vertebro-pubic  position,  229. 
Vertebro -sacral  position,  229. 
Vertical  diameter  of  pelvis,  26. 
Vesicle,  umbilical,  79. 
Vesico-vaginal  fistulae,  635, 
Vulva,  27, 

"      differences  in,  30,  31/ 

'*      imperforation  in,  762. 

"      thrombus  of,  636. 

W. 

Water-bag,  rupture  of,  243. 
Whartonian  gelatine,  86. 
Womb,  38. 


Zonular  placenta,  '^i- 


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